Written by: Nils Peterson

In 2013 President Xi Jinping announced China’s Belt and Road Initiative (BRI), a massive international lending project geared towards developing nations. Nowhere is this more evident than in Africa; the continent contains “half of the top 50 nations most indebted to China as a percent of GDP” and is susceptible to highly contagious diseases like COVID-19, due to a lack of strong healthcare infrastructure. BRI poses an obvious threat to American interests in Africa. By increasing American foreign aid to many African nations, the United States may combat China’s Belt and Road initiative by ingraining itself into these countries’ healthcare systems. Furthermore, as Africa continues to develop and become intertwined with the rest of the world, the development of the continent’s primary healthcare system would serve as a potential defense against the spread of a disease such as Ebola to nations like the United States. 

BRI is a comprehensive project that aims to strengthen China’s worldwide strategic and economic position. To give a sense of scale, today there are roughly 200 countries in the world. China aims to connect itself with around 100 countries via BRI and the plan is estimated to cost anywhere from $1 trillion to $8 trillion. According to the Brookings Institution, “Chinese financing in Africa is about one-third of the total external finance supporting infrastructure investment on the continent.” 

Furthermore, many of the countries that China loans to are high-risk borrowers. If these countries fail to pay back their loans there are consequences. “In 2017, Sri Lanka handed over Hambantota port to Chinese state-owned companies on a 99-year lease after defaulting on an infrastructure loan.” The loans also normally favor Chinese businesses and workers over locals. This has created significant opposition to many BRI projects in “African countries, such as Ethiopia, Kenya, Tanzania, Uganda, and Zambia.” Notably, the Sri Lanka situation, along with the aforementioned African countries, demonstrates the pattern of BRI initiatives heavily revolving around Chinese economic goals. However, the healthcare realm remains relatively untouched. 

Undeniably, the majority of Africa lags behind the developed world in terms of lifespan and healthcare. This presents a golden opportunity for the United States to combat BRI. An American economic strategy along the lines of BRI would be ineffective because the United States would be seven years behind China. Developing African healthcare systems would effectively combat BRI because it would ingrain the United States in these countries’ healthcare systems. Individuals understand and relate to people helping them via healthcare compared to a BRI economic project from which few individuals will derive any direct comprehensible benefit. Providing healthcare fuels the potential for economic growth and stability as seen by the development of Rwanda after the 1994 genocide. The more African countries with strong economies, the less appeal Chinese BRI loans will have because these countries will be able to finance projects via internal lending. By winning the hearts and minds of many Africans via healthcare America will be able to influence public sentiment against BRI initiatives in the future. Considering the United States only spends roughly 1.2% of its federal budget on foreign aid, even less of that goes to the development of healthcare infrastructure, an increase in funding for primary healthcare is warranted. 

Lastly, AIDs still claims hundreds of thousands of lives and Ebola rears its head in countries such as the Democratic Republic of the Congo. With several diseases already posing healthcare concerns for many African nations, pandemics like COVID-19 could be devastating. As Africa becomes more integrated into the world economy, disease outbreaks like Ebola will not remain solely the continent’s problem. They will spread with greater ferocity. However, investment in primary healthcare systems in Africa serves as a way to identify and treat potential outbreaks early on before substantial damage occurs worldwide.

An increase in American foreign aid to Africa will go a long way towards achieving the United States’ national security goal of combating China’s Belt and Road Initiative as well as serve a humanitarian purpose. The United States must act to protect its national security and provide a strong humanitarian presence in Africa.