SampleArticle.docx

2

Contents
Introduction 2
Global Health Diplomacy 3
Conceptual Framework 5
Historical Background 5
Current Situation 7
Impacts 9
Critical Analysis 10
Conclusion 13
Recommendations 13
Bibliography 15

Abstract
The emergence of COVID-19 has provided a new vigor to global health issues. In this regard, global health diplomacy initiatives have seen considerable surge. Countries around the world are using the opportunity to harness the potential of global health diplomacy in cultivating relations with several countries and also building soft power projection. A case in point is how China has been spearheading global health efforts to improve strained relationships with several countries, strengthening relations with some countries and projecting a soft power about how China aims to act as global savior. However, Chinese efforts were able to gain significant traction owing to the fact that the United States under the adminstation of Donald Trump decapiatated its global leadership role, the first such instance in the post World War 2 era. In this paper has explained the concept of global health diplomacy by doing a comparative analysis of the global health efforts and policies undertaken by both the United States and China. The paper has concluded that it is important for both countries to work together in future in case of pandemic to spearhead an international effort against such crises. Moreover, it recommends Chinese authorities to include health corridor as a component with Belt and Road Initiative. On the other hand, the United States under the administration of Joe Biden should invest in multilateral efforts so to empower global health institutions to better prepare for future health crises.

Keywords: Global Health Diplomacy, China, United States, Celebrity Diplomacy

Introduction
After the emergence of SARS-COVID-19 in December 2019 in Wuhan, Central China’s Hubei provinvce, China has continuously remained in the news with taking the blame from the Western states to not informing the world in time about the dangers posed by the new variant of SARS. The epidemic that was called in China soon evolved into a pandemic in March 2020 when the World Health Organization (WHO) warned states to prepare an effective response to the pandemic. The confusion and blame game at the policy front by all major international players triggered a panic which resulted in economic recession around the globe, thus resulting in inflation and job losses. The global south was impacted the most when it comes to economic meltdown. It is significant to note that in such a crisis of health security, the global health diplomacy (GHD) was championed by China, and the world largest spender in health assistance, the U.S. was nowhere to be seen. It even halted the annual funding to the WHO during pandemic. Furthermore, not only it banned exports of commodities but also crucial life saving drugs, including raw material to produce COVID-19 vaccines. Therefore, China emerged as a global health leader in the absence of any significant U.S.’s role. China, which is thought to be the origin of this pandemic, was also the first to beat it. After containing the virus at home, China began engaging in public diplomacy. It sent its medical teams to all corners of the world to assist health officials in mitigating and containing the virus, aided low-income states by providing them testing kits, gloves, face masks, ventilators and oxygen cylinders. More importantly, the China’s ability and experience of containing the virus through the policy of lockdowns was replicated all over the world. Whereas the U.S.’s own response to virus was grim and confused, which caused distress in the masses. Meanwhile, it is also the most affected state in the world both in terms of financial losses and causalities. So, in the backdrop of these developments post pandemic, this study tries to explore, whether China’s rise economically and diplomatically pose any threat to the U.S. by applying the theory of “Thucydides Trap.”
This paper evaluates the role of China and the U.S. comparatively in GHD during COVID-19. The section one of the paper is about global health diplomacy and conceptual framework, which analyzes the GHD and its definitional aspects, as well as how it evolved as a concept of human security. Furthermore, it also explains the “Thucydides Trap” in this section. The section two highlights the historical background where it briefly narrates GHD’s history comparing both U.S.’s and China’s roles in the world over the last few decades. In Section three, it discusses the current scenario and how both states have responded to the challenge of GHD post COVID-19 and winning the trust of other states. Section four deals with the implications of COVID-19 in GHD paradigms of both China and the U.S. Meanwhile, in section five this paper critically analyzes both state’s policies to make sense of their approaches. Lastly, section six and seven, concludes study and provides recommendations, respectively.

Global Health Diplomacy

Power is always viewed as wielding control and influence through military or economic means. However, Josephy Nye coined the concept of soft power by distinguishing power into two types. Hard power is the ability to reach one’s goals through coercive actions or threats. Nye has defined soft power as the ‘ability to affect others to obtain the outcomes which one wants through consent rather than coercion’. He specifically pointed out the fact that country’s culture, political ideals and domestic and foreign policies in international politics.[footnoteRef:1] Soft power gives a nation permission to practice dominant position over other nations, by consent, support and consensus. As a result, health diplomacy has evolved into a soft power instrument that plays an important and vital role in a state’s influence over the other. Global health diplomacy has long been an important part of many countries foreign policy strategy, and the same is true of concerns on national security, commerce, and diplomacy. [1: Priya Gauttam, Bawa Singh, and Jaspal Kaur, “COVID-19 and Chinese Global Health Diplomacy: Geopolitical Opportunity for China’s Hegemony?,” Millennial Asia 11, no. 3 (October 12, 2020): 318–40, https://doi.org/.]

Global health diplomacy (GHD) cannot be defined in a single or specific definition. Various scholars have defined GHD depending on their perspectives; however, given the connection of diplomacy with health, it is not merely improving global health but rather improving it to attain strategic leverage. Vincanne Adams and Thomas Novotny define GHD as “a political change activity that meets the dual goals of improving global health while maintaining and strengthening international relations abroad, particularly in conflict areas and resource-poor environments.”[footnoteRef:2] On the other hand, Ilona Kickbusch, defines GHD “multi-level, multi-actor negotiation processes that shape and manage the global policy environment for health.”[footnoteRef:3] [2: Vincanne Adams, Thomas E. Novotny, and Hannah Leslie. “Global health diplomacy,” Medical Anthropology 27, no. 4 (2008): 315-323.] [3: Ilona Kickbusch, Gaudenz Silberschmidt, and Paulo Buss. “Global health diplomacy: the need for new perspectives, strategic approaches and skills in global health,” Bulletin of the World Health Organization 85 (2007): 230-232.]

This kind of diplomacy can be initiated by the official channels (by states) or through non-state actors (NGOs). As far as International Relations is concerned, the GHD remained at the periphery and was seldom part of the general discourse of the discipline until after the cold war when human security filled the void created after the end of bipolarity.[footnoteRef:4] [4: Arne Ruckert, Ronald Labonté, Raphael Lencucha, Vivien Runnels, and Michelle Gagnon. “Global health diplomacy: a critical review of the literature.” Social Science & Medicine 155 (2016): 61-72; Tanisha M. Fazal, “Health Diplomacy in Pandemical Times,” International Organization 74, no. 51 (December 2020): E78-E97. DOI: https://doi.org/10.1017/S0020818320000326.]

Disease does not recognize any international border and the pathogens that once took several months and years to transfer from one locality to another move at a fast pace in an urbanized and globalized world. Therefore, the importance of health in foreign policy has grown exponentially over the last century, as responding to global health has become a collective responsibility of all states in an international system rather than individual states.[footnoteRef:5] The trillions dollar military-industrial complex of major international players in the COVID-19 pandemic could not defend people against the microbial enemy. Therefore, there is a dire need to spend more on health and include it in the foreign policy objectives.[footnoteRef:6] The U.N. General Assembly adopted a global health resolution in 2008 to include health as a foreign policy aim rather than working on it merely as a humanitarian goal which the big players in the international system were doing throughout the 20th century.[footnoteRef:7] For foreign policy officials, the economy and the security interests were paramount; hence they only considered staying ahead in these departments rather than focusing on public health. However, it is significant to mention that the institute of the WHO was constituted (7 April 1948, the day is now every year celebrated as health day) after world war II at the establishment of the United Nations, and it declared public health a fundamental human right. [5: Sara E. Davies, Adam Kamradt-Scott, and Simon Rushton, Disease Diplomacy: International Norms and Global Health Security, Baltimore: John Hopkins University Press, 2015, 1. ] [6: Fareed Zakaria, Ten Lessons for a Post Pandemic World, (New York: Norton Press and Company, 2021).] [7: David F. Fidler, “Health in Foreign Policy: An Analytical Review,” Canadian Foreign Policy Journal 15, no. 3 (March 2011): 11-29. DOI: 10.1080/11926422.2009.9673489.]

At the international or global level, state frame heath-related concerns as security threats to puruse key goals in the international system.[footnoteRef:8] In terms of domestic or national level analysis, various stakeholders play a key role in shaping health diplomacy objectives. These stakeholders include various interest groups, several civil society actors, professional associations, NGOs, think tanks, etc.[footnoteRef:9] [8: Sara E. Davies, “Securitizing infectious disease.” International Affairs 84, no. 2 (2008): 295-313.] [9: James M. McCormick, ed. The domestic sources of American foreign policy: insights and evidence. Rowman & Littlefield, 2012.]

From an individualistic prespective, ‘celebrity diplomacy’ has emerged a new form of global diplomacy through which influencers promote health related causes. These people have contributed to the surge in GHD activities.[footnoteRef:10] [10: John T. Rourke, and Mark A. Boyer. International politics on the world stage. New York, NY: McGraw-Hill, 2008.]

Conceptual Framework
Given these developments in the GHD over the last seven decades in general and the COVID-19 pandemic in particular, one gets an impression that health is now a significant tool of foreign policy, specifically after the argument by many scholars that it is and can be used for strategic leverage. In this context, the theory of “Thucydides Trap” would evaluate, understand, and interpret whether the dimension of health security can lead to a potential clash between China and the U.S.?
Thucydides Trap is defined as the rise of one power injects fear in the existing power of replacement which leads to the conflict. Thucydides explained his theory keeping in view the Peloponnesian Wars fought between the city-states of Athens and Sparta in the 5th century BCE. Athens was an emerging power then, and it challenged the existing power of Sparta, which resulted in a bloody war. Thucydides stated that in challenging the existing power, the rising power challenges the structures of existing power, which makes the conflict a rule rather than an exception. Thucydides put it that way: “It was the rise of Athens and the fear that this instilled in Sparta that made war inevitable.”[footnoteRef:11] In the analysis section, this research interprets whether this theory can be justified post-COVID-19 pandemic scenario between the two powers of existing international system? Or is there any threat to the existing world order by China? These questions have been analyzed keeping in view the GHD and China’s and the U.S.’s role in winning influence around various regions of the world generally by not specifically looking into a single region or bounding different regions as a case study. This article intends to analyze whether Thucydides Trap could be related to these two powers or not. These questions will be analyzed keeping in view the GHD and China’s and the U.S.’s role in winning influence around various regions of the world generally by not specifically looking into a single region or bounding different regions as a case study. [11: Graham Allison, Destined for War: Can America and China Escape Thucydides’s Trap? New York: Houghton Mifflin Harcourt, 2017. ]

Historical Background
Over the last decade, it has been witnessed that hard power is declining, especially after Operation Enduring Freedom in Afghanistan (2001) and Operation Desert Fox in Iraq (2003) where objectives were not met even after invasion and spending trillions of dollars. Given the objections of human rights watch dogs and lack of interest by the public in military maneuvers, the soft power is taking over the hard power. Hence, among many other tools of soft power, health security offers major players a ground to exploit for strategic leverage in global south.
In the United States, health diplomacy was not practised until 2000 at the state level, even though the NGOs kept on with their humanitarian work in Africa and other developing states. At the state level, the first significant move to include health as a foreign policy tool was initiated by Jimmy Carter in the late 1970s. However, it could not meet with success. Primarily, at that time, the U.S. diplomats were more concerned with the threat of the Soviet Union, and most of their energies were consumed in countering Soviet disinformation and propagating American influence in Eastern Europe, the Middle East, and the Asia. However, post-cold war, specifically after 2000, the U.S. started to give health a status of strategic foreign policy tool. It was linked to national security, and the U.S. became concerned with the threats of pandemics and biological warfare.[footnoteRef:12] [12: Fidler, “Health in Foreign Policy,” 14.]

The human security aspect of the foreign policy came into prominence after the cold war. Furthermore, it was also complemented by the increased globalization that took states to interdependency rather than competition which was witnessed in the bipolar world. With the globalization, there was a threat of the spread of communicable diseases such as influenza, HIV, SARS, Malaria, and Tuberculosis, among many other pathogens. Therefore, health was given a strategic significance.[footnoteRef:13] The U.S. spends most in the world on GHD as it takes it as a component of national security and assists states in the global south to safeguard its own population from diseases as well as extremism, stalling migration and less aid in humanitarian assistance, as the better health results in growth and economic development in underdeveloped states.[footnoteRef:14] In the U.S., the State Department working in cahoots with the United States Agency for International Development (USAID) has taken the task to provide health assistance for poorer states in the global south.[footnoteRef:15] However, most of the US GHD was related to bilateral programs carried out through USAID rather than a multilateral approach. It is also interesting to note that the U.S. only recently realized that it is losing strategic leverage in global south, specifically in Africa, when it comes to health – whereas the Chinese are way ahead in funding health-related programs in global south.[footnoteRef:16] [13: Ibid, 17-19.] [14: Rebecca Katz , Sarah Kornblet , Grace Arnold , Eric Lief ,and Julie E. Fischer, “Defining Health Diplomacy: Changing Demands in the Era of Globalization,” The Milbank Quarterly: A Multidisciplinary Journal of Population Health and Health Policy 89, no. 3 (2011): 503-523.] [15: Sabastian Kevany, “Global Health Diplomacy, ‘Smart Power’, and the New World Order,” Global Public Health: An International Journal for Research, Policy and Practice 9, no. 7 (2014): 787-807. DOI: 10.1080/17441692.2014.921219. ] [16: Mark P, Lagon, and Rachel Sadoff, “America Must Not Allow Africa to Go Viral in Africa,” The National Interest, last modified, May 1, 2020, https://nationalinterest.org/feature/america-must-not-allow-china-go-viral-africa-150566; Emma Louise-Anderson, “African health diplomacy: obscuring power and leveraging dependency through shadow diplomacy,” International Relations 32, no. 2 (June 2018): 194-217. https://doi.org/10.1177/0047117817751595. ]

Physicians like Cahill have criticized pre 2000 role of the U.S. in health diplomacy in Africa. For him, it was meant for only politics, showing the public back home that America cared for the globe, however, the goals were short term, and the U.S. could not consolidate its missions despite spending millions of dollars for conflict-ridden communities.[footnoteRef:17] [17: K. M. Cahill, “Health and foreign policy: An American View,” Annals of Tropical Medicine & Parasitology 91, no. 7 (1997): 735-741, DOI: 10.1080/00034983.1997.11813197. ]

China on the other hand, since its inception in 1949, is engaged in GHD. In the 1950s and 1960s, it sent 6,500 medical personnel to over 40 countries as well as funded more than 20 medical institutions around the world. At that time, the key driving factor behind the health diplomacy initiatives was to forge friendly relations with these countries. Historically, China has been a key contributor to global health owing to its own large population. The Maoist health model of the 1970s improved the health status of about 23% of the global population. The success of this model influenced the WHO’s agenda too. Consequently, WHO declared in 1978 that “health for all” could be achieved through primary health care in 2000.[footnoteRef:18] [18: Yanzhong Huang. “Pursuing health as foreign policy: the case of China.” Indiana Journal of Global Legal Studies 17, no. 1 (2010): 105-146.]

Nonetheless, it is crucial to point out that China’s early international cooperation on health was constrained to socialist countries only. As a Cultural Revolution strategy in the mid-1960s, China made medical assistance a part of exporting revolution. Therefore, it sent medical teams to African countries. These teams were used as an instrument of GHD and operated like US Peace Corps with a primary focus on medical care. Fast forward to 2003, the emergence of the SARS epidemic is considered a watershed moment in the development of China’s public health and international development strategies. The epidemic caused the death of almost 350 people in mainland China and contributed profoundly to the national economy and society. The SARS episode helped Chinese leadership in understanding the significance of public health crises in the shaping of international image. Consequently, Beijing reemphasized the inclusion of health cooperation in its international development agenda. Moreover, it started working on multilateral institutions like WHO.[footnoteRef:19] [19: Tang Bei, “A Brief History of Chinese ‘Health Diplomacy’,” Sixth Tone, last modified May 20, 2020, https:www.sixthtone.com/news/1005687/a-brief-history-of-chinese-health-diplomacy]

Current Situation
Pandemics spread havoc in global health systems, overburden them and cause panic among the population, but they also enable states to enhance their foreign policy goals keeping in view their national interest.[footnoteRef:20] However, as per the WHO regulations, states must provide health assistance through their platform. Moving away from health institutes impacts their usefulness and performance for the next pandemic.[footnoteRef:21] COVID-19 was a surprise for many developed and developing states alike. Yet, it caused more damage to the U.S. than any other state in the world, both in terms of economic and life losses. More than half a million people died in the U.S. as of now, as per Center for Disease Control and Prevention[footnoteRef:22], whereas the economic cost is estimated by the Economist to be more than U.S. dollar ten trillion.[footnoteRef:23]The Covid 19 has affected 220 countries and territories, more than 3.2 million deaths, killing more than half a million in the U.S. alone and around 4600 in China, till date 9 May 2021 (worldometer). [20: Fazal, “Health Diplomacy in Pandemical Times”] [21: Ibid. ] [22: “National Center for Health .” Center for Disease Control and Prevention. Last modified April 21, 2021, https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm, ] [23: The Economist, “What is the economic cost of COVID-19?” last modified January 7, 2021. https:www.economist.com/finance-and-economics/2021/01/09/what-is-the-economic-cost-of-covid-19]

The COVID-19 arrived in the U.S. in the year of Presidential elections, therefore, creating a divide where the former U.S. President termed it a Chinese virus, thus racializing the disease, which not only impacted the U.S.’s internal response to the disease but also greatly affected its global multibillion-dollar health assistance. Consequently, President Trump halted funding (400 million dollars annual) for the WHO on the pretext that it colluded with China and did not inform the U.S. in time.[footnoteRef:24] Furthermore, as far as the mitigation and containment of the virus are concerned, the U.S. failed at both counts; it was an atmosphere of political divide within the country. The Trump administration neither listen to health officials and nor did it go into lockdown like China. The global best practices as advocated by the WHO, for instance, masking up, maintaining social distancing, and staying at home, were avoided by the public as well as authorities which resulted in a widescale spread, thereby causing more causalities.[footnoteRef:25] [24: “Coronavirus: US to halt funding to WHO, says Trump,” BBC News, last modified April 15, 2020, https:www.bbc.com/news/world-us-canada-52289056. ] [25: Nora Kenworthy, Emily Mendenhall, and Adam D. Koon. “On symbols and scripts: The politics of the American COVID-19 response.” Global Public Health: An International Journal for Research, Policy, and Practice (March 2021): 1-15, DOI: 10.1080/17441692.2021.1902549; Peter J. May and David P. Carter. “Making sense of the U.S. COVID-19 pandemic response: A policy regime perspective.” Administrative Theory & Praxis 42, no. 2 (2020): 266-277, DOI:10.1080/10841806.2020.1758991. ]

After the new administration of the Democrats under President Joe Biden, not only did the U.S. resumed the WHO funding, but it also allocated more than dollar four billion in the global fight against COVID-19, specifically aiding states in the global south at the state level. At the national level, Americans stood as the most generous country in the world by giving more than 4.9 billion dollars to various IGOs and NGOs to fight the pandemic.[footnoteRef:26] [26: “Corona Virus Disease 2019.” US, Department of State. Accessed April 22, 2021, https://www.state.gov/coronavirus/#international-aid-relations. ]

In contrast to the U.S., ever since the outbreak of COVID-19, China has exploited the global pandemic as an opportunity to portray a benevolent picture of itself.[footnoteRef:27] In this regard, Beijing has effectively utilized its health diplomacy to offer medical aid to African countries. The Chinese support to African countries included the export of facemasks and dispatching of a medical team. Moreover, experts from more than 30 countries interacted with Chinese counterparts on how to effectively deal with the pandemic. Similarly, Asian countries have remained a crucial part of China’s global health diplomacy. Chinese medical experts have visited several ASEAN countries to advise them on COVID-19 mitigation and containment. Furthermore, material aid has also been provided by the Chinese government and private businessmen to several ASEAN countries. Moreover, the South Asian states such as Pakistan, Afghanistan, Sri Lanka, Bangladesh, Nepal and Maldives, specially Pakistanhave has been the biggest recipients of the tonnes of medical goods, medical aid, including testing kits, personal protective equipment, masks, ventolators and other more than 2 million vaccine as a gift. Exploiting the hostility between the United States and Iran, Beijing extended humanitarian support to Tehran and urged Washington to lift sanctions against Tehran. China even offered help to India, as it is witnessing an extreme surge regarding infections, for help when the U.S. defended its restrictions to export raw material of Corona vaccine to other countries to meet its domestic needs first. The spoke person of China’s foreign ministry told media that, “China is willing to provide assistance to India against the latest COVID-19 rebound in the country, which has caused a temporary shortage of medical materials,”[footnoteRef:28] [27: Bawa Singh, Priya Gauttam, and Jaspal Kaur. “COVID-19 and Chinese Global Health Diplomacy: Geopolitical Opportunity for China’s Hegemony?.” Millennial Asia11, no.3(2020): 318-340.] [28: China, “China ‘Willing’ to Help Virus-Ravaged India,” Aa.com.tr, 2021,]

The European continent was the battlefield for influence between China and the United States. China extended its medical and financial support to European countries. Apart from governmental support, private entities like Huawei and businessman Jack Ma also offered medical aid to several European countries. Several Eastern European countries appreciated Chinese support and criticized the E.U. for its delayed, inert bureaucratism, etc.

Impacts
There will be long term implications of GHD post-COVID-19 scenario, especially in the management of vaccine and giving them as a public good to less resourceful countries in the global south who cannot afford to purchase one. So far, the vaccines have been for regional use mostly produced and administered in the global north. It is reported that only 13% of the world population in global north had already purchased more than 50% of the vaccines produced as of 2020 (the percentage is expected to rise more than 60 % in 2021).[footnoteRef:29] As far as the U.S. is concerned, it has banned the export of the vaccines produced in the U.S. or produced by the firms it has paid for, for instance, AstraZeneca, currently, the U.S. has extra 300 million vaccine doses which it is not using, a decision which is criticized by many countries who are willing to buy those. Furthermore, the U.S. has also imposed a ban on the raw materials used in vaccine production, which can highly risk another billion dosses by May 2017.[footnoteRef:30] [29: Nivedita Saksena, “Global justice and the COVID-19 vaccine: Limitations of the public goods framework,” Global Public Health: An International Journal for Research, Policy and Practice1-10. (March 2021) https:doi.org/10.1080/17441692.2021.1906926. ] [30: Noah Weiland and Rebecca Robbins, “The U.S. Is Sitting on Tens of Millions of Vaccine Doses the World Needs,” The New York Times, last modified March 11, 2021, www.nytimes.com/2021/03/11/us/politics/coronavirus-astrazeneca-united-states.html; “American export controls threaten to hinder global vaccine production,” The Economist, last modified April 17, 2021, www.economist.com/science-and-technology/2021/04/17/american-export-controls-threaten-to-hinder-global-vaccine-production]

For attaining the goodwill and trust of the less resourceful states, vaccine diplomacy would decide the winner among China and the U.S. in post-COVID-19 health diplomacy. It seems China is already winning it. China has so far donated millions of its vaccine doses to low-income and middle-income states. Till April 2021, half of the Chinese produced vaccines were exported, while none by the U.S. during this time.[footnoteRef:31] [31: Leng Shumei, “China provides vaccine aid to 53 developing countries, exports to 22,” The Global Times, last modified February 8, 2021, https://www.globaltimes.cn/page/202102/1215285.shtml; Patrick Atack, “China exports half its vaccine production: the UK and U.S., almost none. Chart,” CGTN, last modified April 1, 2021, https://newseu.cgtn.com/news/2021-04-01/China-exports-half-its-vaccines-the-UK-and-U-S-almost-none-Chart-Z3YKzBnOnK/index.html. ]

Another significant step China took post-COVID-19 was to …