FRIEDRICH-EBERT-STIFTUNG – CHINA’S INTERNATIONAL DEVELOPMENT COOPERATION 2017 and 2019, pharmaceuticals from China accounted for only 7.3 per cent of African imports, while pharmaceuticals from the EU made up 43.8 per cent of this type of import to the continent. 177 China is, however, significantly more im­portant to African economies than the EU as an export des­tination, accounting for 29.6 per cent of exports compared to EU’s 8.2 per cent. 178 Overall, however, there is still too lit­tle information on the extent and detail of Chinese involve­ment in the health sector. – Get a clearer picture of Chinese health engage­ment in Africa: Chinese engagement in the African health sector, particularly efforts to combat HIV-AIDS and Malaria and investments in the African pharmaceu­tic sector, is to be welcomed in principle. If China can help reduce the costs of pharmaceuticals and medical supplies in Africa, making them more affordable for the impoverished sectors of the population, then its in­volvement will be beneficial. However, assessing the impact of Chinese health engagement beyond the pos­itive statements of Chinese diplomats is difficult, as the openly accessible information is fragmentary and in­complete. In order to adopt robust and substantive po­litical positions, more studies are needed, preferably ones grounded in on-site research. – Understand that“China” is not a monolith: The Chinese government incentivises provinces, SOEs, and non–state actors to engage in health-related trade and investment activities. However, contrary to what Chi­nese and African statements might suggest, coordina­tion between different Chinese stakeholders is poor. There is no coherent and coordinated approach be­tween the various government stakeholders involved in health cooperation, such as the Ministry of Foreign Af­fairs, the Ministry of Commerce, the aid agency CIDCA, the National Health Commission, provincial actors, and Chinese enterprises. Quite often, different players even compete, which can be both beneficial and harmful to the African side. – Consider the health sector a potentially worth­while area for technical dialogue or even triangu­lar cooperation. Despite rising systemic rivalry in other areas, improving global health remains a goal China shares with Germany and the EU. China’s health en­gagement is to be welcomed when it yields positive outcomes for the local population. However, there are several significant obstacles to achieving this goal, pri­marily rooted in intercultural differences. Most Chinese actors, including government and research agencies, have little experience carrying out health interventions 177 frica Growth Initiative at Brookings(2021). Foresight Africa 2021. Brookings, 68. https://www.brookings.edu/wp-content/up­loads/2021/01/foresightafrica2021_fullreport.pdf. Calculation based on statistics by the United Nations Conference on Trade and Develop­ment(UNCTAD). 178 Ibid. or collaborations overseas. 179 When constructing hospi­tals and healthcare facilities, Chinese companies may not consider local conditions and use building materials not suited to the local climate. Chinese medical teams are rarely proficient in local languages, and outreach to local communities is often lacking. Moreover, China has few global health professionals with field experience, and there are limited career paths or incentives for glob­al health work. Chinese health aid is still too focused on building hospital facilities or delivering goods instead of supporting the build-up of public health systems. Some of these issues could be addressed in the context of trilateral cooperation or horizontal dialogue. – Acknowledge the significance of Chinese health cooperation in African countries: Beijing’s actions in the initial months of the COVID-19 pandemic represent a notable logistical accomplishment. No other state demonstrated the willingness or capability to provide comparable support to developing nations during this critical time. While the PRC’s actions may not have been entirely altruistic, dismissing them is counterpro­ductive. Moreover, Chinese health cooperation has his­torically played a role in bridging healthcare gaps in Africa. For instance, when the WHO exhibited a leader­ship vacuum during the Ebola outbreak in West Africa in 2014, Chinese medical teams played an important role as responders – simply because they were already present. – Expand German and European health coopera­tion: Germany and the EU should continue to support the establishment of medical manufacturing facilities and strengthen African health organisations. Therefore, it should take into account that different partners, namely Least Developed Countries(LDCs) and Middle Income Countries(MICs), require differentiated ap­proaches. Approaches to the latter should leverage the comprehensive range of tools available within the EU toolbox and extend beyond ODA and conventional modes of political and policy discourse, blending chari­table and commercial elements. – Improve public health diplomacy: Although the EU is a significantly bigger health player in Africa than Chi­na, it has a much lower visibility. China, on the other hand, strategically employs the rhetoric of brotherhood and equality. Despite its investments in global vaccine distribution, Europe has often been perceived as entire­ly self-interested in many parts of Africa due to its refus­al to support patent waivers for the vaccines it manu­factured. The EU has provided billions of euros in support of COVAX and expressed willingness to assist in building pharmaceutical manufacturing capacity in Africa; however, for some African leaders, it was“too 179 & Bloom(2020). Understanding China’s Growing Involve­ment in Global Health. Globalization and Health, 16. https://doi. org/10.1186/s12992-020-00569-0 34