The rise of the BRICS (Brazil, Russia, India, China and South Africa) as a counterweight to waning Western influence is reshaping the global health field. As is well acknowledged now, the past decade marked the transition to a multipolar world, with clear emerging leaders being the BRICS nations who achieved massive economic development throughout the 2010’s – though some more than others. Last year, the BRICS expanded into the BRICS+, pulling Egypt, Ethiopia, Iran, UAE, and this year also Indonesia, into the bloc – with probably more countries to come. This gives the bloc far greater weight, but also further complicates its cohesion, as the group now consists of monarchies, a theocracy, authoritarian dictatorships, and democracies. However, as a bloc they have now achieved a greater combined GDP than the G7 nations and are home to around 45% of the world’s population, transitioning them from growing economies into nations of influence.
A possible changing of the guard?
Earlier this year, the current US administration swiftly set in motion one of the largest shake ups in the development space in decades: imposing a 90-day halt on foreign development assistance and ordering a stop-work directive that paused nearly all US-supported aid programs worldwide. This dramatic change reflects a shifting global dynamic towards more insular policies, certainly from the former Western hegemon. Global development assistance has a long history in the West as a method of projecting soft power on a global stage and fostering stronger foreign relations. The withdrawal of the US from this space has opened the door to other countries interested in furthering their global standing, with the BRICS+ nations appearing to have an appetite for filling this void. Ideally, this would allow LMIC countries themselves to take the lead in the years to come – in line with the New Public Health Order in Africa and the Lusaka agenda.
The BRICS (+) step in
In the development domain, health has emerged as a key area of the BRICS+ nations’ collaboration. Since 2011, the bloc has been hosting annual meetings amongst health ministers, focused on sharing and supporting each other in achieving success in communicable diseases, access to medicines and universal health coverage. Additionally, the establishment of the New Development Bank (formerly the BRICS Development Bank), aimed at providing multilateral South-South aid, is a major shift from the North-South divide that has historically defined development work. This new dynamic is intended to avoid paternalistic donor-recipient relations, and instead tries to foster mutually beneficial relationships – a model which may be more appealing to developing nations who have grown more wary of the Western conditionalities frequently attached to aid.
The shared development experience amongst BRICS+ nations, with China as an obvious prime example and role model, is their unique value proposition. Many of these countries have recent first-hand experience with lifting millions out of poverty and/or constructing health care systems under resource constraints. This can allow them to potentially provide more relevant solutions to challenges facing other countries in development.
On the global stage, China has stepped up in a substantial way as of late, pledging to donate $500M to the WHO at the most recent World Health Assembly (WHA78). The country also made a splash by arriving at WHA78 with 194 delegates (!), indicating growing ambition in the global health space. During the pandemic years, China was also able to use ‘vaccine diplomacy’ as it prioritized the distribution of its vaccines to key strategic partners, allowing for a projection of soft power in a critical moment. India and South Africa similarly engaged in global health diplomacy during the pandemic. In addition, Brazil and South Africa have become leaders in the HIV/AIDS space and as regional coordinating hubs for health responses. Just last year Brazil hosted the G20 (including an important health pillar), while this year South Africa is doing the same. The rising influence of Gulf countries in global health has also been quite remarkable in recent years, including via the organisation of posh global health events.
Challenges and contradictions
As donors, the BRICS+ countries run into many of the same challenges that have been well-identified in the aid space: e.g. the tension between donor-driven projects and recipient countries’ national strategies, or the risk of aid being used as a geopolitical ‘carrot’ and ‘stick’. But where the BRICS appear to differ markedly from the G7 (at least until recently….) is their lack of cohesion, with fewer harmonized approaches to global health projects and broader ideological differences that create greater friction when attempting to coordinate complex multilateral health interventions.
Collaboration or competition?
The global health landscape is at a clear crossroads: WHA78 warned of a 40% decline in external health aid globally, mainly due to cuts by Western nations. This poses acute risks to many aid-reliant countries. As we have seen, however, at least some of the BRICS countries are stepping in, as are philanthropic foundations (the Gates foundation committed $200 billion to global health over the next two decades). And of course, African leaders themselves are adamant that they’ve “gotten the message”.
Against that backdrop, in the coming years, rather than seeing the West and the BRICS+ as competitors, the real opportunity here lies in the possibility of coordinated funding towards key areas that are identified by LMICs. As the world settles into this multipolar landscape, the challenge should not be whether the BRICS+ or the West will “lead”, but whether they can support health leadership in LMICs together, with the overall aim of ‘mutually beneficial partnerships’.