Why Is It in China’s Interest to Promote Health Security in Southeast Asia?

If there is a buzzword one needs to know to understand U.S. foreign policy toward Asia in 2013, it is “rebalancing,” or in the words of President Obama “pivoting.” Rebalancing is of course not solely about military redeployment. Indeed, a critical element of the U.S. rebalancing strategy in the region is to nurture partnerships with countries and international institutions to address common threats in areas such as regional health security.

Being the epicenter of major endemic and epidemic diseases, Southeast Asia has often been perceived as a major threat to global health security. Last week, Indonesia identified a more virulent strain of bird flu that has killed more than 300,000 ducks on the island of Java since November. That said, China and Southeast Asia share a range of health challenges, from SARS to HIV/AIDS and H5N1. Altogether, China and Southeast Asia account for approximately 90 percent of SARS cases and two thirds of the human cases of avian influenza.

Since the wake of the SARS debacle in 2003, Beijing has been actively engaging Southeast Asian countries in health-related cooperative efforts. Today, China’s partnership with countries in this region and other stakeholders (e.g. the United States) around health security has never been so important. There are at least three reasons that make China’s engagement in regional health security imperative.

The first reason why this commitment is vital is tied to regional trade and economic concerns. Economic and trade links are perceived by Beijing as the foundation for cooperation between China and Southeast Asia. While the United States remains the most powerful military power in this region, China is the most robust economic power on the block. U.S. rebalancing efforts in Asia highlight the importance for China to continue sending clear and positive message that China’s rise is more of an economic opportunity than a security threat for Southeast Asia.  Thanks to the launch of the China-ASEAN Free Trade Area (FTA), bilateral trade surged to 362.8 billion dollars in 2011. China is now the largest trading partner of the Association of Southeast Asian Nations (ASEAN), with ASEAN being China’s third-largest trading partner. Last year, personnel exchanges reached 13.6 million. Beijing certainly does not want the flow of trade and people ruined by a SARS-like disease outbreak.

Another reason for greater engagement in regional health security is geostrategic. Beijing initially engaged Southeast Asian nations on health issues as part of efforts to allay fears about rapidly rising Chinese power. Today, the need for such strategic reassurance becomes all the more important given the growing concerns about China’s assertiveness in the South China Sea and the U.S. strategic pivot to Asia. Every country in this region wants to develop better relations with China.  However, with the changing strategic landscape Beijing may find additional reasons to conduct active health diplomacy as a tool to project “smart power.” A growing consensus among foreign policy makers is that expanded cooperation around addressing common challenges helps nations build trust and reduce tensions around more contentious policy issues. By scaling up its health-related cooperative efforts, China will also benefit from an improved image in its “not-so-beautiful neighborhood.” In addition, given the tremendous health challenges China is facing, it is in Beijing’s interest to avoid being seen as a source of health problems in Southeast Asia. More than one third of the anti-malaria drugs today are either fake or substandard in Southeast Asia (which is associated with the rapid rise of drug-resistant malaria in the region), and much of the counterfeiting is believed to take place in China.

China also needs to be more actively involved in efforts for ensuring region health security because of domestic social-political considerations. Increasing trade links within Southeast Asia can serve as conduits spreading infectious disease. The 2002-2003 SARS epidemic resulted in one of the most serious social-political crises in China. The domestic social-political repercussions of major health problems coupled with the growing sense of insecurity among the Chinese leadership render health challenges in Southeast Asia a political stability concern for China. At the subnational level, two Chinese border provinces – Yunnan and Guangxi – would be critical stakeholders in China-ASEAN cooperation on health issues. Bordering Vietnam, Laos, and Myanmar, the two provinces should be seriously concerned about resurging vector-borne diseases such as dengue and Japanese encephalitis, and drug-resistant infections such as arteminsinin-resistant malaria and MDR/XDR-TB in the region. The spillover from a disease outbreak in the region may become more likely due to a lack of core capacities in many ASEAN countries to detect, assess, notify, and effectively respond to public health emergencies.