The study is aimed at analyzing the content and main directions of the formation of the transit health economy on the example of the Chinese Belt and Road Initiative (B&R) and its most important component – the Silk Road of Health (SRH), as well as the measures of the Chinese authorities to combat the spread of the COVID-19 coronavirus pandemic. Goal. To identify and analyze the internal contradictions of the B&R Initiative, which the pandemic has clearly shown, to develop proposals for the mutual linking of the various directions of the Chinese project in relation to the development of the transit economy in Russia. Tasks. Description of the content and main directions of the SRH; analysis of measures to combat the spread of the pandemic carried out by the authorities of the People's Republic of China (PRC), its provinces, as well as Russia, other states involved in the B&R project, in the context of modes of transport and the transport and communication system as a whole in the form of restrictions on export-import and transit cargo and passenger flows, difficulties in crossing borders, ship calls at seaports and crew changes; analysis of the impact of the pandemic and measures to combat it on the development of the transit economy. Methodology. The research uses the methods of world system analysis, evolutionary and institutional theory, economic and mathematical modeling, expert and analytical assessments. Results. It is shown that the pandemic has revealed the relevance and importance of the formation and development of the transit economy of health as a key direction of the post-crisis recovery of the world economy and the Russian national economic system. It was determined that the reorientation of cargo flows to rail transport was particularly evident in the field of transportation, which before the pandemic was carried out by air, i.e., in the segment of expensive goods, for which it is important to reduce the delivery time. It is indicated that an important anti-epidemic measure is the growth and passage of containerized cargo. It was emphasized that the high degree of uncertainty with sanitary standards in China creates nervousness in the market of export and transit cargo transportation. The main directions of the formation of SRH in Russia are outlined. Conclusions. The pandemic has increased awareness of the critical importance of digital connectivity to enhance the adaptive capacity of the global community and the global economy to meet today's challenges. Of all the components of the B&R, the anti-pandemic areas of the Initiative, namely, the SRH, the Digital Silk Road (DSR) and the Green Silk Road (GSR), should have priority. Russia should actively promote its own initiatives and projects for the development of the transit economy of health.