The Role of U.S.-China Competition in Global Health Aid

While health provisioning and health policy have long played an important role in geopolitics, the pandemic helped put a spotlight on the influence that it plays in the broader alignment of interests amongst nations. Lockdown rules, countries with travel lanes to specific countries, and most importantly, vaccine diplomacy, opened a new front in national competition on the battlefield of ideas, systems, and even cultural values.

There was no bigger and more relevant front in this battle than the one between the United States and China. The noisy American political response to the pandemic was roundly criticized in China as ineffective, where the ability of the Chinese leadership to execute a zero Covid policy and ‘keep China safe’ was evidence of the supposed superiority of the Chinese model. The initial triumphant response by the Chinese to the development of the Sinovac-CoronaVac vaccine and quick offers of assistance to struggling countries gave way to questions about its effectiveness. The ability of the United States and its Western allies to quickly embrace novel technologies like mRNA vaccines and then quickly roll out programs to cover billions of people was held out as the supposedly superior technological edge that the West had over the Chinese approach. Whether the continuing political strife in the United States or the economic hangover of extended lockdowns in China was the bigger price to pay for these divergent responses is still being debated to this day.

These pandemic-era developments, taking place against the broader backdrop of the growing rivalry between the US and China, have given way to more recent battles in the Pacific involving healthcare. In July, the Chinese Naval hospital ship Peace Ark set sail for a tour of the Pacific, including stops in Kiribati, the Solomon Islands, Tonga, Vanuatu, and East Timor. This tour comes against the backdrop of the commitment of the United States to send the Navy Hospital ship Mercy to the Solomon Islands at the end of the year to help support the 2023 Pacific Games. While ostensibly structured as humanitarian initiatives, both engagements are thinly veiled public relations initiatives to help win over potential allies amongst the vast island chains of the South Pacific, all of which would be highly strategic in a war between the two geopolitical rivals.

The visits by hospital ships come as the United States scrambles to keep up with Chinese health development assistance. Last month, USAID Administrator Samantha Power toured the region, elevating the USAID presence in Papua New Guinea to that of a country representative office overseeing multiple territories, as well as re-establishing a regional mission in Fiji to work with nine Pacific island countries.

This visit and re-engagement comes after the Chinese government handed over a newly-built hospital to the government of Papua New Guinea in 2022, and amidst criticism that the US response is too little, too late.

The specter of great power competition has also impacted the decision to expand and finance the development of a new hospital in the U.S. outpost of Guam. Notwithstanding the current political impasse around local leases, the proposed $1 billion facility would replace an aging and outdated complex and serve Guam and nearby areas including Micronesia, whose scattered islands comprise an area almost as big as Mexico’s exclusive economic zone. Given the political importance of the project, the battle has now shifted to who should bear the cost of the development of the facility, given its strategic impact on the military readiness of U.S. forces, as well as the soft power implications of providing care to the wider South Pacific region.

The pandemic responses of China and the United States helped expose the relevance of healthcare as a weapon in their growing geopolitical rivalry. As that competition heats up globally, the recent healthcare developments in the Pacific are worth a closer look as they may help preview what that rivalry might mean to the broader world.

Snehal Patel is a physician and attorney based in Singapore. He is currently the managing director of Saena Partners, an investment company, and has co-founded several healthcare startups in the region.