Asia must take the lead in global health – foreign policy
Asia must take the lead in global health – foreign policy

As a result of the COVID-19 pandemic, most of the world now recognizes the importance of addressing global health challenges. But Asian perspectives are still often overlooked by powerful players who have played a role in making global health a diplomatic priority, such as Western governments and multilateral organizations, despite the region’s growing influence in the political and economic spheres. Understanding how Asian countries conceptualize and contribute to global health governance is critical in the coming years.

Asia has considerable variation both between and within its countries. Political, economic and cultural diversity has not only contributed to different health indicators in the region, but has also resulted in differently configured national health systems. Rapid but uneven socioeconomic development has exacerbated health disparities and epidemiological transitions are underway in the region. Asian countries are addressing these challenges through innovation in financing, low-cost delivery models, and digital tools and platforms.

Despite different circumstances, many Asian countries are using shared health challenges to cultivate regional solidarity. They collaborate in a variety of areas, including disaster preparedness, pathogen surveillance, and health promotion and disease prevention strategies. The pandemic has only strengthened cooperation to improve health access and equity in the region, and Asian countries’ leadership in this area deserves recognition.

Western political agendas have long shaped the global health landscape. In the colonial era, economic interests emphasized the control of so-called tropical diseases. The occupying forces sought to protect the local population from disease that could hamper productivity, but they also wanted to protect colonial administrators and officials from disease. The focus on maintaining health for the benefit of the ruling class, rather than addressing local needs, perpetuated inequalities. Inadequate understanding of local ecosystems and practices led to misguided interventions, leaving lasting negative impacts on colonized populations.

This paternalistic approach persisted in the post-colonial era through a system that directed aid to recipient countries according to the priorities of rich donor countries. From the 1980s to the 2000s, aid went primarily to low- and middle-income countries struggling with the challenges of infectious diseases, maternal mortality, and child mortality. This focus served the commercial interests of the pharmaceutical industry in donor countries, which supplied vaccines, antimicrobials, and nutritional supplements. With the global spread of HIV/AIDS, virulent avian and swine flu, and concerns about bioterrorism, biosecurity has become a rallying cry for global health driven by Western aid programs.

The West still shapes the global health agenda in the 21st century, often according to commercial priorities. In a global economy dependent on interconnected labor and markets, rising rates of death and disability from non-communicable diseases (such as cancer, heart disease and diabetes) threaten to affect the workforce and consumer spending. Manufacturers in high-income countries have identified lucrative markets for drugs, medical equipment and diagnostic technologies in developing economies in Asia. However, these wealthy nations are reluctant to curb global trade in tobacco, alcohol, and ultra-processed and sugary foods—the main drivers of noncommunicable disease epidemics in low- and middle-income countries.

During the pandemic, the interests of Western pharmaceutical companies have often prevailed over survival in the Global South. Australia, Canada, the European Union, the United Kingdom and the United States, among others, fiercely defended patent protection for COVID-19 vaccines at the World Trade Organization when India and South Africa sought temporary patent exemptions for drugs, vaccines and equipment related to the pandemic. While hasty travel bans have failed to stop the virus and its variants, supply chain disruptions have created major challenges for low- and middle-income countries and affected production, distribution and access to essential goods, health products and services.

The pandemic has shown that trade alone cannot be the basis for advancing global health. Suppliers and buyers are transactional in nature, trying to maximize benefits for themselves, often ignoring health and social costs. Although the impetus for a more effective global health system initially came from a sense of shared vulnerability, the impetus must now come from a sense of shared values: promoting the health and well-being of all populations.

Asia is well positioned to provide leadership for this transition. The region is home to nearly 60 percent of the world’s population, including nearly 3 billion people in China and India alone. Although differences exist within the continent, a prevailing sense of community and strong social solidarity have increased the resilience of society in the region. In 2019, Japan, South Korea and Singapore ranked among the top five countries in the world in terms of life expectancy, according to data from the World Health Organization. And between 2000 and 2019, many other Asian countries made great strides in improving their life expectancy, including Bhutan, Cambodia, China, Indonesia, Malaysia, Sri Lanka, Thailand and Vietnam.

Both the social and systemic determinants of health are rapidly improving in Asia. Along with economic development, there has been a boom in health technology innovation and its applications in health care delivery and access. The growing number of medical tourists traveling from the United States and Europe to Asian countries attests to the region’s reputation for high-quality clinical and wellness care. In addition, the Asian pharmaceutical sector is increasing the production of quality generic drugs and developing new drugs.

Both China and India have domestically developed COVID-19 vaccines that have been approved by the World Health Organization, and India has become a manufacturing hub for internationally developed vaccines. Chinese-made COVID-19 vaccines account for nearly half of the vaccine doses administered globally in 2021. Meanwhile, despite its own massive wave of infections, India has ultimately been able to meet the needs of its sizable population, as and to supply vaccines to 96 other countries. While the scale of the supply may have been smaller than China’s, the gesture demonstrated a sense of global solidarity.

In Asian countries, health care markets are increasingly organized on the basis of solidarity, and the COVID-19 pandemic has further highlighted the need for cooperation around universal health coverage. The commitment to universal healthcare in the region extends beyond reliance on private insurance. In many Asian countries, tax funding and social security provide access to affordable health services. Primary care is a priority and the value of health promotion is well recognised. There is political will to regulate harmful products such as cigarettes or highly processed foods advertised to low- and middle-income markets, as well as commercial practices that affect health indicators, such as environmental degradation.

Key Asian countries and entities, including China, India, Japan, South Korea and the Association of Southeast Asian Nations (ASEAN), have advocated for joint research cooperation, resource sharing and sustainable health systems. The region is an example of how different countries can collaborate to address cross-border health challenges and promote dialogue on other issues. Active participation in regional partnerships and international organizations will strengthen the region’s role in shaping the collective global response to emerging threats.

However, some challenges persist in cooperation between Asian countries. One major obstacle is the historical prioritization of economic, political and security agendas over health initiatives within regional frameworks such as ASEAN. Asia’s diverse political economies and healthcare models also pose barriers to collaboration when it comes to data collection, surveillance systems and scaling innovative solutions.

Among Asian countries, China is making the fastest progress in institutional innovation and expanding its global commitment to health through its Belt and Road Initiative and other aid to sub-Saharan Africa. The two regions are natural partners: both are home to developing economies that can collectively raise their voices in global forums and demand fairer policies for the Global South. In addition, the young populations of many Asian and African countries will make up the global health workforce of the future, serving not only their own populations but also those in other parts of the world.

How China manages its own engagement has significant implications for other countries in the region, and success requires a collective will to learn from each other and a commitment to develop governance structures conducive to future cooperation without a defensive posture. As new pandemic threats emerge, particularly from Asia, data on potential pathogens must cross national borders before viruses and their variants. Although recent tensions surrounding the COVID-19 pandemic may indicate China’s tendency to isolate itself, it is worth noting that the 2003 SARS pandemic contributed to Beijing’s opening to health cooperation with other countries.

To make this Pax Asiana for global health a reality, Asian countries must assert themselves in multilateral organizations and step confidently onto global platforms. But the collective power of Asia will shine only when harmonious relations exist between its countries; collaboration in global health can catalyze these relationships. Fostering purposeful and productive partnerships is critical when it comes to medical education, health worker training, and health technology research and development.

Global health cooperation provides Asia with an opportunity to change the dynamics of regional politics and influence the trajectory of global health governance. Greater Asian leadership in this area will lead to better health and well-being for low- and middle-income countries, ensuring more equitable benefits. This, in turn, can help shape a world that is both more united and better prepared to deal with the next pandemic.

This essay was published in collaboration with the Asian Peace Program at the Asian Research Institute of the National University of Singapore.

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