SINGAPORE: Intergovernmental cooperation between the United States and China was an important part of the fight against Severe Acute Respiratory Syndrome (SARS) in 2003.
Yet serious collaboration to combat COVID-19 is yet to materialise. The state of US-China bilateral relations and the failure to cooperate has arguably worsened the pandemic.
Despite similarities between the two initial outbreaks, COVID-19 seems to have deepened the antagonism and rivalry between the United States and China.
Many attribute the lack of pandemic cooperation to a preoccupation with the ongoing trade and propaganda war. But signs of US-China cooperation on other issues, such as recent mutual commitments to address the climate crisis, reveal that deteriorating bilateral relations might only be part of the story regarding the failure to cooperate on COVID-19.
A mismatch in perceptions on how to approach domestic health governance, one that was not apparent in 2003, may also be playing a key role.
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US-CHINA COOPERATION DURING SARS OUTBREAK
US-China cooperation on public health began with the normalisation of relations in 1979.
The 1979 Agreement on Cooperation in Science and Technology led to the Protocol for Cooperation in the Science and Technology of Medicine and Public Health. That formed the basis for the two countries to maintain a relationship on health matters.
Cooperation deepened under the leadership of Jeff Koplan, director of the US Centers for Disease Control and Prevention (US CDC) from 1998 to 2002, when the United States helped China build more effective public health infrastructure.
The outbreak of SARS in 2003 highlighted weaknesses in China’s public health emergency management and motivated it to improve, and the US CDC offered important assistance. The US CDC worked with the Chinese National Influenza Center to build up its influenza surveillance capacity.
With US CDC support, Chinese public health staff received virology and epidemiology training. US assistance became a critical aspect of China’s public health response and emergency management.
A general view of the US Centers for Disease Control and Prevention (CDC) headquarters in Atlanta, Georgia, on Sep 30, 2014. (Photo: REUTERS/Tami Chappell)
During the SARS outbreak, China realised it was completely unprepared to effectively manage a public health emergency. The government has since taken measures to address the many weaknesses.
It provided more funding to public health and constructed a multi-tiered network of disease control and prevention. The central government also reorganised different agencies within the Chinese Center for Disease Control and Prevention into a cluster to enhance crisis coordination.
Following that outbreak, China continued to enhance its health cooperation with US counterparts, having had positive perceptions of the US public health model at the time and a willingness to adopt US practices.
During a visit by then US health secretary Tommy Thompson in 2003, the United States promised to work with China to develop more robust public health infrastructure in China.
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CHINA CATCHES UP WITH THE US
But prior to the outbreak of COVID-19, Chinese perceptions on US domestic governance had gradually shifted. While the United States maintains the superiority of its governance approaches, China has increasingly seen itself as on an equal footing to the United States.
When meeting with US Secretary of State Antony Blinken and National Security Adviser Jake Sullivan in Alaska in March, China’s top diplomat Yang Jiechi said: “The United States does not have the qualification to say that it wants to speak to China from a position of strength.”
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A driving factor in these shifting Chinese perceptions is its tremendous advances in building an effective domestic health system over the last decade. Through a number of healthcare reforms since 2009, China made substantial progress in improving access to care, at a standard commended by the World Bank.
The mismanagement of COVID-19 in the United States consolidated China’s belief that the US model of public health crisis response is ineffective. As of late July, US cumulative case numbers have exceeded 34 million, over 10 per cent of its population, while China has reported around 100,000 cases in a population of 1.4 billion.
This solidified the Chinese view that the United States has lost its health superiority, leading to its conclusion that institutional strength and Chinese culture were key to overcoming domestic COVID-19.
Yet China’s system still falls behind in some aspects – the United States ranks fourth in the World Index of Healthcare Innovation, while mainland China does not even qualify for assessment.
FILE PHOTO: People line up for nucleic acid testing at a residential compound following new cases of the coronavirus disease in Ruili, a border city with Myanmar, in Yunnan province, China on Jul 5, 2021. (cnsphoto via Reuters)
Regardless, it would seem that cooperation may be contingent on US recognition of China’s progress in domestic health governance by approaching it as an equal partner. Until then, the situation could remain more akin to that of a competition.
But China needs to also put President Xi Jinping’s words into practice and be “eager to learn what lessons we can from the achievements of other cultures, and welcome helpful suggestions and constructive criticism”.
China should continue to identify its own flaws and limits in domestic health governance and gauge other countries, including identifying successes that the United States has had.
Renowned Chinese diseases expert Zhong Nanshan stated that China still has space to improve and much to learn from the practices of the United States and other developed countries. Future pandemic cooperation between the two great powers may rest on rebuilding mutual trust and developing a shared understanding of one another’s best practices.
Xirui Li is a PhD candidate at the S Rajaratnam School of International Studies, Nanyang Technological University, and a Research Fellow at the Intellisia Institute, Guangzhou. This commentary first appeared on East Asia Forum.