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

Featured Journal Content

PLoS Neglected Tropical Diseases
(Accessed 20 Apr 2019)
Policy Platform
Combating infectious disease epidemics through China’s Belt and Road Initiative
Jin Chen, Robert Bergquist, Xiao-Nong Zhou, Jing-Bo Xue, Men-Bao Qian
| published 18 Apr 2019 PLOS Neglected Tropical Diseases
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. António 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]…

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…

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…

…Challenges regarding infectious diseases in Belt and Road countries
The spectrum of local infectious diseases
The thrust of the BRI has two main directions: the Silk Road, which connects China by land with European countries via central and western Asia and the Middle East, and the 21st Century Maritime connection across the South China Sea, the Indian Ocean, and the Mediterranean to reach sub-Saharan Africa, following the lead of the great Chinese Ming dynasty admiral and explorer Zheng He. These two land and maritime directions from China follow five routes [1].

The Health Silk Road, a core task of the BRI, encourages health development and security along the Road. The 2030 Agenda for SDGs also calls for halting HIV/AIDS, TB, and malaria as well as the termination of the ravages caused by the 17 NTDs by 2030 [13]. Altogether, according to the 2016 GBD study, the cost expressed in disability-adjusted life years (DALYs) amounts to an estimated 63.31 million (with substantial regional variations in the 69 countries), which currently accounts for 36.7% of the total toll of these diseases throughout the world [2, 14, 15].

The DALYs resulting from the ‘big three’ (HIV/AIDS, TB, and malaria) plus those due to the 17 NTDs along the route from China towards Southeast Asia and South Asia (excluding China) amounts to 34.81 million DALYs and are mainly due to HIV/AIDS, TB, and malaria in addition to dengue and intestinal nematode infections. The infectious disease epidemics in countries along the 21st Century Maritime Silk Road are mainly the same set of diseases plus schistosomiasis, which together generate 20.46 million DALYs. The China–central Asia–Russia–Europe route, involving countries in central Asia and eastern Europe, includes many of the same diseases as well as some additional ones—i.e., intestinal nematode infections, cystic echinococcosis, foodborne trematodiases, and cysticercosis—which together cause 2.39 million DALYs. A total of 0.50 million DALYs in the countries along the China–central Asia–west Asia axis are due to TB, leishmaniasis, malaria, HIV/AIDS, intestinal nematode infections, and cystic echinococcosis (Fig 1). Such high endemicity of infectious diseases in the region is a serious hurdle for the global elimination agenda. The DALYs due to these diseases vary across the regions, and so do the collaborative priorities and their expected potential impacts. For example, cooperative actions could lead to regional elimination of lymphatic filariasis (LF) along the Maritime Silk Road while simultaneously having a significant impact on malaria, dengue, intestinal helminth infections, schistosomiasis, and TB [16, 17].

…Conclusion and implication
A major part of the BRI focuses on support and communication to build a new mechanism for global health, prioritising the prevention and control of infectious diseases, preventing outbreaks becoming epidemics, and providing UHC, thus overcoming the vicious circle of poverty and ill health. China will strengthen cooperation with particular regard to the control of TB, echinococcosis, and dengue within the 69 countries and deliver enhanced communication and research leading to the elimination of LF, malaria, and schistosomiasis. Based on opportunities the BRI provides and the cooperative experience gained, the framework shown in Fig 3 should become available and applicable to the response to these challenges by sharing information, joint control, and technical know-how.

UHC and response to the challenges posed by infectious disease epidemics are vital for the new era, with health considerations at the core of the BRI. Despite the serious threats of the infectious disease epidemics, the emphasis on health through the BRI puts us in an excellent position to achieve the health-related aspects of the SDGs by implementing the Health Silk Road concept of improved life through health-related communication. Based on technical experience in this field, mature collaborating mechanisms, and the provision of financial support, the strategies in the context of the BRI reinforce the various countries’ extensive engagement in combating infectious disease epidemics.