How is China contributing to shaping the global health agenda?
Themes: the role of the semi-conductor industry in geopolitics; the implications of recent sanctions; supply chain issues in the semi-conductor industry; the outlook of US-China relations.
Published: Sept 2025
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Response 1 of 3
Dr. Catherine Yuk-ping Lo Assistant Professor, University College Maastricht, Maastricht University
Chinese Health Silk Road
The Health Silk Road (HSR) represents a significant Chinese initiative in actively shaping the global health agenda. The HSR, an integral part of the Belt and Road Initiatives (BRI), was officially unveiled during President Xi’s visit to Uzbekistan in 2016. The concept nevertheless can be traced back to the framework document “Vision and Actions on Jointly Building Silk Road Economic Belt and 21st-Century Maritime Silk Road” issued by the then China’s National Health and Family Planning Commission (NHFPC) in March 2015. Subsequent to Xi’s 2016 speech on the HSR, the Beijing Communiqué of the Belt and Road Health Cooperation was issued in 2017, calling for enhanced collaboration between China and BRIrelated countries and the enrichment of bilateral and multilateral partnerships.
At the bilateral level, the initiative delineates nine cooperation measures with BRI countries, including the establishment of the Belt and Road Health Policy Research Network and the Belt and Road Hospital Alliance, aimed at facilitating personnel exchange and providing Chinese foreign aid and assistance to BRI nations. In concrete terms, Beijing dispatched medical teams to offer technical assistance in infectious disease control, drawing upon its past experiences combating SARS and H1N1 influenza. China also allocated financial resources to enhance health-related infrastructures in developing countries, such as aiding the establishment of the Africa Centre for Disease Control and Prevention (Africa CDC). In terms of soft infrastructure, China established the Belt and Road International Medical Education Alliance (BRIMEA) in 2018 to strengthen medical personnel training cooperation along the route. Notably, China has only invested around USD 4 million since the inception of the HSR towards training over 930 professional medical personnel in ASEAN countries.
In addition to bilateral efforts, the HSR aims to fortify collaboration between China and international organisations, namely the World Health Organization (WHO), UNAIDS, and Gavi. A notable multilateral coordination under the HSR is evident between China and the WHO. In January 2017, the two signed a memorandum of understanding on the Belt and Road health co-operation, with the aim being to bolster health outcomes in BRI countries. China utilises various co-operation frameworks under the BRI theme, including the ASEAN-China, Asia-Pacific Economic Cooperation, ChinaCentral and Eastern Europe 16+1, Shanghai Cooperation Organisation, and the ChinaMongolia-Russia Economic Corridor, to foster a network of cooperative relationships.
The HSR gained heightened importance amidst the COVID-19 pandemic, particularly in its role in facilitating equitable vaccine distribution. While some countries pursued vaccine nationalism, China emerged as a leading global vaccine supplier in 2021 by donating or selling its vaccines to numerous nations. Chinese-manufactured vaccines, though potentially less effective than mRNA vaccines, offer advantages in distribution due to not requiring cold storage infrastructure. This accessibility has made Chinese vaccines more appealing to tropical and subtropical low and middle-income
countries facing challenges with storing mRNA vaccines, like those from Pfizer and Moderna that necessitate sub-zero degree facilities. Moreover, Chinese vaccines have filled the gap left by Western vaccinemanufacturing countries, considering the billions of doses needed, and the shorter delivery time of the Chinese vaccines over the Western ones. For instance, in Chile, when its vaccination programme began in late December 2020, only 150,000 of the 10 million Pfizer doses ordered had arrived. China subsequently offered four million Sinovac doses in late January 2021, helping the South American country to reach the fifth highest vaccination rate per capita in the world by March 2021. Besides, China pledged to provide 10 million vaccine doses in February 2021 and donated US$100 million to WHObacked COVAX.
Limitations of the HSR
The contribution of the Chinese HSR is hampered by several factors. One significant constraint is the existing anti-China sentiment in BRI countries embroiled in territorial disputes with China. For instance, in the case of the Philippines and Vietnam, this sentiment was exacerbated during the pandemic by problems concerning China’s vaccine delivery and pricing. In the Philippines, public discontent arose due to the higher price the country had to pay compared to neighbouring countries, alongside allegations of political corruption. Similarly, in Vietnam, China failed to deliver promised vaccine donations (i.e., it delivered only 5.3 out of 10.5 million vaccines). Allegations of China’s lack of transparency in sharing vaccinerelated data and figures further eroded trust in the HSR.
Regarding the geographic allocation of vaccines, reports suggest that China’s selection of recipient countries is influenced not solely by need or reciprocity, but also by political and strategic considerations. This included factors such as a strong geopolitical connection with China and the lack of diplomatic ties with Taiwan. Moreover, many countries who received Chinese vaccines are participants in the BRI, leading to accusations of China using the HSR for self-interested foreign policy goals. Apart from the questionable motives of the HSR, the efficacy of the Chinese-manufactured COVID-19 vaccines were also a point of contention. Chinese inactivated vaccines are deemed less effective according to the WHO efficacy threshold of 50%. For example, the efficacy rate of Sinovac is just above the threshold (50.6%) and Sinopharm is less than 80% (Wuhan unit: 72.5%; Beijing unit: 79.3%), whereas both Moderna and BioNTech Pfizer had an efficacy rate of over 95%. As alternative COVID-19 vaccines, such as Pfizer, became available, BRI countries like the Philippines and Vietnam swiftly opted for these alternatives. The pragmatic choice of the recipient countries limited Chinese efforts in leading the global health agenda through the HSR. Overall, these disparities challenge the HSR, owing to the selection of the recipient countries and the efficacy of Chinese vaccines.
Despite China’s recent increased engagement in global health via the HSR, their contribution and leadership to global health remains constrained by limited global financial contribution. China’s financial contribution to the WHO is small compared to the contributions being made by Western state donors, or those made by philanthropy such as the Bill and Melinda Gates Foundation. Data from the WHO shows that for the 2020- 2021 2-year budget, China has contributed less than 1 percent of the WHO’s total funding, which includes assessed (annually due) and voluntary donations. In fact, most Chinese contributions have been assessed contributions, suggesting China has not gone above and beyond in terms of monetary contributions to the WHO.
HSR as an Instrument of an Alternative Mode of Global Health Governance
To mark the 80th anniversary of the victory in the Second World War (referred to by the Chinese Communist Party as the World Anti-Fascist War) and the founding of the United Nations, Chinese President Xi Jinping introduced the Global Governance Initiative (GGI)—a framework aimed at reforming international cooperation by promoting “China’s wisdom and solutions.” According to Chinese discourse, the Western-led, rulesbased order often reflects Western dominance rather than universally accepted principles. In contrast, the GGI emphasises multilateralism, inclusivity, and international cooperation, advocating for a more just and equitable global order. The HSR can be seen as a key instrument for advancing this alternative vision of global health governance—one that aligns with China’s broader vision for the global governance reform agenda. However, given the limitations of the HSR and persistent challenges associated with China’s role in global health governance, Beijing’s aspiration to become a global health leader within a Chinaled or China-accommodating international order remains a longterm strategic objective.
Acknowledgements
This paper was supported by the REMIT research project, funded by the European Union’s Horizon Europe research and innovation program under grant agreement No 101094228. The author would like to thank Zhanwei Wang and Sofia Tarony Saisi de Chateauneuf for their research assistance.
About the Author
Dr. Catherine Yuk-ping Lo is an Assistant Professor at University College Maastricht, Maastricht University. Her primary research interests encompass the intersection of international relations and global health. In addition to her academic research, Dr. Lo has consulted for the Dutch Ministry of Health, Welfare and Sport and Ministry of Foreign Affairs on Netherlands-China global health cooperation.
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Response 2 of 3
What China Wants in Global Health, What Developing Countries Are Choosing, And Why the West Still Misunderstands Both
The global development landscape is shifting. Western donors are reducing their commitments, while China’s influence in global health is rising. But these shifts are not parallel: they reflect opposing movements, divergent philosophies and different visions for how development should be structured and delivered. In March, Trump initiated an executive order to terminate 83% of global USAID programmes, and soon after, the UK announced plans to shrink Official Development Assistance (ODA) from 0.5% to 0.3% of Gross National Income by 2027, redirecting funds toward defence and border policy. Across Europe, similar patterns are unfolding as internal political pressures crowd out global health as a long-term priority. Private philanthropy, including the Gates Foundation’s recent multi-decade $200 billion pledge, maintains a visible presence, but it cannot replace the institutional legitimacy or the strategic intent behind state-backed aid.
Amid this retreat, attention has turned to China often through the lens of vaccum-filling. The assumption is that Beijing is stepping in to replace the systems once shaped by Western donors. But this framing misses the fundamental shift underway. China is not replicating the legacy model of multilateral aid, which was built upon ideals of universalism, neutrality, and the provision of global public goods. It is building something else: a framework rooted in its own statecraft, political experience and delivery logic. And across Africa, Southeast Asia and Latin America, governments are engaging with this attractive model, by active choice.
This year’s 78th World Health Assembly in Geneva marked a significant turning point. For the first time in WHO history, the United States sent no senior health officials and withheld over $250 million in assessed dues. China, by contrast, arrived in force. It pledged $500 million to the WHO over five years and dispatched a record-setting delegation of over 180 representatives, including seniors from the National Health Commission and Chinese CDC. Its presence was calculated and coordinated, meeting one-on-one with other governments to sign bilateral agreements, and co-hosting sessions on priority areas designed to highlight its domestic achievements and global alignment.
What emerged in Geneva was a working prototype of China’s global health strategy: selective multilateralism paired with bilateral precision. The goal is not institutional take-over, but system-building on its own terms. China is actively redefining a new way of working, driven by delivery, speed and most importantly, strategic alignment with its own interests.
What China Wants
China’s global health and development approach is guided by a worldview shaped through its own domestic reforms, where delivery outcomes matter more than procedural benchmarks, and performance is the basis of legitimacy. These distinctive institutions, tools, and mindsets are steadily reshaping norms across the Global South, altering the future of access, standards and trust. Five strategic pillars define this model:
1. Bilateral control:
China prefers direct, state-to-state implementation. Projects are managed by government agencies like CIDCA and MOFCOM and executed by Chinese enterprises. This structure compresses timelines and reduces third-party friction. It also avoids the procedural bottlenecks of multilateral consensus and gives Beijing the flexibility to pivot rapidly as priorities evolve.
2. Sovereignty over universality:
: Health is treated as a sovereign domain. China resists frameworks that require data sharing, regulatory convergence or institutional subordination. This is why it prefers to support local capacity building on its own terms rather than submit to frameworks that might constrain its influence or exportability.
3. Strategic alignment:
China’s aid is rarely standalone, but instead embedded within broader political and economic strategies, and interwoven with trade agreements, digital infrastructure and foreign policy. Whether through Belt and Road, the Global Development Initiative and other South–South platforms, China’s priority is to anchor long-term cooperation through frameworks that serve its political and commercial interests.
4. Legitimacy through delivery:
In China’s own political system, legitimacy is earned through performance. That logic carries into its global health engagement: judging success based on whether infrastructure is built, diagnostics function and platforms run. Output matters more than process, and visibility more than adherence to multilateral standards.
5. Replicability over scale:
China’s model favours modular design. Rather than scaling through international institutions such as PEPFAR or COVAX, it exports preconfigured units (vaccine factories, digital platforms and community clinics) engineered to be locally operable with minimal adaptation. This ensures technical consistency and long-term strategic positioning that serve its own interests abroad.
China’s model is effective even if it is controversial. Most importantly, it is being received, and in many cases, welcomed, by developing country partners who often find it more negotiable, workable and actually more transparent, than Western templates. After all, governments across the Global South are far from passive participants, and are increasingly clear-eyed about how to balance delivery needs, sovereignty concerns and long-term infrastructure goals that protect their own agendas and serve their populations in the most optimal way.
What the Global South Wants
Policymakers across the Global South are extremely pragmatic. They must be, for they are pressurised by domestic challenges, fiscal constraints and the need for urgent, visible results. While concepts of “lift them out of poverty” may still apply in some regions, many areas have become modern and prosperous in the 21st century.
Yet the binary logic of geopolitical competition often overlooks this reality. Developing governments are far from passive recipients, and actively oppose the hidden costs and stipulations of traditional, oftunsustainable Western aid models. For many countries still grappling with underfunded health systems and workforce shortages, the appeal of China’s approach lies in its clarity, speed, and alignment with presentday needs:
1. Outcomes that address urgency:
Many post-pandemic governments are underfunded, and their stretched health systems are under intense pressure to show progress. They want projects that start quickly, deliver early, and align with electoral or fiscal timelines – and China is stepping up fast to demonstrate capacity to deliver within election cycles and fiscal years. In Zambia, a Chinese cholera vaccine plant was operational within six months of agreement. In Cambodia, digital health pilots moved from concept to deployment in under a year.
2. Political alignment without paternalism:
Chinese partnerships are clearly transactional and framed as cooperative development rather than conditional aid. And that, paradoxically, gives recipient countries (seemingly) more negotiating leverage. This allows for negotiation on more equal terms, and avoids legacy burdens associated with Western funding, such as governance benchmarks or ambiguous expectations.
3. System coherence:
Chinesefunded projects tend to be selfcontained. The same firms build, equip, and operate facilities, often in coordination with Chinese ministries. This reduces fragmentation and allows for vertical integration, with fewer handovers, fewer intermediary consultants, and fewer bureaucratic pauses. This coherence is appealing for governments burned by donor churn or NGO mandates.
4. Relevance to real constraints:
Western models often focus on ideal-state capacity building such as harmonisation, health worker training pipelines, and institutional reform. China’s fit for-purpose model builds for what exists now, designed with real-world constraints in mind: low-bandwidth settings, uneven provider capacity, and inconsistent infrastructure. These functional tools resonate with governments navigating rural-urban gaps and workforce deficits.
Behind these choices lies a deeper logic of identification. It is understandable that many governments see in China a relevant and recent development trajectory that mirrors their own aspirations. China’s rapid expansion, political stability, and state-led coordination resonate more closely than Western models built under very different political and economic conditions. China knows how to scale fast and under pressure to build systems quickly, navigate resource constraints effectively, and blend state coordination with local experimentation. And among China’s most effective tools, is digital health.
China’s Key Offer: Digital Health
Digital health is where China’s proposition becomes most distinct. The infrastructure developed at home is already being exported abroad: end-to-end systems of teleconsultation, AI-supported diagnosis, digital prescription, and cloud-linked insurance. Platforms like AliHealth and WeDoctor already operate at national scale, integrating care delivery with payment systems and public health monitoring.
These tools are now being adapted and deployed across Africa, Latin America and Southeast Asia. In Ethiopia, the China–Africa Digital Health Demonstration Centre connects regional hospitals via shared platforms. In Kenya and Zambia, Huawei-supported e-clinics offer digital triage in rural settings. These deployments bring end-to-end functionality, low marginal cost and rapid deployment.
However, such platform dependency introduces new risks. Data sovereignty may remain with host governments in name, but system architecture and servicing can be controlled externally. Once embedded, platform dependencies shape governance decisions. Over time, developing partners may find that the very infrastructure that improves access also concentrates control.
Strategic Implications and Next Steps
China’s rise in global health is not a derivative of Western retreat. It is the result of deliberate system-building, structured delivery, and sustained offerings of an alternative framework to the status quo. Its delivery-first model speaks directly to governments facing budget shortfalls, political volatility, and health system strain. Yet for all its speed and coordination, China’s approach faces its own limits. Development agencies like CIDCA remain small relative to their Western counterparts. Incountry presence is minimal, and implementation often relies on ad hoc partnerships with SOEs or tech firms. Monitoring frameworks are weak, and institutional legitimacy in multilateral spaces remains thin.
The most significant global health threats (pandemics, drug resistance, cross-border outbreaks) still require shared accountability. China’s current model excels at deployment, but still lacks mechanisms for co-governance and transparency.
While none of this should be interpreted as inevitability, Western actors must not respond to China’s expansion by simply calling for renewed leadership in the abstract sense. If they want to remain relevant, and match China not just in narrative, but in execution, they must invest in strategies that are not only valuesaligned but technically viable, financially committed, and strategically attuned to the realities that Global South governments now face. Execution determines influence in the next phase of global health.
About the Author
Dr. Ruby Wang is a London-based practising physician and the founder of LINTRIS Health, a consultancy bridging global health, life sciences, and innovation across East and West. She writes the ChinaHealthPulse newsletter and serves on the Digital Health Council of the UK Royal Society of Medicine. She previously led as Head of Health for the UK Government in China and as Health Advisor for the United Nations in Beijing during the COVID pandemic across 2020-2022. Her cross-sector experience also includes roles at Alibaba Health, Holmusk, and the British Medical Association. Dr. Wang obtained her MD and MA from the University of Cambridge and University College London, and MMSc from Tsinghua University as a Schwarzman Scholar. She is currently writing a book on the global impacts of China’s biotech and digital health innovation.
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Response 3 of 3
How is China contributing to shaping the global health agenda?
Dr. Fujie Xu Professor of Global Health, Duke Kunshan University
The landscape of global health has been changing in past decades, with recent major developments generating greater space for China to shape the global health agenda. There are many uncertainties as to if and how the Chinese government and China-based non-governmental organisations will respond to the increasing humanitarian and health needs in developing countries. China currently has an underfunded global health infrastructure, and China’s pragmatic philosophy may limit its interest in the charity-based global health system that relies on multilateralism and Development Assistance for Health (DAH). One thing is relatively certain: China is unlikely to fill the global health funding void left by the United States and other high-income countries, and those who expect China to bring billions of new funds annually to help fill the gaps will be disappointed. However, China can play to its strengths and shape the global health agenda with a new approach.
Over the past decades, the Chinese government has shown a strong desire to reinforce its position as the leader of the Global South during health emergencies, including the Ebola outbreak before the COVID-19 pandemic and the recent
earthquake in Myanmar. During these crises, Chinese government-led activities are increasingly responsive to the health needs in developing countries. China also has proven its ability to offer health solutions ranging from well-equipped laboratories and sizeable doses of vaccines to search-and-rescue teams. Suddenly this year, the Global South is facing a worsening polycrisis and demanding more DAH to fund critical health programs such as HIV treatment. China’s political aspirations coupled with technical know-how can be rapidly translated into a major role in shaping the global health agenda at this critical moment, but Chinese global health institutions are not strong enough yet, and more importantly, in principle China may test the conventional values of DAH. The Chinese government has embraced a pragmatic philosophy towards health aid — that help should be given to people in immediate, critical need (like an outbreak or disaster), but not as ongoing support for those who are chronically poor or dependent. This also implies that emergency aid is justified, but long-term reliance isn’t encouraged.
We should be reminded that major gaps remain in China between the health statuses of richer and poorer regions, and among different socioeconomic groups. These gaps exist even for public health investments: in China, multiple childhood vaccines that have been recommended by the World Health Organisation for universal, routine immunisation are Class II vaccines, for which parents must pay for their children to be immunised.
While governmental agencies and private groups often generously pour in goods and money in response to earthquakes and flooding, Chinese charity donations to help the rural poor, for example, are limited despite chronic health inequity. This phenomenon again reflects the Chinese moral perspective that continuous support might create dependency, while timely aid can help someone get back on their feet.
In response to recent developments, China has taken bigger steps to support the WHO. However, China’s interest in supporting large-scale global health programs remains to be seen. According to the data compiled by the Kaiser Family Foundation, the United States was the largest donor government of DAH in 2023, but China was not among the top 10, and China contributed less than other Asian countries like Japan and South Korea. In past years, China’s main aid agency tended to fund the so-called “Small and Beautiful” projects, with funding level capped at a few million USD; in contrast, PEPFAR alone has contributed 100 billion USD to fight HIV/AIDS. The large global health institutions in Geneva, New York, Atlanta and elsewhere have employed thousands of professionals, and generated even more jobs in recipient countries to deliver health aids. But the Chinese Center for Disease Control and Prevention (China CDC) is the only Chinese institution with a clear global health mandate, and it has only a handful of employees stationed overseas so far, mainly to support China CDC’s flagship global health collaboration with the African Union CDC. To date, China’s global health infrastructure is underfunded and still at an early stage. Some Chinese universities have established global health education programs and research centres, but there are no major funding sources for programmatic activities.
Moving forward, the Chinese government may take a measured approach toward a social and development-oriented agenda rather than financing health programs continuously via DAH-type aid. Chinabased non-governmental organisations are also unlikely to step up donations to shape the new era of global health, as the Bill and Melinda Gates Foundation did over 20 years ago. Although the reach and ability of Chinese private foundations are growing, few are focussing on health inequity in China or overseas, and these foundations face additional barriers to do so, like currency control.
Although China is unlikely to bring in large amounts of new funds year after year to fill the global health gap, China can still play a big role in shaping the global health agenda. In the short-term, there are still uncertainties in U.S. funding for global health, and humanitarian assistance is at risk of disruption. Will the Chinese government view the looming global humanitarian crises, should they occur, as health emergencies and be responsive to critical needs? To what degree will the charity-based global health system be fractured, and will China step in to partner with recipient countries to prevent a free fall? Over the longer term, China can play to its strengths and seek to provide affordable health solutions. China has established its status as the world’s pre-eminent manufacturer, from electronics and telecommunication equipment to automobiles. As a result, China is already a key supplier of health consumables like malaria bed nets. Chinese companies who are interested in the overseas market are growing, and their shares of diagnostics, vaccines, and other pharmaceuticals are expected to increase. The weakened support from the Global North would add pressure for developing countries to find low-cost alternatives, and thus, provide more opportunities for China’s private sector and foundations to contribute to global health.
In this uncertain environment, we can start to speculate about how China will shape the global health agenda with “Chinese characteristics”. China’s experiences in its own development journey, including its successes in eliminating malaria and tackling the challenges of pollution, can offer fresh lessons for the Global South. China recently experienced the transition from an aid recipient to a donor in global health, and thus, Chinese global health professionals and decision makers might utilise their dual perspectives as donor and recipient to facilitate building healthy and effective partnerships. However, China’s future role in global health governance, partnership and agenda setting will be contingent on its stronger support to global health institutions and health delivery programs.
About the Author
Dr. Fujie Xu is a Professor of Global Health and the Co-Director of the Global Health graduate program at Duke Kunshan University. Her research interests focus on outbreak detection and health emergency response, and she was a “disease detective” in the global response to epidemics and pandemics, including the SARS outbreak and the H1N1 influenza pandemic. During “peace” time, her research focuses on the introduction of new vaccines, diagnostics and treatments against infectious diseases in the United States, China and other Asian countries. She has published widely on various aspects of infectious diseases, particularly HIV/STD, viral hepatitis infections, and emerging and re-emerging infections. She has extensive experience in health product innovations. Prior to her appointment at DKU in January 2025, she was the Deputy Director for Health Innovation and Partnership at the Gates Foundation’s China Country Office.
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