Global Trade and Infectious Disease Spread: Risks Associated with China’s Belt and Road Initiative

Many infectious diseases, both of animal and human origin, are known to be transmitted through trade or travel. China’s Belt and Road Initiative is an ambitious regional and global development plan that comprises the establishment of new trade routes connecting China with Europe, Africa and other Asian countries. This study explores associated risks and challenges for cross-border disease surveillance and control. Descriptive and social network analysis of global trade data retrieved from the United Nations International Trade Statistics Database served as a basis to identify patterns of food demand and supply along Belt and Road countries. Potentially plausible scenarios of emerging trade relationships were developed and assessed for the risk of spreading infectious diseases. This study showed that global trade networks of live animals and animal products have become denser and more strongly connected over time. The volume of trade in meat increased steadily and was particularly high for poultry, while it almost quadrupled for pork from 6.6 to 24 million tons per year from 1997 to 2016. Traceability of food will thus become more challenging and the risk of spreading foodborne pathogens, including resistant ones, will intensify. New trade routes are likely to serve as a bridge for infectious diseases between countries that were geographically separated before. China, which so far has been limited to a few trading partners, will become exposed to infectious diseases such as African swine fever through a larger number of introduction routes. However, the effects of China’s Belt and Road Initiative are difficult to anticipate and their evaluation is complex. Potential extent and severity of infectious diseases must be assessed further to facilitate the development of suitable risk management policies. New approaches to cross-border disease control and risk-based surveillance are required to limit the risk of introduction and spread.