Infrastructure facilitates the movement of people, the production and distribution of goods and services, and underpins development. Infrastructure is expensive and long-lasting, and needs long-term policy, planning and management, in terms of design, construction, operation and maintenance. Infrastructure relates particularly to engineering and technology. All technological change brings economic, social, cultural and environmental change, planned and unpredicted. Mega levels of technology bring mega levels of change, effects and impacts. Mega infrastructure such as the Silk Road Economic Belt and 21st Century Maritime Silk Road, the “One Belt, One Road” (OBOR) initiative, announced by President Xi Jinping in 2013, will require equally mega policy, planning and management. This paper will discuss policy, planning and management issues relating to mega infrastructure and the OBOR initiative, with particular reference to energy, communications, transportation, health, emergency preparedness and response, and less predictable areas of change, for example in disease prevention and control, within the overall need for economic, environmental and ecological sustainability. The paper will discuss associated needs for education, training and capacity building in engineering. The paper will also refer to lessons learnt from the original Silk Road in the context of the development of civilizations and intercultural dialogue through the transfer of goods, services, technologies, ideas, knowledge, customs, cultures and philosophies, less predictable and unwanted transfers, for example of disease, and the need for awareness, policy, planning and management of such wider issues.