From charity to connectivity: China remaking global public health

The United States’ official departure from the World Health Organization in January 2026 creates a profound vacuum in global health governance. While news cycles focus on the immediate financial crisis—a US$260 million funding gap and management teams cut in half—the deeper shift is structural.

As Washington retreats, Beijing is not merely filling a seat; it is rewriting the operating system of global health aid. We are witnessing the end of the “donor-recipient” era and the rise of the “infrastructure-investment” model, a transition that carries both stabilizing promise and fragmented peril.

For decades, the Western model of global health—typified by the US and EU—operated on a charity-based framework: wealthy nations donated funds to multilateral bodies or NGOs to deliver services, including vaccines, bed nets and antiretrovirals, to the Global South. It was a model of “delivery.”

China’s approach, accelerated under its Health Silk Road strategy, is fundamentally different. It is a model of “development.” As highlighted by recent agreements to build insulin production facilities in Nigeria and antimalarial factories across West Africa, Beijing prioritizes hard infrastructure over soft aid. Instead of just shipping insulin, Chinese firms build the factory to make it.

This shift appeals to developing nations weary of the paternalism often inherent in Western aid conditions. The Chinese model, framed as “South-South cooperation” and “brotherhood,” emphasizes sovereignty and self-reliance through commercial partnership rather than donor dependency.

By treating health security as an industrial capacity issue rather than a humanitarian one, China offers a value proposition the West has largely neglected: the ability to manufacture one’s own cure.

“Stabilizer” myth and reality

The narrative that China is the new “stabilizer” of global health is partially true but functionally complex. China’s consistent payment of assessed contributions—ranking second only to the now-absent US—and its $500 million pledge at the World Health Assembly in May 2025 demonstrate a commitment to keeping the lights on at the WHO.

However, “stabilization” implies maintaining the status quo, which China is not doing. It is evolving the system to suit its state-centric view of governance. While the US exit triggers chaos—forcing the WHO to cut budgets and scale back operations—China’s “stabilization” comes with a distinct flavor of bilateralism.

Reliance on the Health Silk Road means that while the WHO remains the central forum for norms, the actual machinery of health implementation is increasingly bypassing Geneva in favor of direct Beijing-to-capital deals.

This creates a bifurcated system: a cash-strapped multilateral body, the WHO, setting standards, while a robust bilateral engine, China, builds the physical architecture. The risk here is not Chinese dominance but global fragmentation.

If technical standards for digital health, AI diagnostics and vaccine production diverge between Western-aligned and Chinese-aligned systems, the interoperability crucial for pandemic defense could crumble.

Vacuum is ideological, not just financial

The US withdrawal is often framed as a loss of money, but it is actually a forfeiture of ideological competition. The America First retreat leaves the field open for China to define “global public goods” on its own terms.

During the Covid-19 pandemic, China positioned its vaccines as a global public good, supplying over 2.3 billion doses. Now, in the post-pandemic era, it is doing the same with public health infrastructure.

By dispatching expert teams to the Africa CDC and placing medical teams in 77 countries, China is embedding its personnel and protocols into the nervous systems of foreign health ministries.

This is outside the box thinking for a global health power. While Western nations debate aid budgets in parliaments, China leverages its state-owned enterprises and private-sector champions—like those building the Nigerian facilities—to execute health policy as foreign policy.

It is a faster, more tangible form of diplomacy that the slow-moving machinery of Western multilateralism struggles to match.

A new pragmatism

The world cannot afford to wait for the US to change its mind. The withdrawal is now a geopolitical reality, forcing global health leaders to adopt a new pragmatism.

The future of global health will likely not be a choice between a Western or Chinese order, but a hybrid mess in which countries adopt Western standards, when available, but rely on Chinese bricks and mortar.

To survive this transition, the global health community must stop viewing China’s rise solely through the lens of suspicion. Yes, the Health Silk Road advances Beijing’s soft power, but a factory in Nigeria producing life-saving drugs is a net positive for global health security, regardless of who financed it.

The challenge for the remaining Western powers is not to disparage these contributions, but to compete with them—not with more charity, but with better investments in local capacity.

Until then, Beijing isn’t just filling a void; it is paving a new road. And in the absence of American traffic, it is the only road open.

Y Tony Yang is an Endowed Professor at the George Washington University in Washington, DC.