China and the shifting nature of global health governance

4 March 2026

Global health governance — the system of formal and informal institutions, norms, and behavioural expectations that address cross-border health concerns — faces an existential dilemma. Before 2020, it was widely regarded as firmly entrenched within the liberal international order, with globalisation heightening governments’ awareness of the vital need to cooperate in addressing the world’s pressing health challenges. Today, the global health landscape has changed profoundly. From the ongoing effects of the COVID-19 pandemic to US withdrawal from the World Health Organisation (WHO), global health is in a period of uncertainty. While the institutions and expectations that have governed global health are falling by the wayside, diseases continue to circulate, and cooperation remains necessary to stop their spread and to provide access to the care and medicines necessary for healthy lives. Who or what can fill this void?

One logical place to look is the Chinese government. With the world’s second-largest economy and a growing diplomatic presence, China under Xi Jinping has become far more active in international relations. What’s more, health has long played a role in China’s foreign policy, from its health diplomacy efforts in Africa beginning in the 1960s to, more recently, its Health Silk Road initiative.

If the existing liberal international order is indeed undergoing a profound and transformative shift, and not just a reaction to Trump’s foreign policy, then there is an opportunity for change that will better serve people all over the world — or a chance for humanity to fall further from its collective aspirations.

China may indeed end up becoming a more prominent — if not the prominent — player in global health, but this would require a wholesale transformation of the existing global health governance system. Indeed, if Beijing seeks to play a larger role in global health, it will likely be through a greater emphasis on bilateral, rather than multilateral, outreach. China will not simply fill the gap left by US withdrawal from the WHO and its slashing of development assistance for health; its greater prominence in global health could alter the system itself.

Focusing on bilateral relationships

Amid the chaos within the existing international order, Beijing has positioned itself as a rock of calm, highlighting its respect for non-interference, sovereignty, and economic stability. In doing so, it seeks to shape the international order without looking like an expansionist power, projecting a form of leadership that will necessarily look different from the existing international system. Chinese foreign policy has often stressed Western imperialism and its own experiences of international humiliation to justify a model of international relations that prioritises sovereignty and non-interference. This approach has long shaped China’s approach toward global health.

Chinese health diplomacy has historically been rooted in bilateralism. Beginning in the 1960s, the Chinese government established relationships between specific provinces and individual African governments to provide medical personnel and infrastructure. Rather than pursuing these relationships through the WHO or other international forums, China presented itself as more attuned to the needs of African states, drawing on its own successful experience of implementing economic and political strategies that opposed imperialism.

More recently, much of China’s global health work has been channelled through its Health Silk Road (HSR) initiative. HSR, announced in 2016, complements the broader Belt and Road Initiative by fostering bilateral relations between China and the recipient state to focus on infectious disease prevention, health workforce development, and health technology innovation. During the COVID-19 pandemic, HSR provided the avenue for China to donate vaccines, establish centres for traditional Chinese medicine in 30 countries, and facilitate the importation of Chinese medicines. It also allowed China to provide a positive contrast with slow or ill-devised strategies by the US, Europe, and the WHO.

None of this is to say that China has no interest in existing international institutions or that it rejects multilateralism. Indeed, during his year-end speech this past December, Chinese Foreign Minister Wang Yi stressed the country’s leading role in the United Nations and the need to make the international order more just and fair. He also highlighted “China moments” in global governance reform and the creation of its own forums and relationships for fostering “peaceful development”.

At the same time, there exist frustrations with China’s previous global health governance efforts for being too opaque and for prioritising commercial relationships over effective treatments. WHO officials expressed serious concerns about Beijing’s unwillingness to share epidemiological data — the backbone of WHO’s early warning system for disease outbreaks — for weeks in the early days of the COVID-19 pandemic. A study by the RAND Corporation also noted criticisms from Kenya and Sierra Leonean officials that China’s global health efforts failed to account for local needs and did not provide resources to support the technologies that it sent.

Not just filling the gap

There is a certain irony inherent in the questions about whether China can fill the gap left by the US in departing from the WHO. In both 2019 and 2025, when US President Trump declared his intentions to withdraw the US from the organisation, he specifically claimed that it was too beholden to the interests of the Chinese government and worked against American interests. By leaving the WHO, though, Trump created a space where China could assume a greater role within the organisation — if it so desired.

Prior to the beginning of Trump’s second term, the US was the largest donor of development assistance for health. Roughly one-third of all development assistance for health funds came from the US, with the European Union and the UK contributing another 22 per cent and private philanthropy giving 17 per cent. China’s contribution of USD 184 million to the WHO constituted 3 per cent of the organisation’s overall budget.

China has stepped up financially in the wake of the US’ withdrawal — but not at levels sufficient to replace American funding. This past May, China pledged an additional USD 500 million to the WHO above and beyond its required membership dues — a large increase in its contributions, but one that pales in comparison to the loss of the average of USD 460 million in assessed and voluntary contributions the US paid to the organisation over the past ten years. What’s more, major donors like the UK and EU member-states are also decreasing their aid budgets, making the funding gap in the WHO — and global health governance writ large — all the more challenging.

China’s additional funding will be helpful, but the additional funds are strictly on a voluntary basis. The government has pushed back strenuously against the idea of increasing membership dues for WHO member states in the wake of the US’ departure. Furthermore, even with increased voluntary contributions from China and some other countries, as well as funds from philanthropies and foundations, it is simply not possible to fill the financial gaps. That means that global health governance will necessarily have to change.

Opportunity for innovation?

The existing global health governance system has been far from perfect, particularly at crucial moments when the international system has needed it most. The current challenges to the system could open up spaces for creativity and building new relationships that could prioritise peoples’ health. If existing global health governance organisations like the WHO are faulted for being too inefficient and having outdated structures, then it is possible that a greater emphasis on bilateral relationships could be more responsive to health needs because of a smaller organisational structure and stronger connections between donors and recipients. Afriyie et al. have also argued that China’s approach to health diplomacy embraces a decolonial orientation by prioritising shared power and sovereignty over donor-driven needs and financial dependency. They maintain that Chinese health diplomacy places greater emphasis on including local expertise, embracing complementary therapies, and building local capacity — and that the crises within the existing global health governance system opens up a space for the Chinese approach to take greater prominence.

If the existing liberal international order is indeed undergoing a profound and transformative shift, and not just a reaction to Trump’s foreign policy, then there is an opportunity for change that will better serve people all over the world — or a chance for humanity to fall further from its collective aspirations. China’s economic and political clout means that all eyes will be on its approach to global health to understand which direction things will go.

DISCLAIMER: All views expressed are those of the writer and do not necessarily represent those of the 9DASHLINE.com platform.

Author biography

Jeremy Youde is Dean of the College of Urban and Public Affairs at Portland State University (US) and an expert on global health politics. His research focuses on global health governance, international responses to infectious disease outbreaks, and the role of philanthropy in global health. Image credit: Unsplash/Xiangkun ZHU.