Partners or Patrons? Indonesia, China, and the Terms of Health Cooperation

The opportunity for Southeast Asian nations to shape the future of global health comes at a time when the global health landscape is undergoing profound change. The withdrawal of the United States from many multilateral agreements and institutions has plunged the world into a polycrisis. Within this ecosystem, China is opportunistically accelerating and rebranding existing engagement. For Indonesia, the more pressing question has long been less about whether to engage with China than how to do so in a way that builds national capacity rather than creating new forms of dependency.

A New Kind of Diplomacy

Indonesia’s deepening engagement with China is characterised by institution-to-institution engagement that runs through university faculties, medical schools, and increasingly, think tanks. For a middle-income country like Indonesia, these engagements offer many strategic upsides, particularly by using the language of “co-development” and signalling a reciprocal approach in their cooperative initiatives. This logic, rooted at the institutional level of think tanks, serves as a promising model for newer, more agile forms of collaboration. However, it should also be approached with measured scepticism.

Compared with other modes of engagement, think tank diplomacy is often viewed as more effective because it is more direct, flexible, and less bureaucratic. The result is a kind of transactional clarity often lacking in country-to-country health cooperation within the region, which has delivered tangible progress where traditional partnerships have slowed.

Underpinning this is China’s entrenched role in global pharmaceutical supply chains, which makes its health diplomacy as much about market consolidation as it is about cooperation. China is simultaneously engaging in comparable pursuits across the Global South, but the emphasis differs by region: in Africa and Latin America, the focus centres on large-scale infrastructure development and resource extraction, while in Southeast Asia—even where infrastructure investment is present—the approach places greater emphasis on high-tech co-development, market expansion for Chinese products, and deeper integration into existing ASEAN frameworks. This reflects both the region’s higher technical capacity and its strategic importance in curating a favourable Chinese image.

Compared with other modes of engagement, think tank diplomacy is often viewed as more effective because it is more direct, flexible, and less bureaucratic. The result is a kind of transactional clarity often lacking in country-to-country health cooperation within the region, which has delivered tangible progress where traditional partnerships have slowed. While there is some hesitancy around the bilateral nature of this cooperation and the extent to which it can reinforce dependencies, non-traditional security-focused partnerships allow for a low-stakes entry point—such as health—for future, more focused collaboration.

Chinese support in building domestic capacity, particularly for APIs and vaccines, is welcomed, but must be managed carefully by diversifying partnerships across multiple actors. Chinese entities are also exploring adjacent fields—traditional medicines, AI applications in health, and even robotics—where Indonesian institutions see market and capacity-building potential. 

It is primarily through the Network of ASEAN-China Think Tanks (NACT)—initiated in 2013 by Chinese Premier Li Keqiang to promote the China–ASEAN strategic partnership and comprising about 10 Southeast Asian think tanks—that China interacts with the Indonesian think tank network. By facilitating workshops, guest lectures, and courses, China intentionally keeps channels for dialogue open. This form of engagement has since expanded beyond the ASEAN forum to country-level think tanks such as the Habibie Centre, the Centre for Chinese Studies, and the Centre for Strategic and International Studies in Indonesia.

The Terms of the Deal

While the Chinese narrative is “we collaborate with you so we can advance together,” this framing obscures a clear awareness of Indonesia’s vulnerabilities, especially its resource and capacity constraints.  Shaped by its experience during the COVID-19 pandemic, Indonesia is acutely aware of the pitfalls of overreliance on any single external partner in a context where global supply chains are increasingly disrupted and used as tools of political leverage. Chinese support in building domestic capacity, particularly for APIs and vaccines, is welcomed, but must be managed carefully by diversifying partnerships across multiple actors. Chinese entities are also exploring adjacent fields—traditional medicines, AI applications in health, and even robotics—where Indonesian institutions see market and capacity-building potential. The approach is often more direct: institution-to-institution, bypassing the cumbersome processes of government bureaucracies and multilateral institutions.

The Chinese also attach fewer conditions to collaboration compared to traditional Western engagements, while simultaneously offering more support for research and development, greater flexibility in technology transfer, and the capacity to negotiate contentious issues. Chinese timelines tend to be shorter, and negotiators are open to tailoring arrangements to Indonesian priorities, in contrast to the weakening of domestic health systems caused by a singular focus on donor-driven priority areas. The opportunity to transition from clinical trial sites to pursue its long-term goal of vaccine sovereignty and local production capacity provides an attractive alternative to traditional Western modes of cooperation.

Harnessing this momentum and by treating every partnership—Chinese, Western, or otherwise—as tools for building self-reliance, rather than substituting for it, Indonesia can transform its domestic ecosystem towards greater health system resilience.

If managed well, this strategic give-and-take cuts both ways: China could potentially expand its health industry footprint, while Indonesia could leverage Chinese terms to secure better arrangements for knowledge sharing and local manufacturing. Paired with deliberate negotiation, these partnerships could accelerate progress in areas like genomic sequencing, lab systems, and health technology industrialisation. However, these transactions are neither risk-free nor unique to Chinese partnerships. Concerns about intellectual property, data governance, and dependency have long characterised health cooperation arrangements across different donors and partners. Similarly, despite room for negotiation, as with any external partnership, partner interests may not perfectly align with Indonesia’s public health goals, and if they do, Indonesia may not be able to fully capitalise on the opportunity, given the technology gaps, lack of domestic industry readiness, and human resource constraints. More so, without clear national guidelines on benefit-sharing, data protection, and technology absorption, even seemingly generous offers can fail to translate into sustainable local gains.

Indonesia’s Opportunity to Negotiate From Strength   

China’s health diplomacy presents Indonesia with the opportunity to take advantage of the overtly transactional nature of these engagements to rapidly progress on common areas of cooperation without compromising its strategic autonomy. Harnessing this momentum and by treating every partnership—Chinese, Western, or otherwise—as a tool for building self-reliance, rather than substituting for it, Indonesia can transform its domestic ecosystem towards greater health system resilience.

Furthermore, with the current polycrisis acting as a catalyst for achieving national health sovereignty, Indonesia can facilitate interdisciplinary learning—between university networks, research flagships, and medical professionals—in a fragmented global health governance landscape. Indonesia can also leverage ASEAN mechanisms such as the ASEAN Health Cluster and ASEAN+3 frameworks to insulate against hegemonic interests, whether Chinese or otherwise, and to embed bilateral engagements within a broader regional architecture. By building stronger mechanisms of bottom-up ownership across government, academia, industry, and civil society, and by anchoring these efforts within ASEAN’s collective frameworks, Indonesia can be less reactive and more proactive in shaping its health partnerships, negotiating from a position of strength, and ensuring that external engagements genuinely serve national interests.