China rewrites global health leadership as US retreats from WHO
Beijing sent its largest-ever delegation to this year's World Health Assembly
Ruby Wang is the founder of LINTRIS Health, a health and life sciences consultancy bridging East and West for public and private sector clients, and founder of the ChinaHealthPulse newsletter.
The 78th World Health Assembly in Geneva this May marked a turning point in global health diplomacy. For the first time since the founding of the World Health Organization, the U.S. was both financially and diplomatically absent. It sent no senior officials and has withdrawn all funding, with little indication of re-engagement.
Meanwhile, China arrived in full force: a greater presence, a louder voice and significantly more funding. If fulfilled, its $500 million pledge now makes it the largest state donor to the WHO, and it brought the largest-ever WHA delegation in history. It also embedded its national interests across key technical tracks, side events and diplomatic meetings.
Most headlines have focused on a simple narrative: that China is stepping into a space left by the U.S. But this framing is misleading. China has never sought to replicate the Western models of public goods and technical neutrality. Its approach favors sovereignty-first bilateral cooperation and institutional leverage, and its engagement in global health has always followed a different logic, folded into trade, infrastructure, diplomacy and power, delivered through a mix of public and private mechanisms.
The WHA is where 194 member states discuss and vote on resolutions, funding decisions and treaty endorsements to set out the direction of global health for years to come. This year, China used the opportunity to articulate specific priorities, amplify preferred narratives and consolidate its position across key technical domains. This is selective multilateralism: cooperation, but only where it pays off.
Alongside a 180-strong delegation spanning senior officials from multiple ministries, state-owned firms and diplomatic staff, and led by Vice Premier Liu Guozhong and Health Minister Lei Haichao, China's $500 million pledge over five years now places it ahead of all other state donors to the WHO. Still, given China's economic size and geopolitical aspirations, the figure may appear modest. And unlike traditional U.S. funding, this mix of increased assessed dues, earmarked project contributions and South-South development funds is tied to specific mechanisms, many of which intersect with China's bilateral financing platforms.
This year, the WHO repeatedly and publicly signaled institutional endorsement for China. This mattered. The relationship between Beijing and the WHO has been uneven in recent years, particularly during the COVID-19 pandemic. Among leaders who highlighted China's contributions in key areas was Director-General Tedros Adhanom Ghebreyesus, who stated, "China has made strong contributions to global public health and to the work of WHO." These leaders endorsed new cooperation agreements and described China's role as central to the organization's future direction. The recognition reinforced China's positioning as a responsible actor, and increasingly, a standard-setter, in global health governance.
A major output of the gathering was the Pandemic Agreement, finally adopted in diluted form after three years of negotiations. The framework aims to strengthen preparedness, surveillance and equitable access. China supported the final text but emphasized national sovereignty, digital security and protections for developing countries. The red lines were clear.
With greater WHO funding and visibility, China also deployed its institutional influence in other areas. After all, it views multilateralism as a strategic tool to entrench its worldview. Taiwan's long-standing bid for WHA observer status was again removed from the agenda during a closed-door committee vote. A Chinese representative stated that "Taiwan's participation in the WHA must be handled in strict accordance with the 'One China' principle," while state media described the outcome as both a legal necessity and a diplomatic success.
A well-recognized function of the annual WHA is that of performance. Countries use side events, technical roundtables and joint forums to showcase systems they believe are globally exportable. China seized this opportunity to promote carefully selected areas of strength, particularly in under-addressed WHO priorities like mental health and rare diseases, where it can demonstrate both policy leadership and implementation capacity.
A roundtable on "Empowering Primary Health Care with Digital Intelligence" brought significant credibility. Digital health is a global topic with bipartisan excitement and minimal geopolitical baggage, and this event showcased China's national digital health infrastructure, from AI-supported diagnosis and smart hospital pathways to integrated digital payment systems. The forum was pitched as a replicable solution for lower- and middle-income countries, complete with policy templates and implementation guidance. Over 200 delegates attended, with more queuing outside: a rare sight at WHA.
This year also featured the first WHA side event dedicated to Traditional Chinese Medicine (TCM). Co-hosted with Asian and African partners, the forum presented TCM clinical research centers, harmonized pharmacopoeia and standardized products for global export. The event marked a notable step forward in repositioning TCM, which has long been a political priority for China, as not just soft power, but as a formally recognized component of global health architecture previously hotly contested by some (particularly Western) member states.
Alongside its public-facing pledges and formal speeches, China also ran bilateral diplomacy in parallel. It met with Brazil, South Africa, Indonesia, Tunisia and Morocco to advance cooperation on research, talent pipelines and disease surveillance. Crucially, these engagements were not positioned within WHO frameworks, but framed under Beijing's own initiatives: the Global Development Initiative, the Global Civilization Initiative and the Health Silk Road.
This year's World Health Assembly offered one of the clearest views yet of how China plans to operationalize its "selective multilateralism" approach to global health. Distinct from ambiguous slow-moving Western models, Beijing is building a development ecosystem where health becomes a channel for trust-building in Chinese vaccines, AI systems and TCM products. It supports sovereignty-first positions across data governance, drug regulation and digital norms. It also promotes bilateral diplomacy that blurs the boundaries between health, development and foreign policy.
Some traditionalists remain uneasy with this shift, but it is not hard to see why many lower- and middle-income countries are turning toward China. Faced with shrinking Western aid and uncertain alliances, Beijing's model offers speed, infrastructure and a high degree of political alignment. WHA78 may not have resolved the major structural divides in global health, but it did show that China is moving decisively, on its own terms.