Trump’s Break With China Has Deadly Consequences

After scuttling its partnership with Beijing on public health, the U.S. was unprepared for the pandemic.

Alicia Tatone

The lesson of COVID-19, influential politicians and commentators are claiming, is that the United States must delink itself from China. “China unleashed this plague on the world,” Senator Tom Cotton of Arkansas recently told Sean Hannity, “and China has to be held accountable.” Cotton, who has proposed legislation to ban Americans from buying Chinese pharmaceuticals, isn’t alone. Representative Jim Banks of Indiana has urged Donald Trump to boost tariffs on Chinese products and put the money—which he incorrectly thinks would come from Chinese exporters rather than American importers—into a fund for Americans hurt by the coronavirus. In a recent essay in The American Interest, the political scientist Andrew Michta used the virus to demand a “hard decoupling” from China. Citing that essay approvingly, my Atlantic colleague Shadi Hamid recently argued, “After the crisis, whenever after is, the relationship with China cannot and should not go back to normal.”

These arguments are exactly backwards. The relationship between America and China was not “normal” before COVID-19. It was in rapid decline. And that decline has left Americans more vulnerable to the disease. The lesson of this plague isn’t that America should stop cooperating with China. It’s that America must rebuild the public-health cooperation that the Trump administration helped destroy.

U.S.-Chinese collaboration against infectious disease isn’t a globalist fantasy. It has proved immensely effective in the past. And one of its greatest champions was George W. Bush.

When SARS hit southern China in late 2002, the Bush administration played a crucial role in Beijing’s response. Deborah Seligsohn, a Villanova University political scientist who worked on science and health issues at the U.S. embassy in Beijing from 2003 to 2007, told me that the Centers for Disease Control and Prevention in Atlanta sent 40 experts—under the auspices of the World Health Organization—to assist China in battling SARS. “They provided the majority of the international advice in combatting the disease,” Seligsohn said. The Americans helped their Chinese colleagues “create records, do contact tracing, do proper isolation—all the stuff you needed to do.” The effort, she said, “turned out to be strikingly successful.” SARS was largely contained to Asia. Only 27 Americans were infected; none died.

The SARS success story produced what the Brown University medical anthropologist Katherine Mason calls an “explosion of formal cooperation” between the United States and China in fighting infectious disease. As Jennifer Huang Bouey of the Rand Corporation has documented, Bush’s secretary of health and human services visited Beijing in October 2003 and established a partnership with the Chinese Ministry of Health. In 2004, the U.S. and China began a collaboration “to build Chinese capacity in influenza surveillance,” as Bouey put it. The number of U.S. government employees working on public health in China grew dramatically, with some CDC officials even given offices inside their Chinese counterpart (which, in homage to the American agency, is also called the CDC).

These efforts saved American as well as Chinese lives. When a new virus, H1N1, broke out in 2009, Bouey noted, “American and Chinese health authorities shared information and technology to facilitate national monitoring of H1N1’s spread and to develop a vaccine.” When the H7N9 virus emerged four years later, “the Chinese and American CDCs collaborated throughout … by sharing epidemiological data and engaging in joint research.” When Chinese researchers developed a vaccine, they quickly shared it with their American colleagues, who produced a version in the United States.

By Barack Obama’s second term, the United States and China were expanding this public-health cooperation to the rest of the world. When Ebola hit West Africa in 2014, American and Chinese personnel worked together at a Chinese-built laboratory in Sierra Leone and off-loaded supplies from a Chinese transport plane in Liberia. As the Carter Center has noted, many of the health experts whom China dispatched to fight Ebola had been trained by the Americans whom the Bush administration had sent to Beijing a decade earlier.

Once again, these joint efforts saved lives. From 2014 to 2016, 28,000 people in West Africa contracted Ebola, far fewer than the 1.4 million the U.S. CDC had predicted near the beginning of the outbreak. In August 2014, 40 percent of Americans told pollsters that they expected a “large outbreak” of Ebola in the United States. Ultimately, only a single American died. On Obama’s final trip to China in 2016, the two governments agreed to jointly finance a headquarters for the African Union’s Centres for Disease Control and Prevention so that the continent could better fight infectious diseases itself.

The Trump administration is now trying to prevent that headquarters from being built. That’s just one example of the wrecking ball it has taken to public-health cooperation with Beijing. In 2018, The Washington Post reported that the Trump administration was “dramatically downsizing” the global “epidemic prevention activities” Obama had launched following the Ebola crisis. This year, even as the coronavirus outbreak was raging, Trump proposed cutting American funding for WHO in half.

These cuts have taken a particular toll on American initiatives in China. Since Trump took office, both the CDC and the National Institutes of Health have reduced their staff in Beijing. The National Science Foundation has shut its office in the country entirely. The sentiment inside the Trump administration, Bouey told me, is that “if you have collaborative research with Chinese scientists, you’re helping China to build their capacity, and that’s not good for the U.S., because China is a strategic competitor.”

This hard decoupling on public-health matters almost certainly undermined the U.S. government’s initial understanding of COVID-19. To be sure, Beijing responded to the outbreak with a disastrous cover-up, followed by a harsh quarantine. It repeatedly and inexcusably delayed allowing a WHO delegation into Wuhan. Nonetheless, academics who study U.S.-Chinese cooperation on public health told me that had experts from the CDC and the National Institutes of Health maintained close contact with their Chinese counterparts, those informal channels would have given the United States much better information in the virus’s early days.

“Five years earlier,” Bouey said, “CDC and NIH officials would have been on the ground in Wuhan.” Seligsohn insisted that American officials during the Bush years “would have had a better sense of whether disease was being contained.” Elanah Uretsky, a medical anthropologist at Brandeis University who focuses on China, suggested that “the cooperation on health projects between the U.S. and China that existed before the Trump administration could have helped to pick up the virus sooner.” This week, Reuters reported that among the positions the Trump administration defunded was that of a medical epidemiologist who had been embedded inside China’s CDC. An American who previously occupied that role told the news service that “if someone had been there, public-health officials and governments across the world could have moved much faster.”

Now that COVID-19 is sweeping across the United States, cooperation between Washington and Beijing remains essential. “It’s hard to understate the importance of the U.S.-China relationship in getting through this,” Tom Inglesby, the director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, told me. Since China—after its mistaken early attempts to suppress information—has gotten the virus under control, Inglesby said, “we need to learn from them about what’s going to work. Are they finding ways of returning to normal life without a vaccine? What did China do in terms of social distancing that made the most difference? We can’t and shouldn’t do what they did in terms of movement restrictions and compulsory action, but understanding what they did that we could emulate is very important.” Jeremy Konyndyk, who led the Office of Foreign Disaster Assistance within the U.S. Agency for International Development during Obama’s second term, told me that the United States should bring Chinese doctors to every American city seriously affected by the coronavirus to explain how they managed COVID-19 cases.

In Italy, Chinese doctors are doing exactly that. China is also sending large quantities of protective equipment to Europe now that its enormous manufacturing capacity no longer needs to be directed exclusively toward its own sick. Beijing’s intentions aren’t purely humanitarian, of course. It’s not only donating supplies; it’s selling them. But less of that equipment is entering the United States because, as Chad Bown of the Peterson Institute for International Economics has documented, the Trump administration imposed tariffs on almost $5 billion worth of Chinese medical products. The administration sheepishly lifted some of these tariffs when COVID-19 hit the United States. But, Bown notes, “many critical medical products from China remain subject to tariffs.” Plus, even the tariffs that have been suspended are set to return, thus making America an unreliable market. Trump’s protectionism, Bown observes, “creates perverse incentives for Chinese medical suppliers to make American customers their last choice.”

American doctors and nurses need masks, goggles, gloves, gowns, and thermometers now. That Trump’s tariffs are already making these supplies harder to procure underscores the absurdity of Representative Banks’s call for hiking tariffs even higher in retaliation for the “China virus.” Sure, the United States should, over time, boost its capacity to produce vital medical supplies. But a hard decoupling in which keeping Americans healthy no longer depends on Chinese products and knowledge is a dangerous fantasy. When I asked Brandeis’s Uretsky about Senator Cotton’s call for banning Americans from buying Chinese drugs, she noted that many of the drugs America already produces rely on Chinese raw materials.

Hard decouplers might also contemplate the possibility that Chinese scientists will create the first COVID-19 vaccine, as was the case with H7N9 in 2013. Konyndyk said it’s urgent that the U.S. and China help forge an international agreement to ensure rules for coronavirus-vaccine distribution, no matter which country’s scientists first create it. A world in which vaccines are distributed quickly across borders is far safer for ordinary Americans than a world in which countries hoard them. But that requires cooperation between the United States and China, something Trump’s anti-Chinese insults make far harder.

With brutal force, COVID-19 is clarifying two realities that run directly counter to Trump’s worldview. The first is that in a deeply interconnected world, the safety of ordinary Americans is often better protected by intensifying global cooperation than by buttressing national sovereignty. Some elements of the U.S.-China relationship are, indeed, zero-sum. When China fortifies islands in the South China Sea, its regional power goes up; America’s goes down. But nothing China has done on Mischief Reef has ever tanked the U.S. economy or forced millions of Americans to shelter in their homes. It is now obvious that the two ways through which Chinese behavior most threatens ordinary Americans—pandemics and climate change—do not obey the zero-sum logic that Trump and his ideological allies favor. The same virus that devastated Wuhan is now devastating New York. The rising seas that imperil Miami also imperil Guangzhou. Deeper collaboration between the world’s two superpowers is the logical response to these mammoth common threats. And on infectious disease, we know that such collaboration works.

The second reality the coronavirus is laying bare is that the balance of knowledge and power in today’s globalized world has changed. When SARS hit in 2003, the United States was China’s tutor. Now America’s doctors and scientists are desperate to learn how their Chinese counterparts vanquished the coronavirus in Wuhan. If America’s factories were the arsenal of democracy during World War II, it is more and more clear that China’s factories will be the arsenal of global public health during the COVID-19 pandemic. This shift would be jarring to any U.S. president. But it is particularly threatening to a president who flirts openly with white supremacy. It’s not coincidental that the White House has become a geyser of anti-Chinese bigotry at the very moment America needs China most. Trump’s rhetoric reflects an inability to cope with a geopolitical transition that, to his supporters, is also a racial transition—the kind of racial transition many of them elected Trump to prevent.

The lesson of this plague is not only that the United States must cooperate more deeply with China. It is also that the United States will be less able than in the past to dictate the terms on which that cooperation occurs. Trump, Cotton, and other hard decouplers may find these realities excruciating. But the more they resist them, the more Americans will die.