China’s Pandemic Legacy: Politics, Power, and Public Health with Yanzhong Huang

- Welcome to China Considered a podcast that brings fresh insight and informed discussion to one of the most consequential issues of our time, how China's changing and changing the world. I'm Liz, Economy, Hargrove Senior Fellow and co-director of the Program on the US, China, and the World at the Hoover Institution at Stanford University. Today we're gonna talk about China and public health. It may seem like a niche issue, but from everything that the world has seen with regards to SARS and then with COVID, we know that what China does at home has enormous implications for the rest of the world. And to guide us on our discussion, we're very fortunate to have Yanzhong Huang. He is a Senior Fellow at the Council on Foreign Relations and a professor at Seton Hall University. He's also the author most recently of toxic politics in in-depth exploration into how China's environmental problems contribute to its health problems. Welcome, Yanzhong. It's great to have you with us.

- Well, thank you, Liz, for having me.

- So let's start with what's going on inside China. You have, I think, followed China's public health system for probably longer than almost anybody else in the field. What kind of changes have you seen over time since you first began studying, you know, China's public health system? What has, what has really struck you most about the changes and what hasn't changed?

- Well, I think if you just look at the, the, the public health system in China, right, that you've seen, right? The, you know, they are making significant strides, right? With average life expectancy rising to 78.5 years. That up, that was up from 77 2020. They've made so much progress in biotech, you know, that there is now becoming a global leader. You know, quickly catching up with the United States. If you look at the data, you know, 20, 25, 30 7% of molecules licensed by major pharma firms originated from China, right? The, you know, they, you know, also, you know, major changes in, I would say challenges, you know, that are happening in the population by population. Aging certainly is acute. Now, 20% of the population, we are talking about nearly 300 million aged over 60. They have non-communicable diseases we call NCDs. And they cause more than 80% of the death in China. That is

- Exactly, what are those like, that's like what? Cancer, obesity, diabetes. These are ncd,

- Yeah. We call the, the cancer, diabetes, you know, cardiovascular disease, disease. But all, all those issues, you know, like respiratory conditions, you know, so, and their risk factors you consider like obesity, right? Approximately 50% of Chinese adults are overweight or obese according to a 2020 report. Smoking continue to be a challenge, right? Over 50% of the adult men in Shriners smoke. And there's, you know, infectious diseases continue to be a challenge, right? That is exemplified by the, this year, by the, in the summer, right? The, the chi gonia outbreak in Guangdong, right? That started for Shang, you know, driven by mosquito boom transmission, you know, raising concerns for open spread. You know, there are all these challenges of problems. But in the meantime, if you look at the, the public health infrastructure, right? Continue to be centrally coordinated by the National Health Commission, you know, that oversees a vast network of over 1 million healthcare facilities, including state owned tertiary hospitals, community health centers, specialized in centers for disease control and prevention. They call it also CDC, right? But, you know, they have CDCs at national prevention and local levels, right? Universal bail, basic medical insurance now covers over 95% of the population. You know, but you know, the, you know, the benefits varies, depends on what schemes you are subscribed. The, and, you know, the local government now are facing in the post COVID year, all this fiscal challenges in providing, right. The, the public services, right? And the, they're trying to fix the loopholes, you know, left by, in the post COVID era, right? The, the public health system, you know, with this, the, this newly revised infectious disease law, you know, now encouraged for, which I found this is very interesting. Now, finally, by this law effective, you know, this last month encouraged the individual sharing and reporting disease related information by, you know, mentioning that entities and individuals will report in good faith eligible for rewards and exempt from liability if the event is later rolled out. So, so yeah, we're seeing both challenges, you know, changes and also stability in the system, essentially.

- I mean, it used to be the case that, you know, doctors were not paid well. So the medical profession, it was hard to attract people sometimes. Is that, has that changed? Has investment, has government investment in the practice medicine, for example, improved so that now you're getting more and better doctors and they're getting paid more?

- Well, well, in, in the United States, but typical that you have, you know, the, the, the, some of the best brightest people, right? When go to a medical school, you know, that is not the case in China. The, although, you know, we are seeing over the past year, this seems to be improving. You have more people get interested, you know, studying at the medical schools in top universities. But I think for those doctors who work at the, you know, the grassroots level, you know, even township health centers still, right? They, they, there are few people who trained, you know, receive formal training, right? To walk by in at that level, you know, even though we were assigned to those institutions, you know, still, right? That you would try your best to get into like a county hospital urban hospital because the pay is, you know, not good, is you have to, you know, rely on, you know, basic salary, which is really small, not attractive at all. But in those institutions, you know, you, if you rely on bonus, but the, you have to count on demand, but the demand for their service is really still small. People would still prefer to bypass institutions for urban health centers.

- Oh, interesting. And that of course, also prompted another challenge in, in sort of the public health system, which was corruption, right? Because you had a system where the doctors weren't making any money, and so people would pay them extra to get seen, or they would overcharge for medicines. How, you know, effectively has, you know, Xi Jinping's ongoing campaign against corruption. Now, I think it must be in its 13th year. How effective has that been in the medical field?

- Well, actually launched a, a, a anti-corruption campaign in the medical sector in 2023, right after

- Oh, late. Oh, late, okay.

- I, yeah, the end of the, the COVID pandemic, you know, so this campaign so far has punished, I believe over 40,000 people, including like hospital managers, you know, the health officials by who are involved in procurement and bribes, you know, the, although that enforcement gaps remain the, you know, and that campaign continued that there is, the government has not indicate when this is going to end. I assume that if that all systematic, you know, problems, you know, sustained, there's no way to get rid of all this corruptions in this sector,

- Right? I mean, I think we've seen that in many other sectors like the military where it seems to be a never ending

- Candidate exactly.

- Against corruption. So perhaps the same will unfortunately be true in the, in the medical sector. So let's talk a little bit about COVID and what you've seen post COVID in terms of the government's response. I have to say, I was speaking at a media round table the other day to a bunch of journalists, and one of them asked me whether I thought that China had been sufficiently punished or had sufficiently taken responsibility for COVID. I wonder how you would answer that question. I mean, do you think that China has been held sufficiently accountable for its role in COVI and its spread?

- Well, this is the, well, interesting question, right? I, I think in a way, like in February, like early February after Lee Leon died, you know, the, by the way, what Leon was the whistle blower, right? That, you know, right? The share the information about the upcoming, you know, pandemic. And he was then punished, right? And then he died from the, the, the, the, the COVID himself, right? So at that time where you, you have seen, right, this is sort of like a China's by noble moment, you know, people really, you know, like demanding accountability, you know, the, you know, the flooded the internet, right? Showing their dysplasia and frustration. But I think, you know, and many people I thought that what leads to transformative political change, right? But, you know, instead was followed by, by the information, you know, cracked down by more tightened political control. And so, you know, this, the, one of the lessons we've learned that there all this major, you know, crisis not always followed by, you know, liberalization or transformative political change. China, it might be the opposite is true, you know, the, but, but I think, you know, it's really, I, I found it really fascinating when I was studying, right? That there's the, the, the state response, you know, to the, the, the pandemic. You know, it's just that kind of resilience. I found very, you could say impressive, you know, the, you know, if, if you consider right this, this, this swing between different political modes, right? This, I think this is the most striking thing, right? The, it's capacity for sudden dramatic pivotals without apparent legitimacy cost, right? If you think about the shifts we witnessed, right from initial inaction by December, 2019 and early January, 2020 to the decisive lockdown of Wuhan in late January, 2020, you know, then the swing to overreaction with draconian zero COVID for three years, but then almost overnight by, in early December, 2022, there's a complete, there was a complete reversal, right? Sudden reopening with minimal preparation, and then COVID just disappeared from public discourse entirely. Like, you know, nothing had ever happened, right? So nobody mentioned it anymore, you know, so, you know, I, I find, you know, this, this, that kind of adaptability, or maybe resilience is the better word. It tells us something profound about how the system operates and maintains control.

- So I think that's really interesting. Let me ask two follow-up questions on that. So first, what's your explanation for that? I think it was a December decision to just lift the controls and, you know, overnight, as you said, without thought to some kind of ensuring that people would be protected or even the elderly somehow, that, that, what, what do you think was behind the decision at that very moment? And then do you think that COVID is still an issue in people's heads? I mean, despite the fact that it's not talked about, is it still in the minds of, you know, people in Chinese society? I mean, presumably many people lost loved ones, you know, to COVID as they did here in the United States, of course, you know, is it something that's not talked about, but nonetheless still has lessons, you know, that people have taken away? And what would those lessons be?

- Well, well, first of all, when we talk about the forces or factors that led to by the reopening, right? You know, certainly you could have, you know, the confluence of factors, but the influences by the, but you know, I think, you know, we still need, right, the more information, right? And what exactly happened, right? In Hai, you know, that made, you know, the, the government leader to make that decision to completely right, ditch the zero COVID. And we could just, you know, list some of the, you know, the factors we know, right? That, that, for example, by that time, by, you know, November, December, 2022, it was clear by that approach no longer sustainable right? Diminishing returns problems, very clear, right? And there was also by, according to the media reports by those reporters, was based in Beijing, you know, they also, you know, you know, talk about, found the information suggesting that government was seriously considering, right? The having a, you know, a new strategy, right. To replace by the zero COVID, you know? But you know, that still, I did not explain why, but the change come, came so sudden, right? With so minimal preparation. And it seems to be irrational, right? That the, so, you know, I, I, I think certainly why in that sense, the November, you know, 2022, all this protest, right? In Beijing, Shanghai and Elsewell played a sort of like, you know, you know, sort of a transformative role here. You know, that when the leaders, you know, actually might solve, you know, from the, you know, the, the, the, the footage rest the, of this pro that, you know, the, the, the people were so frustrated, right? That even, right, that there's this sort of like the, the largest protest, you know, since 1989 in a way, right? And then there also, right, there's clear, right, the regime legitimacy implications there from the slogans. They were enchanting. The, I think, you know, they were really shocked in my understanding. And then I think the, maybe what this, again, we don't know the exact details there. Some talk about this like sort of revenge reopening, you know, that is that, well, this, this is what you want, right? You want reopening, you want ditch the zero COVID, you got it, right. You know? Wow. So it's that kind of, but we still, again, we don't have enough information to make sort of affirmative conclusion, you know, on the, the forces that lead to the change.

- Yeah. And what about whether COVID still sits in the back of people's minds? I mean, you continue to go back and forth to China, you do your research, you, you know, have friends and, and family there. I mean, is this something that people still talk about? Is it raised is, you know, do people say, you know, should we be concerned about another pandemic of some sort? How does, how does it play out do you think, broadly within society?

- Well, again, officially, right, both state media, social media, right, that you seldom heard, right? This term COVID, right? They have those, you know, other terms, you know, replacing that we call it like during the special times, during the, the mask era, right? This, the, you know, so clearly what this still like politically sensitive issue, taboo, aerial, you know, that discourage public discussion, right? The, the pandemic, you know, the state re the government response to it, you know? But, but you know, again, the problem is that you have that many people, right? Who died by the, during the COVID, especially by the, during that maybe 35 days after the December seven, December 7th, by 2022. You know, we, we, we have met people who lost their loved ones by the, during that period of time. You know, they were, you know, certainly not happy with that. You know, the, I I, I can tell, right? That that kind of emotion, right, that was suppressed, right? The, there, the one person just said, you know, I feel I need to do something, but in the meantime, I also feel like I'm numb. You know, this kind of numb, you know that in Chinese, right? It's so you don't get a clear sense what exactly people are thinking about. It's kind of very feeling that was difficult to describe. Maybe it will disappear over time, you know, but, you know, who knows if that become part of the collective memory of the society, you know, when the, you know, social political conditions change, you know, they might, you know, like become

- Part of the process,

- Right? It is just like, you know, they great leap forward, right? That, you know, they become important imp, impacters, you know, for the post more rural reform

- Yeah. Reform. So that's really interesting. So you, you mentioned, you know, one change in Chinese policy in terms of reporting when you know you are sick or reporting on a potential disease that people will be rewarded in some way and not punished and not punished if it turns out not to be true. Are there other important changes that you think have come as a result of like, lessons learned from COVID by the Chinese government issues around greater transparency, public transparency, or, you know, different ways that health, you know, is being monitored in society? I assume those bracelets are no longer part of, you know, everyday life in China, is that right? The ones that we're tracking people's, you know, exposure to COVID, ostensibly,

- Well, COVID is still there, right? And it's still spreading in, in, in the country, right? And across the globe, right? It's just that, you know, now it's no longer considered a public health threat, you know, a major public health threat, right? The, if you consider all this, the, the government actions on chicken Goya outbreak in Guangdong, right? That the sort of, that was remini reminiscent of the zero COVID approaches, right? To a localized outbreak, which is certainly much, you know, much less federal, you know, than COVID-19 in 2020. So we have seen by this, you know, this revised infectious disease law, you know, that seems to like the, well after, you know, finally by the, I thought that there was, you know, basically little public discussion, right? Right. What we did, right? What we did wrong, you know, during, you know, COVID-19, you know, how do we get, are we going to fix, right? That this loopholes might expose during the system, right? That, that, you know, the, it seems to be by, you don't see that kind of, right. The scale of, with this public health investments we saw after, you know, sas, right? In 2003, right after sars, there was, you know, you don't, there was not just a, like a, you know, transparency, you know, the sort of this investment in public health. In fact, if you visit any of the provincial by the CDC, by those state of art buildings, labs, they were almost all build, you know, in the wake of sars, you know, outbreak. But you don't see that kind of similar level of investment, right? In the post COVID era. That is my impression. And certainly what that has something to do with the local financial capacity, because right, we know the local government, right? The debt reading, you know, the and era economic slow down, right? That they really didn't have that much in interest, right? Incentive right. To invest in public health, you know. But at the central level, we have seen like this, some of the, like the anti graphic campaigns, you know, launch of the healthy China, you know, 20, 30 more state intervention, you know, like managing people's weight. But that, that does seems, doesn't seem to have anything with like a future pandemic preparedness, you know, and response.

- So what, what do you, when you say that the government is managing people's weight, they're not, they're not going in there like the family planning offices, are they? And actually weighing people and, and checking on them.

- No, no, it's not like that. Well, that's the, but, but it, it sort of still reminds me this sort of like a recurring, right? This the, is the, the, this biopower, right? The, you have this sort of more, it's like a form, you know, as a fail approach, right? In dealing with sort of individual lifestyle diseases, you know, like, you know, overweight, right? The not diseases risk factors, right? Or this is like obesity. The, you now you see the government is taking action, right? In those areas, you know, that clearly show, you know, that the government, you know, wants to do more, right? In this field. But it also represents sort of like a subtle, right, the state penetration right to people's lives, but in order to achieve by this macro health objectives. Right?

- I see. So, so more information campaigns and sort of

- Yeah, health, wellness, education, you know, the, the campaigns, you know, maybe also provide some incentives for people to sort of, you know, exercise constrained, right? In the, their diet habits, you know, that we are seeing that there's people validating in China more concerned by their weight, this how, you know, this, like this, you know, the weight reduction by those, the camps become so, and drugs become so popular now in China.

- Interesting. Interesting. Okay. But not, but not in terms of the government actually taking individuals and, and subjecting them to sort of pressure, right? It's not at that level. It's a

- Broader, not that kind of,

- Yeah.

- The, the, the,

- It hasn't

- Gone that zero COVID type of campaign.

- Okay. It hasn't, it hasn't gone, it hasn't gone that far. That's, that's a relief, I have to say. So let me, let me ask you, I wanna, I wanna talk more about China's role on the global stage, but let me just take a beat and ask you how you decided to study this field of public health. I mean, I think you are, you know, certainly one of few in the United States and in the world. You are one of the top, you know, experts in this space. I mean, how did you decide that this was something you wanted to pursue?

- Well, thank you, Liz. I'll take this the a, a compliment, well, why I got hooked on global health and China. Let me, well, certainly because I'm a Chinese, right? That, that naturally, when you came to this country, you wanted to study your country, there's certain right comparative advantages like language or cultural, right? But, but let me take you through this journey, right? I started as a China specialist, right? Diving deep into its policies and institutions, you know, during my graduate study at the U of Chicago. So my dissertation focused on Chinese health politics in the post more era, right? Essentially look at, you know, how the state, you know, tackled health issues after those massive, you know, liberal reforms kicked off, right? So that was my first love really, you know, understanding how China's political institutions shaped its health policies by, in the mal era. But when I graduated in 2000, global health was just starting to bubble up as a field, right? That it was not a huge field. It was like almost like everybody knows everybody community, but it was this passionate community by talking about health as a global issue, not just the local one. And also they talk about it as a national international security challenge, not just a pure public health concern. So I was intrigued, right? It feel like, you know, the perfect bridge, right, between my China expertise and the bigger, right. The award problems, right? You know, then, you know, we have sars, right? That hit in 2003, and that was a wake up call in highlight, right? The health as a high politics issue, right? So the outbreak showed how faster my health crisis could spew across borders, and it sort of, you know, cemented my interesting global health governance and global health security, you know, and, you know, that is Wayne, you know, sitting hall by the University School of Diplomacy came calling, right? That they hired me as a global health person, right? To build their global health program. You know, that was actually one of the first to tie health to security and foreign policy in the professional school of international affairs. And that to me was a dream gig, right? To shape something new and later, right? I'm fortunate, I was fortunate to become affiliated with the Council on Foreign Relations, you know, as a senior fellow for global health. That gave me a bigger platform to blend my China knowledge with global health challenges. And also I was really, you know, lucky, but I was able to work with great minds, great colleagues like you, right? On the China side and, you know, Laurie Garrett and letter tomboy, you on the global health side, you know, from there, by this is being a wide ride, you know, writing books right? On Chinese health politics test testifying to Congress and diving into everything from China's environmental health crisis to its COVID response by, so it's, it's all about connecting the dots, you know, between Chinese politics, Chinese policies, and the world, the, I mean, the global health issues.

- Yeah. I mean, I, I think, you know, it's also just you become such a, such an incredible blend of both, you know, scholarship, right? As you said, the, the research that you do on the issues, which is, you know, rigorous research, but at the same time, there's an ability for you to contribute to the debates and sort of policies that affect, you know, millions, tens of millions of people globally by sharing your knowledge and your ideas. So it's, it's both, it's like a, a half academic and not activist exactly, but an element, right, of activism, of being able to take your knowledge and really make it worth something. I think on the, on the larger global stage, it's, I think it's terrific. So, okay, so a great, a great career trajectory that's led you to, I think, an important place. So let's revert now. Let me just touch on a couple of of final issues. You know, China, despite, you know, the role that it played in COVID as the originator, despite the fact that it was not as transparent as should have been, despite the fact that it used its control over personal protective equipment in sometimes coercive ways to try to get countries, you know, not to say anything bad about it or, you know, use it for, for other reasons has become an important player in the global public health diplomacy space, I think through its health, silk Road, for example. Talk a little bit about, and, and I will say, you know, one of the things I've found interesting just in some of my own reading, is that it does seem as though many countries emerging and middle income economies don't look at China as bearing the same kind of responsibility that many European and advanced economies do. They have a different perception of the role that China played in COVID often because China was providing these countries with vaccines when they couldn't get them, for example, from the United States. And notwithstanding the fact that those vaccines were not as good as, you know, the uss or, or other countries. Nonetheless, they were very appreciative of the fact that China was selling them. So talk a little bit about how the role that China's playing on the global stage in terms of health and health diplomacy, what its ambitions are, do you think, and then I wanna finish and talk a little bit about the US China sort of cooperation or competition or how you see that emerging. But first, let's talk about how you see China playing on the global stage.

- Well, if you look at this, it's the response by toward the, the, the global, the, the COVID-19 pandemic, right? The, the people often, you know, mentioned, right, this, the vaccine diplomacy, right? When I was visiting southeast Asian countries, you know, the meeting with the, the, the scholars, the government officials there, but they all mentioned, right, that, that, you know, in the, at the time in the way, but the western countries, including United States, were practicing the, their vaccine nationalism, right? Stockpiling the vaccines for their own population, right? It was China, right? Who that provided the battery needed the vaccines, right? Even though by, you might say in terms of the efficacy by the, maybe safety not as good by as like the MI vaccines, although that's debatable to some people, the, you know, still, right? The China was the first right to provide those desperate needed the medical supplies by not just the vaccines, by talking about the masks, ventilators, you know, so this is, you know, sort of broadly defined, the vaccine diplomacy, you might also call it, you know, the health diplomacy, right? The President Xi pledged the Chinese vaccine would be a global public good, you know, that position China as a leader, right? In the global response. And the countries did appreciate, you know, what China was doing, right? You know, survey data showed that those initial gains, right? That those 56% of the surveyed countries, the, the journalists, right, the, the observed more positive media coverage of China following the outbreak. You, and in Southeast Asia, you know, China was perceived as the most generous provider of the COVID assistance, you know, but those gains, you know, proved fragile and fleeting, right? The, especially with the rapid spread of this highly transmissible, you know, delta having omicron variants, you know, we saw actually a steep drop in the global delivery of the Chinese vaccines. You know, they since four, 2021, right? Then the zero COVID policy initially was marketed as a proof of the, the, the effectiveness of the China's solution by to the global pandemic, essentially, you know, become a TROs, you know, when, you know China was locking down Shanghai when spring 2022, while the world moved on, I this only projected the Brutalness not strength, you know? And then, so by 20 22, 20 23, much of that good will had evaporated, right? The, the pure global attitude survey clearly showed by that even after all this efforts, by only 28% of the respondents across 24 countries say they had the favorable view of China in spring 23, right? Compared to 59% for the United States. You know, but if you look at the, the, the post COVID era, right? China's health diplomacy, you know, the, they have pivoted from emergency response to institutionalized health engagement, and they are playing the long games strategically. They've pledged 500 million to the WHO, the World Health Organization after, you know, Trump, president Trump announced the withdrawal from the International Health Organization. They have increased health related development assistance to lower and middle income countries. And where we, of course, the Be and Road Health Sea Road was a key framework, right? Which allowed China continue to invest in hospitals, pharmaceutical production facilities, public health capacity building across Africa, Southeast Asia, Latin America. Well, these are tangible, visible projects, but that creates soft power, right? Dependency in a way simultaneously. So I think, you know, the, you know, president Trump's second term is absolutely critical, right? To the strategist effectiveness, right? Because it essentially might allow China to sort of portray itself as a defend of multilateralism, you know, global health governance, you know, China becomes the go-to partner for countries dependent on foreign aid programs, you know, and that essentially, right, the changes the competitive dynamic fundamentally, right? So, you know, China doesn't have to significantly, dramatically increase this health related development systems to fill the void, you know, left by the United States, right? There just needs to be present and why America is absent, right? That's a much lower bar, right? In this competition for global health leadership. And so, you know, you know, I think the, the, the, you could say by the current administration isn't just an opportunity for China, it's policy, not just a present opportunity for trying, it becomes a force multiply, right? Because Beijing doesn't have to be particularly good at right health diplomacy or significantly or dramatically increase health related development assistance. They just have to be there, you know, when we are not, you know, I think that should worry the United States because leadership in global health governance isn't just about altruism, it's about influence the standard setting, right? Agenda setting and shaping, right. The rules of games for the next health crisis. So if we see that space, we are gonna find it very difficult to reclaim,

- Right? Yeah, no, I, you're making a point. I completely agree. And, and I, I think about this more broadly in terms of the development assistance and the shuttering of U-S-A-I-D that, you know, people say, well, China's gonna fill the vacuum. I said, it's not gonna fill the vacuum, it's gonna do just enough. You know? Exactly. To, because we're gone. So it doesn't need, exactly as you said, it doesn't need to do much. It can go and, and support the rural reading program in Cambodia for a million dollars, and it's going to receive all sorts of, you know, accolades. Just Exactly. Exactly. So I, I think we're, we're very much on, on the same page there. And I think the other aspect, and I'm, I'm curious whether you think this is, is accurate, is that it also gives China all of this health diplomacy gives China the opportunity to promote its traditional Chinese medicine, Chinese made medical devices. It becomes a, an economic play as well, an export mechanism, right? As you're saying a force multiplier, but it, it also multiplies oppor other kinds of opportunities for China. When we pull out, I think it really enables them to gain ground in other areas where the United States, you know, may have also had advantages because of our aid, you know, linking to, you know, US made medical devices or Western made medical devices. I think it's another Entry point for China. Do you, do you agree with that or, or

- Oh yeah, absolutely, right. That it is they, because if you look at by this, the COVID diplomacy where when we are, they are actually exporting, right? Their vaccines masks ventilators, right? It's officially claim it's as a global public good, but it is not right if with the, we believe that global public good means it's not excludable by, if it's like, you know, joining is of supply, right? That they, you know, anything but global public good, right? Is actually, look, the vaccines China shift overseas by 85% of them actually for commercial or sale, you know, the, right. So it's, you know, but by, but by doing so, they're not just, you know, you know, expanding its geopolitical influence and not just projecting soft power, but also expand it by the commercial, right. The influence, right,

- Right. Commercial influence and, and opportunities for Chinese companies. Right?

- Right.

- So, so one last question. I think, you know, the health, health space, like the environment, which you know, I've worked on for many years, is always sort of promoted as an area for good US China cooperation, right? Everybody says, well, we can cooperate and health and the environment. So in the current context, what do you see there? Do you see any possibility for cooperation in particular given what's going on in the health space here in the United States? I would imagine that opportunities are much, much diminished, but, but maybe things are going on that, that I don't know about.

- Well, well, Susan, well, I think this is a great question, right? That they are, you know, many people when we talk about, you know, US China corporation, you know, they, this is just naive, right? Given the

- Throwaway a throwaway sort of health environment, right?

- Yeah. Given the geopolitical tensions, given the lack of trust, you know, and, and well, this, one of the specific, right? The, the hurdles is with that COVID-19 origins, right? This, this controversy, right? Basically, many lawmakers heal, right? That they say, well, you know that if you want the corporate US to cooperate with China health first, let's fix this problem first. If we, we can't even fix this, they forget about any corporation, right? So that is becoming one of the biggest hurdles, you know, for US China Health Corporation. But, but

- I still just so I'm so yen, just so I'm clear by the, the hurdle is the fact that China won't acknowledge the actual origin of the virus, or what's the hurdle exactly?

- Well, the hurdle is basically, this is all what the WHO has been demanding. I mean, the way this also has solid, the w o's relationship with China and the Dr. Teros, you know, since July, 2021, you know, WHO has been requesting China to be trans, to be cooperative, right? In the second stage of the, the investigation among the COVID nine, the origins of COVID-19, but the first, right, the stage was sort of like a WHO China joint study conducted in the spring of 2021. You know, that they launched a, a, a sort of a, a, a report in, in end of March, you know, basically accepted, you know, all the explanations provided by the Chinese side. So, you know, that, you know, sort of actually damaged to by the reputation, the credibility in a way of the WHO and the us right? And then the, under the Trump 1.0, right? They essentially also, I believe that's basically a whitewashed report, right? The, the want to China to be more forthcoming, to be more transparent, right? To be more cooperative, right? In the, the, the original survey, but, you know, China, sort of the, the narrative here is that, you know, a right, that the, the pandemic or the outbreak started in Wuhan doesn't necessarily mean China is the origin point, was the origin point of the pandemic. And second, right, that if, you know, you, you believe that the lab leaks the problem that caused the pandemic. Let's also investigate for Dietrich, you know, your military labs here in the us you know, the, so, you know, indicating that US could be a, a, a origin point of the, the pandemic, right? So you have that kind of finger pointing right over the origin of the pandemic. That is becoming a, one of the biggest hurdles, you know, for US China Health Corporation.

- Yeah. So no, no real prospect, I think in the immediate future for some breakthrough on health cooperation. Is that fair to say?

- Right. Well, you feel, you know, actually it's, in a way it's even worse by the, so beginning 2020, right? The since the, the early spring that year, right? And until 2023 last year, 24 last year, there was no high level dialogue, you know, public health issues. There was no, of course, there was no serious discussion on corporation, right? During the pandemic, but even after the pandemic was over, right? That we have, you know, that that accepted for last year, right? That there was a Chinese vice health minister visiting Washington, you know, meeting his counterpart. At HHS, we have essentially no high level health dialogue, you know, and even the, the, at the working level, you know, now with under the new administration, our diplomats, our health attach, well, actually there's no formal health attach. They are now is acting, they were very, they're very cautious in terms of reaching out their counterparts in China. That is very unusual, I would say, I would say abnormal, right? And this shouldn't be the case, you know, as the, when I was in Beijing, a Chinese diplomacy professor at the leading top university in China said, if there is no cooperation of health, how could you expect the effective corporation in other areas? It just to shows that dire state of US China relations, unfortunately.

- Yeah, no, i, I, I tend to agree with you, and I will say, I think even it was up until like health diplomacy was up until the, you know, second to last year, last year of the Biden administration, before we had real talks on commercial negotiations, on military negotiations, the only thing that was going on was really the climate change discussions. And that was very much a sort of a, a personal, you know, kind of love affair for, you know, former Secretary Kerry who was so committed to climate change and had the personal relationship with Shia Genis. So yeah.

- And unfortunately, but even that right there, this walking group now as the, i I think it is that the corporation has also stalled, right? Under the numerous,

- Yeah, well, I'm, I'm sure since we've pulled out of the Paris Climate accord, that there's not gonna be much cooperation at the national level on, on climate change. Okay, last quick, three questions, just boom, boom, boom. So first question, what book would you recommend to our viewers book or article on China that you think is really just excellent and people should read?

- Well, I would recommend, you know, a, a book by won ds, the title, the Breakneck, you know, that's to have this interesting comparison, you know, between the, the governance in the US and China, right? The, the, well, the, well China, according to the authors, sort of managed by the engineers, the US governed by lawyers, and they, they believe, you know, that sort of shaped the different governance model that explain why right now, you know, China is quickly catching up in this key, right, the high tech areas by the AI biotech, right? The robotics, you name it, of course for the author want to claim it's not the chairman leader. No, no,

- No, no. And his name is, it's his English name. Just to be clear, is Dan Wong. So you can Dan Wong. So it's a little different, but Right. So Dan Wong, yes, I agree. It's a great book and I think it made it's New York Times bestseller and I reviewed it for foreign affairs, I think in the upcoming issue. And it's really, I agree with you. It's a great, it's a terrific, terrific read. Okay. What issue in China, let's put aside public health though. What issue about China or in China do you think Americans don't really understand or need to know more about? What, what do you know that other people don't know that they should?

- Well, I think what set aside public health, I think it was, I, I'm still sort of puzzled, you know, by these, you know, sort of almost like over the past, just a couple of years you've seen, right, the China quickly catching up, right? In the high tech area, right? The, well, biotech is a very good example, right? Just years ago, we are still, when we talk about China's innovation capability, which says, well, they're making good progress, but it's going to be a long way before they can catch up. But now guess what? Why? They're not just catching up, but in some areas they become, they're becoming a leader, right? And in a way, this is creating sort of the, another kind of dependence, you know, in addition to the APIs, active pharmaceutical ingredients, key starting materials, but this innovative drugs and, and biosimilar molecules, you know, they are, you know, like we are becoming increasingly dependent upon them. If you look at by the, this, the number of deals by the o of the, of the licensing, right? The, the, with the sign with the Chinese companies, you know, this is, I found it very, you know, interesting, especially if you think about this, you know, this era of economic slow down, right? Well, you know, unemployment rate of the use is so high, right? That the consumption level is low. You know, the real industry is like all probably seems the almost, you know, all like a is in such a bad shape, you know, how could that happen, right?

- Yeah. No, I think that's, that's great. And actually I'll do a little plug for our, our, our next podcast, which is gonna be with Dr. Ch Lee, who is a well-known geneticist and works on biotech issues and, and on cancer drugs and goes between China and the United States. And he's gonna talk to us exactly about innovation and science and technology, particularly in the biotech field. So thank you, thank you for that leading Yanzhong. But one last question for you. If you had a recommendation for the Trump administration right now, either thinking in terms of US China competition or cooperation, what, what would it be?

- Well, I, I would say princip support engagement. I was, you know, it is interesting when you ask this question, just finish this, the part of the, at tribute to our old colleague Jerry Cohen, right? He was the person, right? That I think, you know, if there's something I remember the most, in the most, it was this, I, right? He's the commitment to, you know, rule of law and human rights. So he is the principled person, but I also had this flexibility, right? That in dealing with people with opposed views, right? So that is how he was admired, respected in both sides of the Taiwan Street, you know, so, you know, I think, you know, he, as I I I said in the tribute, you know, that this principled engagement just to show, you know, that when we are dealing with, well sort of give a example, right? This, the suggesting that when we are dealing with like a geopolitical right rival like China, even, we disagreed upon many things. I think engagement and even cooperation remains possible and vital.

- And that is a great note to end on. And, and thank you for the reminder of our truly wonderful colleague Jerry Cohen, who passed away just recently, you know, towering figure in the field of China, legal studies, someone who spanned both, you know, the corporate work, government work, and of course was renowned for his work on Chinese human rights issues as well. So Yan Jang, thank you so much for a really rich discussion. I expect no less from you from one of the best and top figures in the field, so I appreciate your taking the time to speak with us.

- Thank you, Liz.

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