This study examines the dynamics of China's COVID-19 control policy change through the lens of securitization theory. Findings reveal a phased strategic approach: COVID-19 was framed as an existential threat via hybrid assemblages of discourse and techno-political instruments, to facilitate stringent pandemic control measures. However, the concerns over social stability, economic stagnation, and resource unsustainability caused by the prolonged emergency governance, coupled with the escalating difference between securitizing actors and the audience undermined the securitization logic, precipitating China's abrupt change in pandemic control policy. China's capacity for selective (de)securitization was inextricably linked to its centralized leadership system, collectivist ideology, and adaptability to performance-based legitimacy.

Interactions between International Organisations (IOs) within a regime complex often manifest themselves through competition and cooperation. Current research has examined the factors that promote inter-organisational competition and cooperation, yet the precise timing of when such competition or cooperation commences remains unclear. This paper focuses on two pivotal IOs in global health governance, the World Health Organization (WHO) and the World Bank, to explore the timing and onset of competition and cooperation within a regime complex, as well as the driving factors in the evolution of their inter-organisational relationships. By looking into the interactions between the WHO and the World Bank in norm-setting and resource mobilising, the paper sheds light on how their relationships have transitioned from competitors to cooperators. It systematically presents the mechanisms and processes of policy transformation in inter-organisational interactions. As a new agenda arises, IOs within a regime complex often compete for dominance, with ideational differences driving them to propose and implement distinct governance strategies. They will compete for resources and mainstream of their strategy. The negative spillover effects of competitive policies consequently undermine the effectiveness of IOs’ policy, thereby undercut their legitimacy. To surmount these challenges, the international community should promote inter-institutional coordination in global governance.

拜登政府上台后发布了《新冠应对和大流行防范的国家战略》《国家生物技术和生物制造倡议》和《国家生物防御战略和实施计划》等聚焦生物安全的系列文件和倡议,标志着生物安全战略已经上升为美国政府的重要政策议程.新冠肺炎疫情对美国造成了史无前例的生物安全危机,拜登政府通过调整国内生物安全治理机制、加大生物安全领域的投资和开展卫生外交三种路径来推行其生物安全战略.该战略呈现出"全社会""伪多边主义"和"地缘政治化"等特点,其目标在于:以促进美国生物安全强化美国整体国家安全、以生物安全为议题重塑美国国际领导力、以发展生物产业巩固美国生物技术霸权.在美国已确立对中国实施全面"竞赢"战略的背景下,生物安全治理领域不可避免地成为中美竞争的场域.这种竞争主要体现在全球生物安全治理制度和生物技术经济两个方面.拜登政府基于地缘政治考量和以"竞赢"为基调的生物安全战略使得中美生物安全合作前景黯淡.

The COVID-19 pandemic has wreaked havoc on global economy and human communities. Promoting the accessibility and affordability of vaccine via diplomacy is the key to mitigating the pandemic crisis. China has been accused of seeking geopolitical objectives by launching vaccine diplomacy. The definition of vaccine diplomacy is neutral by nature. China's vaccine diplomacy is based on its holistic approach to national security and the importance China attaches to the "Belt and Road" Initiative. With a whole-of-government approach on both the bilateral and multilateral levels and marketization of vaccines, China's vaccine diplomacy has immense implications for global health governance, in that it helps to narrow the global immunization vaccination gap and to promote human-right-based approach to global health governance. However, the sustainability of China's vaccine diplomacy is questionable because of the Sino-American geopolitical competition and doubts over the efficacy of China's vaccines. The escalation of power rivalry between China and the U.S. and the concerns over the efficacy of China's vaccines forebode the gloomy future of China's vaccine diplomacy.

作为世界卫生组织最大的资金捐助国,美国与世界卫生组织如何互动关乎该组织全球卫生治理功能的发挥.新冠肺炎疫情暴发后,美国与世界卫生组织的关系急转直下,特朗普政府史无前例地做出了断供世界卫生组织资金乃至退出该组织的决定,标志着美国与世界卫生组织互动关系的重大转变.通过对历史的分析可以发现,在与世卫组织互动的过程中,美国拥有更大的行动自由度,将卫生问题作为谋求国家利益的手段.在意识形态利益、经济利益及卫生安全利益的驱动下,美国与世界卫生组织的关系经历了冷战时期的控制与合作(1946—1978)、南北斗争时期的疏离与对抗(1979—1993)、冷战后共建卫生伙伴关系(1993—2016),以及特朗普政府时期的削减与退出(2017—2020)四个阶段.历史经验表明,美国对世界卫生组织的政策从来不是只考虑单一的卫生治理因素,而是与美国不同时期不同的利益重点密切相关.拜登政府上台之后做出的重返世界卫生组织的决策亦不例外.

分权化的区域治理结构已成为世界卫生组织(世卫组织)发挥其全球卫生治理功能的制度障碍.世卫组织针对分权化的区域治理结构发起了多次改革,但均无果而终.通过历史制度主义的视角,可以解释世卫组织区域化治理结构改革难以实现的原因并展望谭德赛发起的世卫组织DNA改革的前景.历史制度主义认为,国际组织创设时刻的制度选择深受业已存在的制度形式影响.制度确立之后,出于维护既得利益的考量,制度受益者会抵制根本性的制度变革,造成制度发展的路径依赖.由于世卫组织成立之初已存在泛美卫生组织等区域性卫生治理机构,其选择了分权化的区域治理模式,并赋予区域办公室在人事任命和预算制定方面的高度自主权.随着区域办公室在财政和人事两方面的权力不断加强,区域从中获得了"递增收益",强化了世卫组织变革中的区域分权化路径依赖,导致世卫组织历次有关区域治理结构的改革难以成功,这也决定了谭德赛发起的世卫组织DNA改革不具有现实性.

Since the outbreak of COVID-19, the whole world has suffered great losses in personnel and economy. While there had been encouraging news about the research, development and production of several COVID-19 vaccines in 2020, it was imperative to make the vaccines accessible to all. To address this issue, Gavi, The Vaccine Alliance, together with other organizations, launched the COVAX initiative in April 2020 and set an Advance Market Commitment (AMC) mechanism to contribute to it. Until October 2020, China had not officially signed any related contracts or agreements with Gavi to join the initiative. However, there has since been a shift in China’s attitude from hesitation towards active participation. In the early stages, China’s concern over problems within the AMC mechanism, success in combating COVID-19 and concern on the participation conditions of COVAX caused it to take a cautious stance towards this initiative. However, upholding the flag of multilateralism, China has committed to offering international public goods, assisting in coordinating the equitable distribution of vaccines and promoting Chinese-made vaccines internationally. These factors have motivated China to join the initiative actively.

在全球治理领域,机制之间的互动在所难免,同处全球层次也不存在隶属关系的国际机制之间的互动则以合作与竞争为主要互动模式.在全球卫生治理领域,世界卫生组织和世界银行是两个重要的参与机制,两者之间也存在广泛的合作与竞争.在传染病专项应对、卫生长效机制建设和实现全民健康覆盖等共同目标上,双方建立起密切的合作;而在涉及机制自身发展利益的议程、模式和资源领域,双方又展开了激烈的竞争.双方之间的竞争与合作使得全球传染病应对能力得到提升,国家基础卫生能力状况能力也得到改善;同时也对全球卫生治理体系的稳定性造成了不良影响,削弱了世卫组织的领导地位,提倡建立机制间常态化的协作型互动模式.

新冠肺炎疫情触发了全球安全危机,这也是对全球卫生治理的一场未曾有的压力测试.有效的全球卫生治理取决于全球卫生公共产品的供应.一般而言,霸权国家通过其全球领导力在全球卫生公共产品的供给中发挥关键作用,从而促进全球卫生安全体系的发展和稳定.但是,当霸权国既无能力、又无意愿维护全球卫生安全体系时,全球卫生治理将陷入"金德尔伯格陷阱".当前全球卫生治理体系的失序以及日益恶化的全球新冠肺炎疫情危机,本质上就是"金德尔伯格陷阱"风险的体现.因此,在双边层面促成中美卫生合作,在区域层面提升东盟与中、日、韩和"一带一路"沿线国家的卫生合作机制化,在全球层面优化世界卫生组织和二十国集团的全球卫生治理功能,应当成为中国全球卫生治理战略的多维图景.另外,推动卫生治理的区域化合作更具操作性和现实性,也是国际社会跨越全球卫生治理"金德尔伯格陷阱"的必由之路.

The Covid-19 pandemic is both a public health crisis and a stress test for global health governance. Effective health governance hinges on the provision of global public goods for health. Generally, the hegemon underwrites the operation and stability of the global public health architecture by ensuring the sustained supply of global public goods for health. But when the hegemon is unable or unwilling to shoulder this responsibility, global health governance may run the risk of falling into a Kindleberger Trap. The leadership vacuum that is opening up amid the coronavirus pandemic is accelerating the process. At present, China should adopt a three-pronged approach to promote bilateral health cooperation with leading countries like the United States, strengthen regional institution-building with ASEAN, South Korea, Japan, and Belt and Road countries, and improve the performance, credibility, and integrity of global organizations like the WHO and G-20. The Kindleberger Trap in global health governance can be overcome by adapting regional health coordination to make it more agile and effective.

进入21世纪以来,新型冠状病毒、埃博拉、重症急性呼吸综合征以及甲流感等新发和复发传染病危机对全球卫生安全构成严重威胁,因此,如何促进全球卫生安全治理是当今国际社会亟待解决的问题.尽管美国曾经在全球卫生安全治理中发挥了重要作用,但尚未形成清晰的全球卫生安全治理政策.美国于2019年5月首次发布《全球卫生安全战略》,标志着特朗普政府全球卫生安全政策正式出台.该《全球卫生安全战略》以应对传染病威胁为核心,呈现出了以国家安全为导向和"全政府"路径的特点,充分体现了特朗普政府的"负担分担""美国优先"和反多边主义的思维.在全球卫生安全领域,各国已成为"因病相依"的全球命运共同体.有效的全球卫生安全治理需要全球多边主义,特朗普政府以国家安全为导向和以"美国优先"为原则的《全球卫生安全战略》与全球卫生安全的实现之间存在张力.特朗普政府的上述思维不仅侵蚀了全球卫生安全体系建构所必需的国际政治合作基础,也恶化了全球卫生安全的融资体系,因此对全球卫生安全体系构成了挑战.

新型冠状病毒、埃博拉病毒以及寨卡病毒等新发和复发传染病危机对全球卫生安全构成严重威胁.卫生问题不仅已成为全球发展的重要议题,而且日益占据国际政治和外交的优先议程.在全球化深入发展的背景下,公共卫生危机的频发和扩散对全球卫生治理提出了更高的要求.当前,全球卫生治理呈现出治理行为体多元化、治理层次多维化、治理形式多样化的特点.与此同时,全球卫生治理也面临卫生问题政治化、协调机制碎片化、多边机制双边化等挑战.只有秉持人类命运共同体理念,摒弃"建墙"和"甩锅"思维,坚持以世界卫生组织为主导的多边主义,持续加强全球卫生治理与合作,才是国际社会增进人类健康福祉的正确努力方向.

2018年美国政府发布的《国家生物防御战略》,标志着特朗普政府生物安全政策的正式出台.该战略性文件是特朗普政府的《国家安全战略》在生物安全领域的具体化,也是美国历届政府有关生物安全议题最系统、最全面的阐述.与前任政府相比,特朗普政府的生物安全政策呈现出部门协调集权化和生物威胁应对一体化的特点.特朗普政府的生物安全政策充分体现了其“美国优先”和“单边主义”的执政理念.美国生物防御战略在牵头机制安排上的“去安全化”,并没有改变美国通过实施生物安全战略来追求国家安全利益的本质.特朗普政府通过加大生物科技领域的投入,以实现生物科技创新和生物防御系统相互赋能,在促进卫生安全的同时,维护美国在生物科技创新领域的霸权地位.

为应对公共卫生安全威胁和全球卫生治理机制的功能失调、维持组织活力,二十国集团积极介入全球卫生治理,并成为推动全球卫生治理的新生力量.利用自身灵活性和包容性的机制优势,二十国集团在议程设置、多边融资机制建设以及影响相关多边机制等方面促进了全球卫生治理,但也面临着成员国间卫生优先事项存在差异、缺乏有约束力的监督机制等挑战.营造有利于全球疫情防控的政治环境、推动自身卫生治理机制化以及强化世界卫生组织作用,将是二十国集团参与全球卫生治理的重要方向.

新冠肺炎疫情是当前国际社会遇到的极为严重的公共卫生安全危机,不但给全球政治经济发展带来前所未有的挑战,也对全球卫生治理机制构成史无前例的压力测试.作为全球卫生治理最重要的多边机制,世界卫生组织积极致力于新冠肺炎疫情防控,成为全球卫生安全命运共同体理念的“推动者”、全球抗疫合作的“协调者”、全球抗疫薄弱环节的“补位者”以及全球抗疫规范和技术的“提供者”.实际上,世界卫生组织一直通过机构改革来适应不断变化的全球卫生安全形势,优化和提升其全球卫生治理功能.特别是在谭德塞担任总干事后,世界卫生组织发起了该组织“历史上最广泛的改革”,将项目规划、应急能力建设、对外关系和治理以及组织规范与标准作为其改革的四大支柱,使其全球卫生治理功能得到显著提升.然而,新冠肺炎疫情防控同样也暴露了世界卫生组织全球卫生治理功能的不足和局限.国际社会唯有诉诸通力合作、彰显责任担当,共同为以世界卫生组织为主体的全球卫生治理机制运作创造更有利的国际政治环境,新冠肺炎疫情方能尽快平息,全球卫生治理才能真正进入健康的运行轨道.

作为全球公共卫生治理领域的重要行为体,联合国在实践中遵循了基于人权、发展和安全的全球公共卫生治理理念.通过构建自身人权议程框架中的卫生话语和议题,联合国基于人权的公共卫生治理理念成为全球公共卫生治理的价值引领;通过在全球发展战略或倡议中设定健康改进目标,联合国明确了基于社会经济发展的全球公共卫生治理的发展理念;通过在全球公共卫生治理危机中采用安全话语或安全考量,联合国全球公共卫生治理的安全理念提升了公共卫生问题在全球政治议程中的能见度.毋庸置疑,联合国上述全球公共卫生治理理念相辅相成,共同促进了新冠疫情防控,但同时也暴露出其存在的原则制定不明晰、卫生问题"政治化"等诸多问题,对联合国全球公共卫生治理的成效和公平性产生了负面影响.