Health Diplomacy and Transnational Health Infrastructures in the Mekong-Region

Over the last decade, the infrastructural needs of Southeast Asia have received international attention. Among others, the Chinese Belt-and-Road-Initiative (BRI, 2013) and the Japanese Partnership for Quality Infrastructure (PQI, 2015) have developed competing connectivity strategies to support projects in this geostrategically and economically important region. This competition for influence has been particularly marked in the Mekong-Region composed of the riparian states of the Mekong (Cambodia, China, Laos, Myanmar, Thailand, Vietnam). In 2016, both Japan and China have launched development frameworks focusing on this region: the Japan-Mekong Connectivity Initiative and the Mekong-Lancang Cooperation.

Even before the outbreak of the Covid-19 pandemic put the spotlight on health infrastructures, namely the institutions, facilities, and people, necessary for providing health services to the public, the Japanese and Chinese connectivity and infrastructure initiatives for the region have included investments in public health.

In 2013, the Japanese government launched Japan’s Strategy on Global Health Diplomacy, making health diplomacy a central pillar of Japanese foreign policy. The Japan-Mekong Connectivity Initiative of 2016 subsequently combined Japan’s global health and infrastructure initiatives in the Mekong-Region. During the Covid-19 pandemic, Japan donated both vaccines and cold chain equipment for their delivery to the countries of the Mekong-Region. One particular focus of Japanese health diplomacy is the support of the necessary infrastructure for the introduction of universal health coverage. Japan has not only supported the Thai universal healthcare system (since 2002) but also introduced the Partnership Project for Global Health and Universal Health Coverage in 2016 which includes support for the countries of the Mekong-Region.

The outbreak of the Covid-19 pandemic likewise led to an increased emphasis on health infrastructures within the Lancang-Mekong Cooperation from 2020 onward. This initiative could build on previous investments in health infrastructure and health cooperation as part of the original BRI framework of 2015. They were further emphasized from 2016 onward through the introduction of the Health Silk Road as one major branch of the BRI.

This project contributes to the global health literature by investigating how projects in the Mekong-Region supported by Japan and the People’s Republic of China as elements of their connectivity and health strategies have contributed to public health as well as to foreign policy objectives. Based on desktop research and semi-structured interviews, case studies cover specific projects of Japanese and Chinese Covid-19 diplomacy and cooperation between private Thai and Japanese hospitals.

Outcomes are also of particular interest from a European perspective given that the European Union in 2021 has launched its own global infrastructure initiative (“Global Gateway”) and explicitly named Japan and the Association of Southeast Asian Nations (ASEAN) as partners in their Indo-Pacific Strategy.