Chinese Health Diplomacy and the Maghreb in the COVID-19 Era

This article is part of the series on “COVID-19 in the Middle East and Asia: Impacts and Responses”. Read more ...

Beijing’s economic presence across the Maghreb has grown in recent years. The new global power has forged a close partnership with Algeria and Morocco, while also continuing to develop relationships with other countries in the region. China, which views the Maghreb region as a geostrategic intersection between Mediterranean, Middle East, and Africa, has primarily focused its efforts on developing bilateral relations, while also working within the Forum on China-Africa Cooperation (FOCAC) and the China-Arab States Cooperation Forum (CASCF).

Since 2013, Beijing has gradually constructed a multidimensional global partnership network that involves great powers, neighboring countries, developing countries, and regional organizations. China has established two strategic partnerships in the Maghreb region, with Morocco (2016)[1] and with Algeria (2014),[2] the latter being at a “comprehensive” level. However, while Beijing has signed BRI MoUs with the rest of the North African countries, it has yet to establish a formal partnership with Tunisia, Libya, and Mauritania and its growing presence in these countries remains primarily economic. 

The COVID-19 pandemic has illuminated the depth of Sino-Maghreb relations. When novel coronavirus began to spread globally, most Western Asia and North Africa (WANA) states sent aid to China and maintained close communication with the country’s leadership. Although the governments of the Maghreb countries introduced measures to restrict travel between the region and China, they also demonstrated strong solidarity with Beijing.[3] Algeria was one of the first countries to send medical supplies to Beijing. Morocco followed suit.[4]

These expressions of solidarity reflected the importance that Algeria and Morocco attach to their relationship with China, which has risen to become one of their most important economic partners. This article discusses the other side of the equation, namely China’s reciprocation of these acts of goodwill within the context of the “global health diplomacy“ it has deployed since the onset of the pandemic.

China’s Unfolding “Global Health Diplomacy”

China’s health diplomacy has long been an integral part of its engagement with international partners. Over the past quarter century, China has become a key actor in providing medical assistance to African countries as part of its expanding aid program on the continent.[5]

China has made use of its health diplomacy to extend its geopolitical reach, to build solidarity and gain influence over other states through humanitarian gestures. Specifically regarding the COVID-19 response, China’s medical assistance was deployed by various actors — the central government and local authorities, state enterprises and private companies, foundations, and individual donors — in two waves

.In the first wave, after suffering from the reputational damage of being the origin of the COVID-19 outbreak, the main tool of China’s policy was “mask diplomacy.” Mask diplomacy in Africa initially focused exclusively on the distribution of Personal Protective Equipment (PPE) and other medical supplies provided through government-to-government channels[6] and philanthropic gifts such as the PPE donation by the Jack Ma Foundation.[7] China’s pandemic response efforts also included sending medical teams to various countries in Africa and also connecting local health providers across the continent with infectious disease experts back in China.[8]l

In the second wave, China’s pandemic response has taken several forms, notably President Xi Jinping’s pledge to provide the Chinese vaccine as a “public good” at an affordable price. Beijing has also joined COVAX — the vaccine partnership that aims to subsidize vaccine access for poorer countries and ensure equitable global distribution.

China’s Health Diplomacy in the Maghreb

While it is true that the WANA is important for Beijing’s energy security and BRI realization, evidence shows that China’s actions derive from its evolving conceptions of responsibility and its plans to act as a responsible and benevolent global power.

In the first wave, China's contributions and support to all the Maghreb countries consisted mainly of medical supplies and extend payment credit, but it also included medical advice and scientific knowledge transfer to treat patients, and trade deals to purchase medical supplies from China.

Algeria, China’s close ally and largest trade partner, was the first African country to receive Chinese medical experts when a 13-member team joined a relief flight carrying PPE and other medical supplies including badly-needed respirators. China is also expected to build a small hospital in Algeria that will be used for preventive care for an estimated 5,000 Algerians and 4,000 Chinese employed by China State Construction Engineering Corporation (CSCEC) in the country.[9] In March 2020, CSCEC donated medical aid worth $450,000 that contains 500,000 medical surgical masks, 50,000 N95 masks, and 2,000 units of medical protective clothing and medical face masks as well as respirators for intensive care.[10]

In April 2020, Algeria received a second shipment of medical supplies from China, composed of prevention equipment, including medical masks, test devices, and medical protective outfits.[11] That same month, CSCEC and the Algerian government signed a $500 million design and construction contract for a 700-bed hospital in the Zéralda district of Algiers.[12] In May 2020, A Chinese medical team arrives in Algeria to share anti-COVID-19 experiences with their Algerian counterparts. The Chinese medical team is composed of 20 medical experts who specialize in areas including respiratory, intensive care, infectious diseases, nursing, building and management of hospitals, and Chinese traditional medicine.[13]

Beijing has also provided help to Morocco, which has been worse hit by the pandemic than its North African neighbors, in the form of four large air cargo shipments of medical supplies.[14]

In the case of Tunisia, China has sent sterile and antiseptic masks and other materials to reinforce the efforts taken by the local government to curb the spread of COVID-19. The “Telnet” group donated drones equipped with temperature sensors and loudspeakers.[15] President Xi Jinping declared his country’s willingness to provide Tunisia within the limits of its capacity all the required material resources and the urgent prevention supplies and equipment needed to fight the coronavirus, as well as to extend payment credit to purchase medical supplies.[16]

Last June, China donated a shipment of medical supplies to Libya to help the country fight against the pandemic.[17] In July 2020, the Chinese Embassy in the northern African country handed over a shipment of medical supplies to the Libyan Embassy in Tunisia to help the country fight the COVID-19 pandemic.[18] The Chinese Ministry of Health offers to its counterpart in Libya to hold an international training program to introduce experts in Libya to the protocols used by China in diagnosing and treating cases of the novel coronavirus.[19]

In Mauritania, Jack Ma Foundation and the Alibaba Foundation donated two shipments (in March and April 2020) of medical equipment. The shipments include respirators, tests, and other medical equipment. This Chinese medical aid will allow Mauritania to strengthen its preventive means against this pandemic, in particular through analyzing and testing which will allow a more precise knowledge of the health situation.[20]

In August 2020, Chinese pharmaceutical companies reached agreement with the Kingdom of Morocco to carry out clinical tests for the COVID-19 vaccine (which was tested on 600 Moroccans as part of clinical trials), positioning Morocco as a key player in the fight against the pandemic on the Africa continent. The Kingdom prepares to launch a COVID-19 vaccination program that aims to immunize 80 percent of the country’s adults or 25 million people. Morocco also acquired 65 million doses of COVID-19 vaccines from the Chinese vaccine produced by Sinopharm and Britain's Oxford University and AstraZeneca.[21]

More importantly, the Kingdom intends to be the first to distribute vaccines in the Maghreb and hopes to become a vaccine manufacturing and distribution hub for the Maghreb and Africa as a whole.[22] Morocco aims to soon produce and distribute Moroccan-made vaccines across the continent. The kingdom has one of the most advanced vaccination plans in the region.[23] China National Pharmaceutical Group Corp, Sinopharm, is discussing with Moroccan Sothema laboratories ways to produce the Chinese COVID-19 solution in Casablanca, wherefrom it will be shipped across the Africa continent.[24]

In April 2020, at the height of the pandemic, CSCEC and the Algerian government signed a $500 million contract for a 700-bed hospital in the Zéralda district of Algiers.[25] In February 2021, China has decided to provide 10 million COVID-19 vaccine doses to COVAX to meet the urgent needs of developing countries, at the request of the World Health Organization (WHO).[26]

The renovation of China-Mauritania Friendship Hospital and the construction of the infectious and tropical diseases treatment center of Nouakchott National Hospital passed the quality checks and were delivered ahead of schedule. A videoconference has been held for health experts of the two countries to share epidemic control experience.[27] 

Conclusion

The novel coronavirus pandemic outbreak provided an opportunity for China and Maghreb countries not only to express their gratitude for aiding each other but also to reiterate the solidity of their long-lasting relations. For Algeria and Morocco, this will undoubtedly be taken to a higher level, to boost their Strategic Partnership and cooperating further within the BRI framework. Beijing certainly needs countries like Algeria and Morocco to burnish its image in the WANA region, especially when Western countries, the US, in particular, have decided to counter China’s power and to demonize China’s medical diplomacy.

China’s health diplomacy has certainly strengthened bilateral relations with the Maghreb states in various ways. In the first wave, when the COVID-19 pandemic affected Maghreb countries, Beijing helped all of them, donating medical supplies and equipment. In the second wave, the main tool of vaccine diplomacy highlights Beijing’s renewed global ambitions. As the Chinese president repeatedly made it clear that once a COVID-19 vaccine is developed and put into use in China, it will be made a global public good, and developing countries, especially African countries, will be among the first to benefit.[28] China’s health diplomacy will probably follow the Belt and Road in facing backlash and bumps along the way. Nevertheless, we can expect the importance of vaccine diplomacy to overshadow mask diplomacy.