Combating infectious disease epidemics through China’s Belt and Road Initiative

On March 17, 2017, the United Nations (UN) Security Council, backed by the consensus of its 193 member states, adopted Resolution 2344, which calls for strengthening regional economic cooperation through China’s Belt and Road (also called Silk Road) Initiative (BRI) [1]. Based on the cornerstones of peace and cooperation, openness and inclusiveness, and mutual learning and sharing benefit, this initiative was proposed by the Chinese government and is participated in by various parties. Its goal is to provide fundamental solutions to boost global economic development through enhancing policy coordination, facility connection, unimpeded trade, financial integration, and people-to-people bonds. The UN Secretary-General, Mr. Antonio Guterres, acknowledged that the BRI tallies with, and complements, the Sustainable Development Goals (SDGs) in terms of promoting inclusive development, strengthening exchange between countries, and benefiting people within the initiative’s scope [2]. The BRI currently involves 69 countries (mainly those named in the initial Belt and Road outreach and those having signed cooperation agreements), 70% of the world population in total, 30% of the global gross domestic product, and 75% of the world's energy reserves [2–4]. Although the BRI is primarily economic, it also includes important health dimensions. The Healthy China 2030 plan, promulgated in 2016, considers health as one of the national policy priorities, and the Memorandum of Understanding with the World Health Organization (WHO), signed in 2017, which promotes global health security and development along the terms of the initiative [5, 6]. Based on these agreements, the building of a Health Silk Road has become a core task leading to an extensive engagement in global health development [7, 8]. During the Belt and Road High-Level Meeting for Health Cooperation: Towards a Health Silk Road, held in August 2017 in Beijing, the Director-General of WHO, Dr Tedros Adhanom Ghebreyesus, positively commented on the initiative, saying that it may become the stimulus needed to drive our united activities towards universal health coverage (UHC) and that it contains the necessary fundamentals, such as infrastructure building, access to medicines, and human resources, needed to build a platform for sharing experience and promoting best practices [5]. The Health Silk Road concept establishes the importance of promoting cooperation among the related countries in the prevention and control of communicable diseases, medical system and policies, healthcare capacity building, staff training and exchange, traditional medicine, and health education as well as disaster relief, aid, and poverty reduction for health [1]. In this way, building the contextual Health Silk Road would advance political commitment to mobilise all resources for better health in the world. The world is currently witnessing increasingly complex epidemics as well as natural disasters with a rising impact on both human health and the economy [1]. Growing commercial trade and more frequent personal exchange following the implementation of the BRI may amplify infectious disease transmission or inadvertently introduce emerging infectious diseases, leading to an increased burden for local medical systems. Moreover, infectious diseases resulting from poverty disproportionately affect poor and marginalised communities, which remains a more serious hurdle to achieving the SDGs and UHC [9, 10]. This is the reason why the initiative has made the need to combat infectious diseases a priority for social and economic development. The implementation of the BRI is expected to facilitate progress in eliminating infectious diseases such as the acquired immunodeficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV), tuberculosis (TB), malaria, and 17 neglected tropical diseases (NTDs), which make up SDG 3.3. It has also gained the support of WHO, which has proposed a strategic cooperation with the BRI [5, 6, 11]. Taking the opportunities provided by this initiative, action for combating the diseases will be conducted through the sharing of information and experience and cooperative disease control programmes, including interventions and research innovation [5]. It will also mediate resources including the building of medical infrastructures, funding support, training of staff, and delivery of emergency healthcare [1, 10, 12]. The initiative provides guidance for stronger health collaboration, which should hopefully break the vicious cycle of poverty and infectious disease [13]. Delegates from the Joint UN Programme on HIV/AIDS (UNAIDS), the Global Fund (https://www.theglobalfund.org/en/), the Global Alliance for Vaccines and Immunisation (GAVI) (https://www.gavi.org/), and more than 30 countries participated in the Belt and Road High-Level Meeting for Health Cooperation, signed the Beijing Communique, and agreed to participate in building the Health Silk Road. As for the infectious diseases, cooperation on control and elimination has been the highest priority, together with mounting an effective response to disease outbreaks and reemerging infections [2]. However, details regarding how this should be carried out in practice have not yet been presented; in particular, we still lack proposals that take up the challenges, specify indicators of expected impact, and develop opportunities for collaboration in this area. The purpose of this paper is to analyse the existing spectrum of the main infectious diseases in epidemics (based on the Global Burden of Diseases [GBD] study of 2016 [14, 15]), the potential negative effect on the economy, and the challenges to elimination. The paper also aims to explore opportunities and a feasible approach of global disease control with specific consideration of the BRI.