Over the past month, I’ve moved between a flurry of summits and conferences across London’s digital health circuit. At Apple HQ, engineers demoed new health-tracking sensors; at Google, researchers spoke about plans to integrate AI into community care. At Imperial College and the Francis Crick Institute, panellists debated digital twins, AI-driven drug discovery, augmented-reality surgery and next-generation biomarkers.

These places are arguably the shining pinnacles of Western innovation, where the frontier of medicine meets the optimism of technology. And onstage, the buzz was certainly palpable. Ministers from the Department of Health and NHS England innovation leads mingled with healthtech founders, policy advisers, venture capitalists and clinicians. Conversations spilled over from panels into corridors and drinks, each promising some breakthrough in interoperability, automation or patient engagement.

The same faces kept appearing across events: a small ecosystem of believers convinced that the right algorithm, partnership or pilot could fix what politics cannot. Topics repeated in different accents, and from different angles: how to integrate large language models safely, how to fund data infrastructure, how to avoid clinician burnout. The vision is very much real, but frustration and fatigue persists behind the enthusiasm.

Because looking closer, most of these conversations still circled frustratingly around pilots: controlled environments, small-scale projects, “future” trials. Theword “implementation” is often followed by knowing looks, or else a sigh, and the gap between what’s being imagined and what’s actually happening remains vast. Procurement cycles crawl, and promising pilots struggle to survive contact with real patients, real data and real budgets. One policy analyst joked that Western digital health suffers from a chronic condition called “pilot-itis” – it’s an uncomfortably accurate diagnosis.

The everyday reality of our health systems tells a different story, and everyone in those conference rooms admits it. Anyone who has tried to book an appointment or chase a blood test result in the UK’s National Health Service, knows how far “digital transformation” still feels from daily life.

Despite billions invested, the NHS remains low on digital maturity. Waiting lists now exceed 7.6 million, and booking a GP appointment takes weeks. Even where e-portals exist, they often involve endless form-filling that leads back to a phone call rather than faster care. Over 80% of NHS trusts now have electronic records, but fewer than one in five are considered digitally advanced.

The UK’s gap between ambition and delivery is staggering, and across much of Europe and North America, the pattern repeats. Progress is real but patchy, with portals, apps and pilots layered awkwardly on top of old infrastructure.

There are bright spots. The US’s market-driven, albeit eye-wateringly expensive model, allows health chains like Kaiser Permanente to conduct more than half of outpatient consults virtually. And few European nations have achieved digital health integration: Finland’s geography and dispersed population made telemedicine a necessity, while Estonia rebuilt its post-Soviet institutions as a digital state by design. But nowhere else has governance been operationalised at such scale or speed.

The barrier has not been a lack of innovation at all. Instead, it’s the tangle of privacy debates, regulatory drag, siloed procurement and bureaucracy. Evolution is happening, but far too slowly, and digital layers grafted onto analogue foundations rather than a redesign of the system itself. The result is a structure that leaks efficiency, costing the system billions and patients precious time.

Now imagine something different: a patient scans a QR code on a mobile app, describes their symptoms, books a consult, receives an e-prescription and has medicines delivered within hours. Insurance claims, follow-up care and even preventive monitoring flow through the same online system.

It sounds futuristic - dystopian, even. And in the systems we know, it certainly feels miraculously unattainable. But for readers of this newsletter, it might sound a little familiar: because in China, it already exists.

China’s system is not pilot or prototype, but a whole-system digital revolution that is redefining what healthcare can look like when technology and policy move in the same direction, embedded across national infrastructure, and touching daily life at scale.

I recently launched the ChinaHealthPulse Podcast (subscribe on Spotify or Apple), and in the first episode, I spoke with Professor Tien-Yin Wong, who is working to build China’s first AI hospital - a potentially groundbreaking project that pushes the frontier of digital medicine.

But in today’s post, I want to step back and look at digital ecosystem that made such an idea possible in the first place. At the heart of it all, is the internet hospital.

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What is an “Internet Hospital”?

We all know that tele-health is not new. For decades, countries around the world have experimented with virtual consultations, from phone triage lines in the UK to remote clinics in the US and Nordic e-health platforms linking prescriptions and records nationwide. Yet these models have only changed access at the margins, digitise encounters and not systems.

China’s internet hospitals are something else entirely. Since the 2018 Internet + Healthcare regulation, they have been licensed digital counterparts of physical hospitals, integrated with offline infrastructure and authorised to deliver care online as official medical institutions. This legal shift unlocked thousands of hospital-run platforms, gave technology firms a legitimate market, and laid the foundation for digitally enabled triage and care delivery nationwide.

In 2019, when I was conducting market-entry analysis for an APAC health-tech start-up, I saw this transformation up close. Internet hospitals had only just been licensed the year prior, and I was researching their nascent role in China’s healthcare landscape, assessing whether they were worth taking seriously, and whether genuine partnership opportunities could be found. To outsiders, they looked like curiosities of China’s “wild-west” innovation culture, throwing everything at the wall to

But my interviews told a different story. What sounded like a speculative policy experiment was already becoming systemic redesign. Provincial officials were integrating online consultations into their workflows, and clinicians were trialling reimbursement codes for virtual prescriptions.

Fewer than 300 official internet hospitals existed nationwide in 2019. By 2023, turbo-charged by the COVID-19 pandemic, the number had multiplied tenfold to more than 3,000. Today, virtually every brick-and-mortar hospital in China operates alongside an online twin.

Patients can move fluidly between digital and in-person services: there’s no separate login, no new platform to download. Booking a doctor feels as simple as ordering food delivery or paying a bill. Access runs through the apps already used for daily life, from social-media platforms such as Tencent’s WeChat to the payment ecosystem of Alibaba’s Alipay.

Behind that simplicity sits a deeply coordinated loop. Electronic medical records, insurance claims, logistics and pharmacy data flow through the same digital spine, linking hospitals, technology firms and public insurers. This architecture drives China’s digital momentum, converting interoperability from a technical challenge into a strategic advantage across the entire health sector. For a comprehensive breakdown of the digital health landscape, see my post on AI & Health in China, which details the multi-layered impact of technological integration for patients, clinicians, hospitals, communities and governance.

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How China Built So Quickly

Multiple forces made the speed and scale of Chinas internet hospitals possible: clear regulation, structural demand and cultural alignment.

1. Demand made it necessary
China’s ageing population, chronic-disease burden and vast geographic disparities created a pressure that technology could uniquely relieve. Internet hospitals offered a way to stretch limited specialist capacity across provinces without building new infrastructure. Immediacy for patients, for efficiency for hospitals, and continuous access for government, without unsustainable capital spending.

1. Governance made it possible
China state has a unique ability to coordinate across ministries, insurers, hospitals and technology firms toward a single strategic goal. I’ve written before about how this administrative machinery drives industrial policy and infrastructure planning now manages digital health as a matter of national capability.

This coherence is rare even among advanced economies, and enables China to move from pilot projects to national infrastructure with remarkable pace. It also raised difficult questions about data sovereignty, consent and accountability: who ultimately owns and safeguards the health information of 1.4 billion people, and how it is used? Nevertheless, whether admired or contested, China’s approach shows what can happen when digital transformation is treated not as a project but as a governing principle.

3. Regulation made it certain
The 2018 Internet + Healthcare policy reclassified online services as healthcare. Hospitals could apply for internet-hospital licences, and reimbursement was soon tied to the same insurance funds that cover physical visits. During COVID-19, the National Health Commission went further, mandating that hospitals maintain online channels to ensure continuity of care. What would have required years of lobbying and pilot evaluation elsewhere, was able to became a national standard at astonishing pace.

4. Culture made it acceptable
This is where the contrast with the West runs deepest. UK, US and other health systems prize individual privacy and institutional autonomy, as guardrails against state or corporate overreach, but these values intrinsically fracture data flows and slow integration. Health data sits behind legal firewalls, scattered across institutions that rarely talk to each other. Hospitals, insurers and regulators each run their own systems, and the law is written to keep them that way. Integration feels risky even when everyone agrees it would make care safer and faster.

But China’s social contract has evolved differently. The idea of health as a shared responsibility runs deep from Confucian family ethics to Mao-era communist collectivism, and now into the digital state. Data is viewed less as private property and more as a resource that gains value through coordination. Citizens are accustomed to shared platforms and to trading visibility for convenience. As I explained in my Q&A for The Wire China, the same trust that Chinese people place in WeChat and Alipay to manage their finances extends easily to managing their health. When they scan their face or link their health ID to an app, it’s rarely read as surrendering privacy; it’s proof of belonging to a system that delivers.

Taken together, these layers explain the astonishing pace and scale of China’s internet hospital expansion, and the wider digital health system alongside it. Where Western systems pilot and debate, China builds and iterates. Its internet hospitals are proof of alignment between policy and infrastructure, necessity and design, people and the state.

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Why it matters

China’s internet hospitals mark a profound shift in what it means to build a modern health system. The country has long struggled with uneven access, overstretched tertiary hospitals and a weak primary-care base. Digital integration hasn’t erased these gaps, but it has begun to rewire how the system allocates care, money and attention. Specialists can now reach patients in remote provinces, chronic care can be monitored continuously, and the state can manage data, logistics and insurance through a coordinated network.

By turning digital access into a policy instrument, China has moved faster than almost any other major economy from experiments to infrastructure. The internet hospital has become the default entry point for millions of citizens: an efficient and effective mechanism for triage, reimbursement and data collection all at once. Provinces such as Guangdong and Zhejiang have gone furthest, integrating online consultations into regional insurance and referral systems. Their success has encouraged others to replicate similar models, reinforcing internet hospitals as a permanent feature rather than a passing reform.

China’s approach suggests that when regulation is decisive and citizens are digitally fluent, system-level change can move at engineering speed, where policy, funding and public behaviour move together. It challenges common assumptions ofWestern systems, that digital transformation must proceed through caution, pilots and incrementalism.

This understanding is critical, and it’s why I’ve been delivering analysis on China’s internet hospitals across both policy and industry work for a while now: advising think tanks and government partners on system reform, supporting multinational pharma companies as they navigate China’s new digital access channels, and working with digital health firms to stay competitive within China while adapting its lessons abroad. There is so much opportunity in what China has built: not only in its market potential, but in the practical lessons it offers on how digital infrastructure, policy and patient behaviour can align to create real, scalable change.

For policymakers: it offers a proof of concept: large-scale digital health becomes possible when regulation, incentives and public behaviour are aligned. And for hospitals and clinicians, it transforms workflow and status. Online clinics can count toward performance metrics, follow-up visits are reimbursed on par with in-person care, and rotation between digital and physical wards can blend flexibility with accountability.

For industry and investors: it opens an entirely new commercial logic. Biopharma and medtech firms now have direct digital channels for patient education, recruitment and real-world evidence generation. The anonymised, population-scale data flowing through internet hospitals is already fuelling AI model training and clinical research, and platforms like Ping An and AliHealth have become gatekeepers for richly detailed clinical information flows.

For global health observers: this remote-first, cloud-enabled and platform-integrated internet-hospital architecture appeals because it can leapfrog to deliver immediate capacity. In developing countries, where budgets are thin and geography vast, the logic of remote-first care makes perfect sense. Chinese partnerships are already linking district hospitals to national referral centres through cloud-based triage and deploying mobile apps that handle prescriptions and insurance verification in real time.

Of course, this progress is not without edges and risks. Elderly, rural and migrant populations risk being left behind, as inequalities in access and literacy persist. System outages or underfunded backend infrastructure can expose new fragilities, and enforcement and interoperability remain uneven, as such scale and ambition take time to deliver across vast landscapes. And crucially, China’s treatment of health data as a sovereign asset, while powerful for national resilience, complicates international collaboration and trust. When Chinese platforms host cloud infrastructure or manage health-data flows, sovereignty on paper can become dependency in practice. What begins as digital empowerment can hardwire new forms of reliance.

In the end, China’s internet hospitals show what happens when technology, governance and public behaviour move in sync, even if imperfectly. Demographics created pressure. Governance opened possibility. Regulation gave permission. Culture provided acceptance. China’s rapid scale-up highlights what policy coherence and public alignment can achieve. It exposes how Western systems’ pluralism and caution, while protecting rights, also limit reach. The challenge now is to learn from China’s speed without replicating its control: to build digital health ecosystems that are integrated yet transparent, efficient yet accountable.

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The Context Is Crucial

This idea, that technology succeeds only within the culture and politics that shape it, has been firmly front of mind for me this past week, as I travelled to Budapest for a regional dialogue on governance and innovation.

We met with government and industry leaders, including the heads of Gedeon Richter, Hungary’s largest pharmaceutical company, the national research network HUN-REN and its Artificial Intelligence Coalition, as well as the Minister of Culture and Innovation. Conversations ahead of next April’s national election - including with Balázs Orbán, Political Director and right-hand to Prime Minister Viktor Orbán, as well as senior figures from the opposition - revealed a country sitting intriguingly between East and West, particularly in how it approaches digital transformation.

Hungary makes for a fascinating test case. Even as it upholds European norms on privacy, autonomy and competition, its legacy of communism, central planning and compact population systems has enabled the creation of a health-data infrastructure that is remarkably connected: linking hospitals, pharmacies and research institutions through a national ecosystem. This is a mindset that feels closer to East Asia’s pragmatism than to the privacy-first caution of Northwestern Europe.

The leaders I spoke with described a general public that is comparatively more willing to accept digitisation when it is framed as a collective good. This balance is precisely what defines the global conversation on health technology today. As countries around the world grapple with how to digitise care responsibly, we should note that historical path-dependence matters as much as innovation itself: each system carries its own imprint of politics, culture and people.

These contrasts, and what they reveal about the future of health, are exactly what I explore in my forthcoming book on China’s health innovation and the global impact of its fast-rising biotech and digital-health evolution - stay tuned!

🩺 This is a Vital Signs post: series of essential explainers from China Health Pulse, where I lay out the key structures and systems shaping health in China.

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You may have come across parts of these headlines already, but I wanted to review and piece together the deeper meaning behind what has been unfolding. Among the noise, I’ve selected five significant topics that I believe deserve close attention.

Whether you're an investor, industry leader, academic, clinician or China watcher, each one highlights changes that will most certainly impact your work and research in the months and even years ahead. We’ve already been tracking these dynamic developments for our biopharma and healthtech clients at LINTRIS Health consultancy, building out strategy around portfolios, markets and pipelines. But I wanted to offer a broader view here at China Health Pulse, along with a few reflections I haven’t shared elsewhere. Where relevant, I’ve linked to earlier CHP posts that explore each theme in more detail.

Let’s begin:

1. POLICY: transformative national childcare & preschool subsidies - new social welfare policies that mark a pivot in China's approach to family support and demographic strategy.

2. MARKET STRUCTURE: reimbursement and the new Commercial Insurance Drug List - new pricing dynamics signal China’s active support for its private health sector.

3. INDUSTRY: record-breaking biopharma partnerships - Chinese biotech is hotter than ever, and foreign big Pharma are rushing to buy in and partner.

4. PUBLIC HEALTH: a virus outbreak in Southern China - fear-mongering headlines need myth-busting.

5. GEOPOLITICS: silence on cross-border pharma tariffs - it’s still watch-and-wait mode.

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1. POLICY: A Groundbreaking National Childcare Subsidy, With Free Preschool on the Way

On 28th July, China launched its first-ever universal childcare subsidy (育儿补贴). Starting retroactively from January 1, 2025, families will receive 3,600 RMB (~$500 USD) per child per year until age 3, for those born from January 1, 2022 onward, regardless of region, ethnicity or birth order. Backed by 90 billion RMB (~$12.56 billion USD) in central funds from the Ministry of Finance and overseen by the National Health Commission, over 20 million families are expected to benefit.

The following day, the State Council announced a companion plan to roll out free preschool education starting September 2025. Fees will be waived for children in their final year of public kindergarten (aged 5–6), with equivalent subsidies extended to approved private kindergartens. The central government will cover 50–80% of local costs, depending on regional income levels, with projected household savings of 60  billion RMB annually.

The subsidy will be funded by government budgets and works alongside other levers like tax breaks, housing support, education reform, and paid parental leave. According to NHC Deputy Guo Yanhong, the approach draws on international examples of pro-natalist strategies which have operated long-standing family benefit systems. Indeed, the UK provides child benefits of £1,248 per year for the first child and £826.80 for each additional child, and Germany provides €3,000 per year per child through Kindergeld. By contrast, the US has no permanent universal child allowance since the expiration of the 2021 Child Tax Credit. China’s ~$500 benefit is much smaller in monetary terms, but its national rollout, simplicity and universality mark a major policy inflection point.

Why this matters

These measures represent the most direct, centrally funded parenting support China has introduced since 1949. At the 2025 Two Sessions (see my posts: Part 1 / Part 2), top leaders reinforced the idea of social support as economic stimulus. These family policies are part of that strategic logic.

“Research and formulate support policies to encourage childbirth, improve the fertility support system, and develop inclusive childcare services.” - Li Qiang, Premier, 2025 Government Work Report, 5th March 2025

China’s central government is stepping in more forcefully to address declining birth rates, deepening gender inequalities and the economic drag of a rapidly ageing population, with highly coordinated interventions. The aim is to shift care costs from households to the state, freeing up consumption and anchoring longer-term demand. This signals deeper investment in building a birth-friendly society that can support workforce size, productivity and domestic consumption decades ahead.

What to watch

The modest 3,600 RMB covers only a fraction of real childrearing costs, and local implementation will depend on whether local governments receive and deploy funds effectively. But it reflects a broader change. China is laying the groundwork for a national family policy infrastructure, embedded in long-range demographic strategy.

For stakeholders across consumer health, paediatrics, diagnostics, women’s health and early-life services, this opens up new and exciting opportunities for policy alignment and market access. We can expect public–private collaborations to expand in areas like parenting platforms, maternal mental health, early screening and integrated community care, among others.

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2. MARKET STRUCTURE: New Commercial Drug List Signals China’s Commitment to Private Health Sector

On July 1, China’s National Health Commission and National Healthcare Security Administration (NHSA) jointly unveiled the long-anticipated Commercial Insurance Innovative Drug List (CIIDL), the first national policy specifically enabling commercial insurers to reimburse certain innovative drugs. It’s an important signal that China now sees its private health sector as a strategic pillar, and not just a supplement to public coverage.

The CIIDL will cover “high clinical-value drugs beyond the scope of basic medical insurance”, targeting medicines not included under the National Reimbursement Drug List (NRDL). This is the essential, hard-to enter list of products under public health insurance which is both the bane and the aspiration of biopharma companies – which I will cover in more detail in a future post.

This announcement hasn’t made many major international headlines but the implications are highly significant for pharma, payers as well as China’s long-term access model. Private hospitals, VIP wings and high-end clinics will be able to have formal access to drugs previously unreachable through public insurance.

Why this matters

China’s public insurance is expansive and centralised, covering more than 95% of the population (1.327 billion), via a national pooled medical insurance fund of 3.86 trillion yuan ($539.1 billion by end 2024), as reported by the NHSA, China’s health insurance bureau, with 3,159 NRDL-listed medicines as of 2025. The NRDL remains the key gateway for market access, coverage and scale, but it imposes heavy price cuts, long delays and strict inclusion criteria, as it is designed for high-burden diseases, not low-prevalence innovation, making it unviable for many high-cost or early-stage therapies.

The new CIIDL may offer an alternative and enticing pathway: speed, flexibility and pricing discretion for drugs unsuited to NRDL negotiation. Importantly, CIIDL-listed drugs can bypass certain public insurance constraints, such as cost-sharing caps, volume-based procurement substitution and DRG spending limits, which commonly restrict early market access.

This is particularly relevant for innovative drug pipelines like cell therapies, rare disease treatments and next-gen oncology products that need clinical traction and commercial visibility before price negotiation, but often face delays or budget blocks under the NRDL. The CIIDL’s emphasis on price confidentiality may also enable multinationals to better manage reference pricing across markets. In addition, the NHSA has flagged upcoming data-sharing infrastructure for hospitals, payers and pharma, which could enable risk-based pricing models that insurers have so far lacked.

What to watch

China’s intent is clear, but it’s still too soon to tell. Market response and infrastructure development in the next months and years will be very interesting to follow. The real impact will depend on whether the insurance ecosystem matures fast enough to meet the policy ambition.

Currently, commercial health insurance still accounts for approximately just 4.2% of total health expenditure (even though this is already a four-fold increase within a decade). Most commercial insurers remain loss-making in health plans, so without better pricing tools, regulatory guidance or premium volume, few may willingly take on high-cost CIIDL drugs. In the near term, CIIDL-listed therapies may see coverage limited to top-tier cities, high‑income patients and hospital systems already familiar with commercial billing.

Still, this policy sets precedent. The CIIDL is not meant to replace public access, but to expand access overall. It opens a new frontier for innovative biopharma companies facing NRDL bottlenecks, who want to establish presence in China’s premium-tier market while building clinical and policy data for future reimbursement listing.

The CIIDL formalises a dual-access health system, where public reimbursement provides scale and equity, and private coverage supports innovation and premium-tier therapy access. This blended model may well define the next decade of healthcare system evolution. Success for industry stakeholders will depend on their fluency in both public and private strategies, and on their agility to navigate the shifting incentives, data regimes and reimbursement pathways.

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3. INDUSTRY: Major Cross-Border Biotech Partnerships Reinforce China’s Innovation across Global Pipelines

28^th July saw one of the largest and most significant China–West biopharma partnerships in recent history. UK giant GSK signed a record-breaking deal worth up to $12 billion with one of China’s top biotech, Hengrui Pharma. It includes $500 million in upfront payments, to license global (ex‑China) rights for up to 12 oncology assets.

This is not a one-off. It reflects a shift in global pipelines, from importing innovation into China, to exporting innovation out. In May, Pfizer acquired global rights to China biotech 3SBio’s PD-1/VEGF bispecific candidate SSGJ-707, alongside an equity stake and up to $4.8 billion in milestone payments, to manufacture and commercialise abroad. And earlier in July, AstraZeneca signed a $5.3 billion deal with China’s CSPC Pharma, which includes AI-led co-development of novel assets in oncology and chronic diseases, with $110 million in upfront payment. This followed AZ’s $2.5 billion investment into a new global strategic R&D centre in Beijing. Late last year, Merck also licensed a GLP‑1 candidate from Hansoh Pharma worth up to $1.9 billion.

Why this matters

China is no longer on the periphery of global biotech. It’s now a credible and competitive source of quality assets. Western pharma is shifting from tentative engagement to full-scale partnerships, especially in oncology, immunology and metabolic disease, where Chinese science has demonstrated delivery both speed and scale.

Several structural drivers are powering this shift: faster trial timelines, lower R&D costs, strong government support and increasingly robust early data. After years of scrutiny over IP and quality, Chinese assets are now headlining at global medical meetings, including ASCO, ESMO and AHA, to set benchmarks for first- and best-in-class in emerging modalities.

The pace of innovation is ever-accelerating. Since 2022, Chinese firms have developed 639 first-in-class candidates. This is a 360% increase from 2018–2021, outpacing the US, EU and Japan. Investor sentiment has followed. In the first three months of 2025, 32% of out-licensing biotech deal value occurred in China versus 21% reported in both 2024 and 2023. And the Hang Seng Biotech Index, which tracks the 50 largest biotech, pharmaceutical, and medical device companies listed in Hong Kong, is up 61.8% year-to-date, which is three times the return of the broader Hang Seng Index’s 20.6%.

What to watch

These billion-dollar deals provide strong validation for China’s biotech. The sector has crossed a credibility threshold, and is now being actively built into global drug pipelines. But success depends on execution. Trial protocols, IP transfer and regulatory harmonisation all remain key friction points. Some assets will stall, and others will expose the limits of current cross-border coordination - we will have to wait and see.

Nevertheless, Chinese biotechs are now actively evolving their business models to no longer focus only on the domestic market. They’re now designing trials, collecting real-world data and investing in manufacturing with global out-licensing as a primary objective from the outset. And Western pharma is also continuing to adjust. In-licensing from China, through dedicated China sourcing teams, new BD structures and early engagement mechanisms, is becoming a firm pillar of pipeline strategy.

Geopolitical risk remains the wildcard. So far, regulators in the US and Europe have taken a hands-off approach, as long as IP stays clean and commercial control remains with Western firms. But even if the form of cross-border deals shifts, the fundamentals cost, speed, and scientific quality are simply too attractive to ignore. China’s outbound innovation will certainly continue to be a growing force in global pipelines.

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4. PUBLIC HEALTH: The Chikungunya Virus Outbreak Receiving Hyper Media Attention

China is facing its largest chikungunya outbreak since it first appeared in-country in 2008. Confirmed infections have surged from 478 to 3,000 and now to over 7,000 cases within weeks, as the mosquito-borne tropical virus spread from Foshan in Guangdong province, across to Hong Kong, Macau and Hunan Province. The rapid escalation has pushed the situation onto the international stage to garner significant media attention.

The root cause of China’s outbreak has been attributed by both Chinese authorities and international health experts to climate change: amplified by Guangdong’s second-heaviest monsoon rains on record, which created ideal conditions for Aedes mosquito breeding.

Globally, the virus is non-fatal in most cases, with severe illness and deaths typically occurring in young infants, the elderly or those with pre-existing conditions. Official figures for 2025 report around 90 deaths across 16 countries, out of approximately 240,000 confirmed cases. The WHO recommends protection from mosquito bites through repellant, long-sleeved clothing and nets, and to destroy breeding grounds including stagnant water and debris.

Why this matters

Chikungunya is active globally and has been for decades, with endemic and epidemic spread documented in South America, Africa, Asia and Europe. Brazil alone has reported over 185,000 cases so far this year, and France has recorded 800 cases since 1^st May. The current wave began in early 2025 with outbreaks in the Indian Ocean. The last epidemic in 2004–2005 in the same region affected nearly half a million people .

Media coverage has concentrated more heavily on China, despite Brazil having higher overall case counts, likely due to the outbreak’s suddenness and political visibility. The US CDC has already issued a Level 2 travel alert for China. This reflects not just differences in outbreak patterns, but also post-COVID narrative sensitivities.

China is well aware that infectious disease flare-ups have become proxies for geopolitical tension. This outbreak is being framed internally not only as a public health challenge, but as a performance test of China's crisis management systems. Vice Premier Liu Guozhong personally toured Foshan on August 1, calling for a “decisive victory” and convening emergency coordination on mosquito eradication, strengthened surveillance and even port-of-entry quarantines, which are not routine containment steps, but mirror post-SARS and COVID-era vigilance.

What to Watch

The next days and weeks will reveal whether China can contain this outbreak locally, or if further geographic spread will follow. The current risk lies not in mortality but in scale. There are no approved treatments, but two vaccines exist globally although not widely available for use. China has not yet authorised either, and the current outbreak may accelerate regulatory attention or domestic R&D trial activity.

RT-PCR testing is available and effective within the first 8 days of symptom onset, though rapid testing scale-up remains a bottleneck. Diagnosis is further complicated by symptom overlap with dengue and Zika, both of which are also present in China.

Media interest is high, and China's response is under intense scrutiny. The line between public health control and political optics will be watched closely, particularly given China’s COVID legacy.

More importantly, this flare-up is a climate signal to the world. The Chikungunya virus was once confined to tropical zones, but its seasonal pattern is now shifting. The 2025 surge shows how fragile current preparedness remains, not just in China, but globally. More outbreaks are likely, and cross-border health coordination will need to become more predictive and less reactive, in order to build climate-health resilience.

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5. GEOPOLITICS: Tariffs - a waiting game

I’ve written on pharma tariffs before (Part 1, Part 2), especially as they relate to China. They are now back in the headlines. New duties of 10–50% are live across dozens of countries, with Brazil facing the steepest increases. The US expects to collect $50  billion in tariff revenue, the highest in over a century.

Although China hasn’t yet been subject to tariff changes, including pharma-specific ones, that is set to shift very soon:

• the US–China 90-day tariff truce ends on 12^th August, with no extension confirmed. Meanwhile, pharmaceuticals remain under active review under the Biden-era Section 232 national security probe, with no end date announced.

• On 5th August, Donald Trump told CNBC he would impose a “small” pharmaceutical import tariff first, rising to 150% within 18 months, and reaching 250% thereafter. “Because we want pharmaceuticals made in our country” he said, name-checking China and Ireland as countries where drugs are currently made for the US market.

Why this matters

While no new measures have landed yet, markets are already reacting. European pharma stocks fell to a four-month low, even as the European Commission reiterated its stance that any new global pharma tariffs must remain under a 15% cap it had agreed with the US.

Pharma firms in the US market now face pressure on multiple fronts. Trump’s proposed pharma tariffs are not China-specific, as he has referred to “many foreign nations” as targets of future duties, explicitly naming Ireland, India, and Germany as countries that produce for the US market but lack domestic manufacturing. If enacted, these measures could fragment global production, raise costs, and force a reshoring race that few are currently equipped for.

Multinationals have been actively recalibrating global supply chains over the past months. AstraZeneca recently committed $50 billion to expand US manufacturing and R&D capacity by 2030, after Eli Lilly, Johnson & Johnson and others had announced their commitments earlier in the year.

In contrast, many Chinese biotech companies with global ambitions, have future-proofed from the outset. Dual listings in Asia and the US, diversified manufacturing and multi-regional supply chains mean that they are insulated from geopolitical frictions. Their activities will likely continue to be untouched by tariffs, and their localised pipelines, trials and manufacturing infrastructure continue to stay resilient, even in a climate of heightened sensitivity.

What to watch

The next days and weeks will reveal what’s next for pharma and for China, with real-world consequences for drug supply, trade relations and healthcare affordability. Details on the opening tariff rate and rollout timeline will set the pace for downstream impact on cost structures and investment decisions. Industry groups and international allies (Europe, Australia, Canada, the EU) may lobby or initiate trade responses if pricing policy threatens global public health access.

China’s response has been restrained so far, but countermeasures could be on the cards, to target foreign drugmakers that move against its own exports. Overall, it’s looking to be an increasingly fractured pharma landscape, will affect global drug pricing, innovation partnerships and access to essential medicines for the global population.

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Finally

Each of these developments signals a deeper shift in how China is rebalancing its health system, state–market dynamics, and geopolitical posture. I’ll be tracking these closely in the weeks ahead and sharing updates through the CHP newsletter as they unfold.

Please do share and comment - as always, I look forward to hearing what you all think.

A System Without a Centre

In China’s health system, governance truly matters more than anything else. The shape of policy architecture doesn’t just influence the public system; it defines the rules, boundaries and incentives of the private market too. Even in sectors where the pace of digital innovation or biotech R&D can move quickly towards commercialisation, alignment matters more than data or product, and survival (let alone success) is fully dependent upon reading policy signals and navigating institutional relationships.

Understanding health governance in China is essential. But it’s complex and distinctive.

Governance fragmentation is not unique to China. The US splits power across CMS, FDA, CDC and NIH among others. The UK separates policy from provision, devolves power across four nations, and maintains agencies for licensing, pricing and regulation. The same goes for every country in Europe, and really, around the world.

What is unique to China’s strategic jigsaw, however, is is how flat the hierarchy runs. Reporting lines are diffuse, and power flows not only from the State Council but through Party commissions, local Party secretaries and long-standing institutional momentum.

There’s also deliberate decoupling: where top-down policy drive is combined with bottom-up decentralised execution to produce regional variations in access, outcomes and speed of reform. National agencies set frameworks and launch pilots, but they cannot directly enforce uniform execution. Implementation on the ground depends on local finances, reform incentives and provincial leadership (I’ve written about this before). This means that what happens in clinics and hospitals (and hence, what patients actually experience) varies dramatically across geography.

Understanding who does what and why requires tracing both the architecture and the incentives.

This post provides a starter map, setting out the ecosystem as it stands in 2025: who the major players are, what they’re responsible for, and how they interact. In future Real Diagnosis posts, I’ll go deeper into key ministries to explain their history and trajectory - as well as anecdotes from my time working with them.

Here’s my exclusive and comprehensive stakeholder map of the major bodies governing China’s health:

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My own fascination with AI in healthcare started in the operating theatre.

When I was training in surgery as a resident doctor in the UK’s National Health Service, we were taught the old operating line: See one. Do one. Teach one.

I might have stitched a pork belly once or twice in the lab, but to be honest, that came after I’d already sutured plenty of live patients in theatre. We didn’t practice much on peeling grapes in boxes with keyhole instruments, either. It was straight into real laparoscopic appendicectomies or cholecystectomies, as soon as our seniors gave the nod.

Surgery is an apprenticeship, after all, and there’s truth in the idea that muscle memory builds dexterity and technique. But it cannot be denied that, when so much is at stake, amateur practice on real patients presents questionable odds — even if that has always been the profession’s tradition.

Then the incredible DaVinci surgical robot arrived in our hospital.

It used intelligent robotics to enhance surgeon autonomy, with force feedback systems that let you sense tissue tension with your fingertips, even remotely. We all lined up to try it, and the excitement was palpable among seniors and juniors alike. That machine helped me see clearly: the future of health would be shaped through technology.

Today, I see how AI in health bridges borders to enhance both precision and safety, all around the world: how medical students can practise operations with augmented and virtual reality, getting the reps they need without compromising real patients; how established surgeons outperform their own hands with intelligent robotics, and how experts in New York can remotely operate on patients as far as in India, assisted by real-time AI.

Robotic surgery is just one example of how AI can empower both doctors and patients. Recently, former British PM Tony Blair called for the deployment of “AI doctors” to help fix the NHS, and across London, SF and Boston, every healthtech start-up promises to “revolutionise care” through AI. From my seat on the UK Royal Society of Medicine’s Digital Health Council, I see these promises up close: running national events, curating expert panels and promoting conversations on everything from digital twins to ethical frameworks for remote care.

The innovation is real, and the hype is, too. But after working across both systems, I can say this: China is operating on a different timeline.

Take that same DaVinci robot. Years after I first tried it in the UK, one of my close family members underwent robotic kidney surgery — in China. Its sophisticated functionality allowed part of the kidney to be preserved, instead of having the entire organ removed. Better safety. Better outcomes. Better quality of life. Yet at the time, what was already a widely recognised surgical indication in China, was still used with limitation in UK hospitals.

AI isn’t a future ambition in China. It’s already embedded across every layer of the health system.

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China is Already Leading in AI x Health

AI and health in China go far beyond scale and speed. What truly sets it apart is a combination of bold build-out, early integration and a willingness to apply technology directly to systemic problems, with unusual momentum. And that makes it not only worth watching, but essential to understand.

I’ve been tracking this space for years, writing with academics, visiting hospitals, working in big tech, partnering with regulators, and watching with both curiosity and caution, to see where the sharpest edges of AI are being deployed nationally.

I recently wrote how, during visits to Beijing, Shanghai and Hangzhou last month, I saw it all up close: health in China is now digital by default, because life itself has become digital. Where other countries continue proceed with caution, China already integrates. Where others treat “digital health” as a standalone initiative, China now embeds it directly into the operational core of how care is accessed, delivered, and financed.

AI is now well-integrated within China’s public hospitals, community health platforms, and centralised policy infrastructure, but there are still plenty of rough edges. Some tools overpromise. Outcomes vary by region. Regulatory frameworks remain uneven. But the overall direction of travel is unmistakable: from pilot to practice, powered by national mandates, cross-sector partnerships, and a culture of digital fluency among patients, clinicians and administrators alike. My post on the biggest healthcare myths about China I see, provides wider context about trends vs misconceptions.

In November 2024, China’s National Health Commission co-released the “Smart Hospital National Initiative” a comprehensive outline to fully leverage AI's advantages in the healthcare setting. It set clear policy KPIs and covered 84 specific scenarios including medical service management, primary public health services, health industry development, medical education and research, clinical efficiency and workflow metrics, as well as patient satisfaction.

With such strong policy drive, the attraction is clear for industry. Healthcare in China offers both a vast and urgent market and a policy environment that rewards innovation. With an ageing population and increasing demand for chronic disease management, China’s annual healthcare spending could reach an estimated 205 trillion RMB (28 trillion USD) by 2030.

China has become a kind of live experimental lab for health AI, in ways that few other countries can match. That’s why what happens here matters for anyone, anywhere, working in, funding, regulating, or using healthcare.

Below, I break down the five layers where AI is already changing how China delivers health: patient access, clinical practice, hospital operations, community prevention and system governance (scroll to end for summary table).

In future pieces, I will explore each area in more depth, with examples from frontline hospitals, startups and national pilots. But for now, take this as your guide to the basic landscape: what’s already real, where the gaps are, and why the rest of the world should be paying attention now.

To note, this post focuses on how AI is transforming health with direct relation to care systems and patient impact, and not China’s equally impressive biotech pipelines and science-driven R&D. For that, you can read my piece on China’s biotech sector.

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1. AI Helps Patients Access Care

In China, healthcare is increasingly seamless, digital and embedded in the platforms people already use daily. I’ve described before how you can simply scan a QR code, input your symptoms and receive guidance via text, voice note, video consult, or book yourself into a public clinic — all at your fingertips.

China’s health AI isn’t a separate app or system. It’s built into social super-apps WeChat and Alipay, which are used for everything from messaging to food delivery, payment, and now, access to care. E-pharmacy orders, insurance claims and doctor follow-ups are all able to happen within the same ecosystem.

Adoption is still strongest in tier 1 and 2 cities, where digital literacy is high and the infrastructure mature, particularly among the tens of millions of younger urban populations. AI is so ubiquitous and invisible that it is no longer labeled as AI by the people who use it every day. It simply is the backbone of how care is accessed at scale:

• Symptom checkers integrated into public clinic platforms: Alibaba’s AI Medical Assistant guides users through symptoms and directs them to nearby clinics or online consultations.

• Chatbots triaging millions daily via WeChat and Alipay: Baidu’s Melody aims to triage user queries and offer instant recommendations, embedded into platforms patients already use and more discreetly than physical consultations.

• “Internet hospitals” as digital front doors: Alibaba, Tencent’s WeDoctor and Ping An Good Doctor are some of the big tech players who have partnered with physical infrastructure to create licensed internet hospitals that enable patients to consult doctors, fill prescriptions, and access follow-up care online, removing the need to physically enter a clinic for first contact.

Why It Matters

Connecting health service delivery with e-prescriptions and online reimbursement or payment provide more than convenience. When so many patients now enter care services through AI-enabled platforms, health systems change from the front door outwards. This all loops back, transforming how people interact with care, how data is generated and how services are designed.

Investors: Massive, sticky platforms with high engagement showcase huge scale, real-world engines for harnessing behavioural data

Biopharma: Valuable channels that can access targeted populations for education, retention and digital trial recruitment

Policymakers: Practical models for managing demand and expanding reach: reducing congestion, expanding access and supporting triage, all without need for costly physical infrastructure

Global health & academia: Real-time population data that provides insights into how digital tools can meet large-scale access needs, applicable for both low and middle income settings

⚠ What to Watch

Digital entry points still exclude key populations. Older adults, rural residents and people with low digital literacy all remain underserved. There’s a lack of standardised validation across platforms, even despite approvals and regulatory scrutiny, and as private firms dominate patient interfaces, accountability for triage outcomes and personal data handling will remain fragmented.

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2. AI Helps Doctors to Diagnose and Treat

AI is speeding up China’s clinical workflows, standardising quality and expanding access to expertise. Chinese doctors are adopting AI to assist in both diagnostics and therapeutics, including CT scans, X-rays and MRIs to detect benign nodules and cancerous malignancies.

China’s fast AI health uptake can be attributed to the combination of immense disease burden, chronic shortages of trained specialists, and a digital-native policy environment: real pressure and real appetite for diagnostic augmentation. Local companies can access large labeled datasets to tailor real-world tools specifically to Chinese disease patterns:

• Diagnostic AI: CT, MRI, ultrasound, and pathology tools are widely deployed across major hospitals. Chinese companies like Mindray already have significant global footprint too, including in the US and Europe.

• Therapeutics: In robotic surgery, MicroPort’s SkyWalker system is a Chinese alternative to Da Vinci, used in orthopaedic and laparoscopic procedures.

• Clinical decision support: DeepSeek’s AI is already in use in over 100 hospitals, supporting digital nurse triage, medical record summarisation and diagnostic suggestions, including at Peking Union Hospital to diagnose rare diseases through risk stratification and symptom clustering.

• Virtual hospitals: Tsinghua’s AIR Agent Hospital is a fully AI-staffed virtual care platform, simulating the entire care journey, from intake to prescription, used for research and potential future clinical deployment.

Why It Matters

AI can super-boost clinical judgment, helping junior doctors make faster, safer decisions, and allowing senior clinicians more time to solve disease complexity. It can scale expertise for overstretched health workforces, without scaling personnel.

Investors: A volume-rich, mission-critical use case that’s already proven in China’s biggest institutions.

Biopharma: Earlier detection means earlier intervention, better trial eligibility and more precise patient identification for targeted therapies.

Policymakers: Supports national goals to improve rural diagnostic quality and standardise care across provinces.

Global health & academia: A testbed to study clinical AI implementation at scale, whether in low-resource or high-volume contexts.

⚠ What to Watch

Not all AI tools are created equal. In lower-tier hospitals, local datasets may be sparse or poorly labeled, which undermines model accuracy. Few systems currently offer clinical audit trails or explainability features. This is a real gap, which complicates trust and safety, as well as responsibility, particularly when AI and human assessments may diverge.

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3. AI Helps Hospitals Work Faster

Beyond the patient clinic or doctor’s ward, AI is also reshaping how Chinese hospitals fundamentally function. It can efficiently manage flow, records and decisions, streamlining the behind-the-scenes infrastructure, including for electronic medical records (EMRs), lab results, prescription systems and bed occupancy dashboards, leading to faster triage, safer discharges and smarter staffing:

Ping An Smart Healthcare, AliHealth and Huawei Cloud offer full-stack modular platforms that are integrated into hospital PACS/RIS, EMRs and billing tools. This can include:

• Workflow AI: Automates staff scheduling, inventory replenishment and patient routing for efficiency gains.

• Smart triage: AI systems pre-sort ED patients, flag high-risk cases and optimise bed assignment.

• Real-time dashboards: Used by hospital administrators to monitor bottlenecks, predict discharges and manage clinical KPIs.

Why It Matters

AI can transform through-put, efficiency and patient flow for overstretched public hospitals, as well as optimise service pathways for private health services.

Investors: Recurring SaaS revenue linked to hospital procurement cycles and enterprise-level digitisation.

Biopharma: Better infrastructure provides more reliable real-world data, stronger trial sites and faster recruitment cycles, including valuable feedback loops for monitoring and surveillance.

Policymakers: Eases frontline pressure while meeting performance targets to create more structured, standardised data streams.

Global health & academia: A rare window into what national-scale AI implementation looks like, from initiating procurement to tracking outcomes.

⚠ What to Watch

Hospital-wide systems face practical integration hurdles. Many facilities rely on outdated infrastructure, with fragmented data systems and limited procurement flexibility. Interoperability between platforms remains significantly poor, especially across provinces. This is partly because there are few incentives to share systems, and this will require top-down governance and push. So, while vendor consolidation deepens, the long-term implications for data sovereignty and institutional reliance, are still unfolding.

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4. AI Promotes Community Disease Prevention

Prevention is a crucial part of healthcare, that all systems need to focus more on. Delaying or avoiding disease progression at scale is the crucial piece that enables lower costs, smart resource allocation and better patient outcomes. And across China, AI is reshaping how chronic illness is detected, tracked and managed beyond the hospital: in the community, in homes, and through everyday apps and wearable devices.

The stakes are high, and that’s why the AI push is strong. China is ageing rapidly, with rising rates of hypertension, diabetes and cardiovascular conditions. “Healthy China 2030”, the national policy blueprint, has accelerated investments into digital prevention, and tech companies, insurers and local governments have all stepped in:

• Wearable-linked risk tracking: Like Apple and Oura’s offers, Huawei and Xiaomi offer popular wearables that monitor sleep, heart rate and so on, with AI-assisted alerts and risk scores.

• Digital twins + health scorecards: Ant Group-backed scorecards and Ping An insurer-integrated dashboards simulate patient health states and offer personalised risk reduction prompts.

• AI nudges for chronic care: Ping An and regional public health pilots use automated messages to encourage medication adherence, healthy eating and physical activity, especially for diabetes and hypertension.

• Home-based monitoring tools: In cities like Shanghai and Hangzhou, pilot schemes link home blood pressure monitors to community clinics via AI-assisted data interpretation.

Why It Matters

China is making keen efforts to decentralise its health approach from frontline of care to daily life, in order to reduce its long-term care burdens. Its experiments provide valuable lessons for other countries facing the same challenges, on what to do, and what not to do.

Investors: Opportunity for markets in ageing tech, digital therapeutics and population risk platforms.

Biopharma: Valuable post-market tracking, digital endpoints and better real-world data.

Policymakers: Supports cost containment and chronic disease control without needing more clinics or staff.

Global health & academia: Offers scalable lessons for other LMICs on prevention tech integration.

⚠ What to Watch

There are hotspots of innovation, and certainly some companies are doing very well, but this health space is consumer-led, and therefore implementation is patchy in terms of both quality and reach. Devices, apps and pilots are all siloed, without needing to adhere too strictly to national data standards. Behavioural nudges often lack long-term validation, and few systems are yet integrated into clinical records, which limit accountability and continuity of care. Uptake again skews younger and urban, while rural communities and older adults remain digitally excluded.

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5. AI Powers Health System Governance

Unlike other countries, where governments are often the most resistant to AI adoption, China is already embracing it and eagerly embedding it into national health infrastructure, as both enforcement and optimisation. This is a crucial differentiation that sets China apart from the rest of the world.

From prescription claims to symptom logs, algorithms comb through billions of health transactions, flagging what’s out of line and guiding how public resources are spent. Nearly all drug reimbursements in China flow through the National Healthcare Security Administration (NHSA), and electronic prescriptions are tied to real-name IDs:

• Reimbursement and fraud analytics: The NHSA uses AI tools to scan for unusual billing patterns, over-prescription and fraudulent claims

• Drug procurement and formulary optimisation: AI tools analyse utilisation patterns and pricing to inform centralised bulk-buying strategies and adjust reimbursement categories in real time.

• Outbreak modelling: Provincial CDCs use AI to flag anomalous symptom clusters from outpatient records and pharmacy sales, building early warning systems for infectious disease.

• Rare disease identification and registry building: EMRs are mined for diagnostic clues to uncover rare conditions, aiding earlier detection and inclusion in coverage lists.

Why It Matters

In China, AI is operational in public policy. This creates a uniquely centralised health data environment, where system-level view becomes computationally actionable.

Investors: Signals around pricing, reimbursement and market access are increasingly AI-influenced.

Biopharma: AI can determine which products are funded, flagged or excluded, which impact uptake, pricing, and tender dynamics.

Policymakers: Allows real-time surveillance and enforcement without need to expand staff.

Global health & researchers: Useful case studies in algorithm-led governance at the national health system level.

⚠ What to Watch

Despite national ambitions, including by NHSA and China CDC, execution still may vary at the local level, as AI tools are not uniformly implemented across provinces. On the recipient side, patients still lack transparency or consent around how their data is used - even if their concerns might be culturally different from populations in the West. While AI can flag patterns, human oversight and action at the local level still lag, which create gaps between insight and implementation.

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To wrap up, for now:

China’s health AI progress matters for all of us. The pressures that drive its domestic adoption (ageing populations, chronic diseases, clinician shortages) are shared by most high-income countries. And as I’ve written before, China’s promises of low-cost, high-volume digital augmentation, hold particular relevance for lower-middle-income countries, whose fewer doctors, fewer hospitals and weaker infrastructure, yet enormous care burdens, have become existential crises.

The open question is whether China’s scale and pragmatism towards AI can translate into global trust. Whether tools trained on Chinese data find traction in African or Southeast Asian contexts. Whether governance models adapt or clash, and if they are implemented abroad, whether they carry intrinsic risks and biases of their own. After all, who gets to define “responsible” use when risks and needs differ so dramatically across geographies and contexts?

This is especially important in healthcare. Compared to other sectors, the stakes are uniquely high for ethical governance: medical records are deeply sensitive, and outcomes can mean life or death. At the same time, the potential upsides are also much clearer in health than almost anywhere else. AI can improve safety, reduce harm and expand capacity, especially in overstretched systems. It can step in where workforces are dwindling, and help clinicians make better decisions in less time.

In future posts on this ever-fascinating topic, I’ll dive deeper into how China’s health AI tools are built, bought and regulated, and where I predict things are heading next.

If there’s a specific angle you’d like me to explore, then as always, I’d love to hear from you.

🩺 The Vital Signs series at China Health Pulse provides essential explainers on key contexts and trends shaping health in China today. Today’s post is an essential overview of AI in healthcare.

For more on China’s healthtech landscape, please see part 1 of my deep dive into Alibaba’s health strategy:

And my essential explainer on the 5 biggest myths in China’s healthcare:

I recently returned to London after a fast-paced and energising multi-city trip across Hangzhou, Beijing and Shanghai, where each day was packed to the brim: conferences, meetings, informal debriefs — and many delicious feasts.

I caught up with friends and colleagues across government, multilaterals, academia and industry, but I also made sure to carve out time to visit hospitals and clinics. After all, high-level conversations and glossy stats can only tell you one part of how care is actually delivered. To understand a system, you have to see it move: to test a health app, queue with patients, or ask doctors what’s changed.

I left feeling invigorated, very well fed — and more certain than ever that China’s health transformations speak to a future we all need to better understand and work with, especially in a world of deepening health inequities, shifting data regimes and contested science norms.

These motivations are exactly why I started the CHP newsletter, and they also drive the core of our consulting work at LINTRIS Health: helping clients across care systems, health sectors and far-flung geographies to better understand each other, align policy, navigate markets — and build real health outcomes.

I’ve already published Part 1 of my Alibaba HQ visit in Hangzhou. This trip sparked many more insights, anecdotes and photos, which I look forward to sharing in detail.

Today’s post, however, aims to provide a sentiment check, rather than a comprehensive overview. It is centred around four themes that kept surfacing everywhere I went:

1. Health diplomacy recalibrated

2. Global health confusion

3. Health technology in action

4. China’s real confidence

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1. China’s Health Diplomacy Has Recalibrated

China now sets its own terms for diplomatic health engagement, prioritising domestic policy alignment and parity over traditional Western technical cooperation models.

Two weeks ago in Beijing, I sat in a packed hall at an EU–China Conference marking 50 years of diplomatic ties. Senior Chinese officials laid out China’s global strategy on health, climate and development. What stood out wasn’t what they said, but what they didn’t: little reference to Western frameworks, and far more emphasis on China-led priorities.

That moment crystallised a pattern I’d been sensing all trip. China’s global engagement, especially in health, has entered a new phase. Health diplomacy is no longer framed around how the West can provide guidance, but around who China wants to selectively engage with, and how.

I saw this even more clearly at a closed-door briefing for the 2025 UK–China Ministerial Health Dialogue at the Ambassador’s residence, where I joined discussions alongside former colleagues from my time leading the UK Foreign Office’s health team in Beijing. The bilateral tone has shifted. While China now expects strategic alignment, it’s less clear whether it offers the same in return — particularly when it comes to mutual transparency or co-governance of global health standards.

This shift has taken time. When I took on that role in 2020, our embassy teams worked closely with Chinese health counterparts across national and local ministries. Our health programmes focused on sharing UK technical expertise — from policy design and clinical training to health insurance modelling and regulatory standards — while our trade teams promoted UK life sciences and healthtech innovation that mostly targeted inbound market access.

Then came the COVID. Health, a global public good, was swept into the turbulence of geopolitics. Mask, ventilator and vaccine diplomacy burdened the previously neutral domain of public health with strategic competition. Round-robin “origins of the virus” debates further accelerated sensitivities. The collaborative spirit that once bonded patients and populations across borders gave way to risk narratives in the name of defence and national security.

Meanwhile, institutional shifts in the West added further pressure. The UK merged its Department for International Development into the Foreign Office, cutting Official Development Assistance (ODA) to significantly narrow the scope for technical engagement. In Beijing, our £20 million UK-China Prosperity Fund health programme evaporated overnight. These painful cuts echoed patterns already underway. The US had been drawing back its NIH and CDC began scaling down China work under Trump, long before the pandemic.

And yet, even through the turbulence, I saw clearly how Chinese counterparts continued to value technical collaboration with the West, especially in areas like health economics, regulatory systems and clinical trials, where longstanding expertise was still respected and sought after. Nevertheless, bilateral collaborations had now become increasingly governed by a different logic: to serve relevance alongside China’s own standards.

These diplomatic shifts have led to commercial consequences too. In the past, regulatory approval depended on harmonisation with international standards. Today, alignment with national policy goals, including Healthy China 2030 and the 14th Five-Year Plan, increasingly determines review timelines and market access. China’s regulator, the National Medical Products Administration, has expanded fast-track reviews, but these are often skewed toward homegrown innovation. Foreign manufacturers continue to face uphill battles in data localisation compliance, pharmacoeconomic dossier submission, and real-world evidence requirements for reimbursement.

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2. The Global Health System Doesn’t Know What To Do With China

Multilateral institutions lack frameworks to engage China’s dual role as funder and geopolitical competitor, creating a widening disconnect in global health collaboration.

During my trip, I caught up with colleagues who have long worked in China’s global health ecosystem. While it was lovely to return to my old team at the UN Resident Coordinator’s Office, where I’d delivered projects as a Health Advisor, and to visit friends at WHO, Gates, MSF and Ford, as well as academics and researchers at Tsinghua University and Schwarzman College. Their moods were cautious, and the more candidly we talked, the bleaker the conversations became.

Over jasmine tea in a hutong cafe, one friend despaired: “It’s hard to get anything approved that sends money directly here. This country no longer fits into global health frameworks. China makes people nervous.”

That sentiment came up again and again. China’s domestic epidemiological profile and tech capacity no longer align with traditional LMIC categories used in GBD or SDG frameworks, but its middle-income status still masks real health disparities. It is now too advanced for traditional aid, and too complex to fund easily.

China’s hybrid role as aid recipient, donor, manufacturer and geopolitical peer makes it a category-breaker in global health. This ambiguity creates risk for institutions designed around linear flows of capital or capacity-building. Policy analysts and multilateral strategists alike are struggling to adapt engagement protocols to this new configuration.

The Gates Foundation recently announced a $200 billion endowment — one of the largest in global health history. But almost none of it will go toward China. Friends at Gates described the uphill battle of justifying China-facing projects, even long-established collaborations with strong evidence of health outcomes. This tension isn’t new. I had seen it at FCDO, too, when our teams were forced to shrink down and pivot projects mid-stream just to keep them alive. Now, most institutions try to position their China engagements as external: “working with China to support others.” What remains internally is academic — technical exchanges, university partnerships and soft diplomacy workshops.

But just as other multi-laterals scale down, China’s global health visibility is ever-growing. At this year’s World Health Assembly in Geneva, it pledged $500 million to WHO over five years. Whether this is due to increased member fees or otherwise), it make China the world’s largest state donor since the US pullback. Its delegation ran side events on traditional medicine, digital health and South–South cooperation. It shared policy templates and bilateral offers with ASEAN and African Union health leaders. China is also making moves in health through global economic governance: Asia Infrastructure Investment Bank, its multilateral lender, recently committed $1 billion to GAVI, the global vaccine alliance.

As I wrote in a previous post, China is positioning itself as a health partner of choice for the Global South, offering speed, infrastructure and execution. But its model bypasses rights-based frameworks and consensus norms, raising valid concerns: opaque deals, weak civil society input and limited accountability remain consistent blind spots.

The global health ecosystem must work harder to engage China, otherwise it will misread both risk and opportunity. Streamlining bureaucracy, as the UN is now doing, is one step. Dual-track engagement strategies are another: one for conventional aid modalities, and one for peer-level partnerships like China. In addition, the private sector will play an increasingly prominent role — not only in funding where capital is lacking, but in driving actionable engagement and forging sustainable collaborations.

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3. Digital is Now China’s Default Mode of Care

China has scaled digital-first healthcare delivery nationwide, integrating front-end services and back-end governance at a depth and pace unmatched globally.

In China’s urban cities, health is now digital by default, because life itself has become digital. At the airport, smart booths scanned my face to tell me what gate my flight would depart from, and mapped how to get there fastest without being asked. In the corner store, the machine automatically detected my items in seconds without needing the barcodes, and then also scanned my face to take my money through mobile WeChat pay, before I even had chance to blink.

I’ve written before that China contains multitudes, and its rural-urban, east-west and tiered city differences are very real. But the peak of where it innovates remains a sight to behold. Privacy concerns aside, the depth of integration is remarkable, and nowhere is this clearer than in China’s digital-first health delivery.

I’ll deep dive into the idea of internet hospitals in a future post, but the core principle is simple: all services along the clinical pathway— from consultation to diagnosis to prescription and reimbursement — are transitioned frictionlessly from offline to online. And this is not limited to elite urban hospitals. During this trip, I visited not only public and private tertiary facilities, but also local community clinics and township health centres. Every single one had some form of digital cloud service integrated with patient access.

Community care has improved too. In Beijing’s Ritan Park, once part of my daily commute, I paused at a new outdoor gym tucked beneath gingko trees. Elderly residents and children activated digitised machines via touchscreens, and their motion, resistance, and stats were logged onto a large monitor we could all check. This was a new part of the city’s public health infrastructure — prevention-first, ambient and completely free of charge.

When I met with the deputy director of the Beijing Municipal Health Commission, he proudly told me how the China’s digitisation efforts have transformed not just front-end care, but back-end governance across the country. The National Healthcare Security Administration (NHSA), for instance, now tracks the prescription and dispensing of every medicine box nationwide: who prescribed it, who received it and how that all compares to national trends.

Piloted only since April last year, these “drug traceability codes” had already reached 95% coverage by this January. This incredible data backbone now underpins large-scale population health analytics, pharmacovigilance and fraud detection across China: the sort of real-world evidence ecosystem that most other nations can still only dream about.

This whole-scale digital mindset was echoed at the JPMorgan Investment Summit in Shanghai. Panels brimmed with shiny examples of AI-powered diagnostics and smart precision medicine. As Unitree’s robot dog cartwheeled onstage, and MagicLab’s (rather terrifying) humanoid robot served ice creams in the hallway, executives stressed how China’s regulatory environment now enables clinical deployment of tools that remain stuck in pilot elsewhere. For many wide-eyed attendees, especially those visiting China for the first time, this was a profound reality check.

Of course, digital doesn’t mean seamless. I was turned away from one Shanghai hospital I visited, simply because appointments could only be booked online. Though I stood at the front desk, ready to pay and register, the staff couldn’t override the system. At some restaurants, internet lag made browsing e-menus difficult, but there were no paper alternatives to the digital scroll. At the airport, I even saw one of Unitree’s robot dogs again, lying askew in a tech store. The assistant told me its battery had run out: just another dystopian scene.

In China, convenience is defined less by individual comfort, and more by system-wide optimisation. That’s the cultural, societal and political tradeoff. Macro-efficiency over micro-usability, and seamless aggregation over fragmented choice: patients have to adapt. In the UK or US, even suggesting shared care records triggers privacy uproar. In this country of 1.4 billion, AI is already a daily expectation.

China is now the world’s largest testbed for digital-first delivery, and through full-stack government roll-out. The implications are enormous for health access, data governance and system design. But what barriers will surface? What models will last? No other country has scaled this fast or this wide. Regardless of whether others adopt China’s blueprint (for reasons of feasibility, privacy, or political trust), we should all be watching closely for what comes next.

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4. China’s Confidence Is Now Firm. The Real Opportunity Lies in Translation

China’s innovation ecosystem is now solidly self-assured and increasingly outward-looking, but global impact depends on navigating translation risks, whether regulatory, cultural or systemic.

Confidence was the most palpable shift I noticed this time. I’ve spent my life and career traversing China and the West, but on this trip, the mood was truly new: a mixture of assuredness and ambition that I had not felt before.

Hangzhou, my home city, pulsed with it. DeepSeek and the “six little dragons” rule the narrative here in China’s thriving innovation nucleus. At Alibaba’s campus and across West Lake, tech pride has replaced tech catch-up. And in Shanghai, at the JPM Summit, I gave up trying to tally how often “the DeepSeek moment”, as they called it, was referenced, because every speaker did so. Chinese executives cited it as proof of national capability. Foreign investors benchmarked against it.

One said plainly: “We’re proud to be Chinese. We are no longer low-quality. Now innovative and competitive, we are at least equal, or even ahead.” Rest of the World reporting recently captured this too: DeepSeek’s success is “giving the people coming in the wave behind them more confidence to just be themselves. It’s OK to be Chinese overseas.”

This isn’t just rhetoric. China’s innovation engine is now self-propelling. In healthcare, the pipelines are strong: from AI diagnostics to connected devices and novel therapeutics. Many firms are actively exploring or already landing in global markets. As I’ve written before, biotech is one of the clearest sector examples.

And China’s confidence now extends well beyond tech too. One JPM investor proclaimed boldly onstage: “Chinese people can withstand hardship to help their country thrive, far more than Americans could. That’s why China’s economy will stay strong even if the US doesn’t.” The room may have laughed that day, but this sentiment reflects a solid and growing national resilience. Nevertheless, these narratives gloss over many existing risks: demographic decline, youth unemployment, uneven capital flows and tightening external scrutiny, to name a few.

Indeed, this confidence has persisted even under the current and very significant geopolitical strain. Tariffs, capital controls and talk of decoupling were discussed openly, but the mood remained relatively steady when it came to the China side, with many truly believing China’s system is now robust enough to absorb whatever shocks may come.

On day 1 at JPM, a live poll of the 3,000-strong audience of lead investors and global executives, showed that 53% of attendees planned to increase their investments in China, with only 4% planning to reduce. In contrast, 86% predicted the US dollar would weaken within a year. The contrast in sentiment was hard to ignore.

Of course, confidence doesn’t equal impact, and innovation doesn’t always mean export-ready. There are still many challenges across borders, from IP protection and trial transparency, to GMP standards and clinical validation in diverse populations.

Though tariffs are on pause (see my previous post), the US remains embroiled within the competition narrative, to its own detriment. Potential restrictions on Chinese student visas and growing academic distrust mean fewer researchers, fewer joint programmes, fewer human bridges. This loss cuts both ways. For the West, it’s a missed chance to tap into Chinese breakthroughs. And even for this newly confident China, it means fewer partners who understand how global health systems really work. Finally, for global health overall? It’s a loss of diversity, insight and long-term collaboration.

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Final reflections

I left China feeling energised and certain that I would return soon again: being on the ground is more crucial than ever for working with this vast nation on health.

A few hours after I landed back in London, I headed straight to the London Business School’s 2025 China Business Forum, where I spoke on a panel about China’s health innovation and access. It was invigorating to share what I’d just seen on the ground — from digitised infrastructure to AI-enabled policy platforms — and to contrast it with the UK’s NHS and British biopharma, as described by my brilliant fellow panellists. That hour of collective exercise was incredibly exciting, because we translated across systems in real time together. It represents a microcosm of what’s most urgent now.

The future of global health won’t just be defined by who innovates fastest, even if China is racing ahead with confidence. It will be shaped by who can connect across borders, systems and worldviews.

I’m more motivated than ever to keep building bridges, and to keep my finger on the pulse here at CHP: diagnosing the symptoms and sharing the latest on this evolving landscape.

🩺 The Vital Signs series at China Health Pulse provides essential explainers on key contexts and trends shaping health in China today. Today’s post offers four key takeaways from my trip to China in May 2025.

A week or so ago, I caught up with a friend and China expert at a major UK think tank. London’s spring sunshine beamed down at streets lined with bright new blossom, but it all stood in stark contrast to the the gloom of our conversation. As we traded dreary headlines, we tried to make sense of a world that seems to feel less stable by the day.

Beyond the latest tariff drama, the development landscape has been under significant pressure in recent months. Trump has been pulling back from multilateral institutions since he took office (I have published on the US’s exit from the WHO here), eagerly cutting USAID and actively signalling US retreat from global health cooperation. And unfortunately, the UK has followed suit, slashing ODA (official development assistance) funding in favour of defence spend, which other European countries have since mirrored. In global health circles, it has started to feel like a slow, unstoppable retreat.

But across media headlines, a louder story seems to have taken hold: that China is poised to fill the vacuum—and take over.

This narrative is everywhere, and it might be dramatic clickbait, but it definitely grabs attention with success (even I can never resist a look, despite my better instincts). Unfortunately, this means that it drowns out the more sensible protests and thoughtful analysis from public health experts and system designers who understand what global health actually requires.

That day, as my friend and I discussed the crux of all of this hype, we found ourselves circling back to the same, rather bleak, conclusion: that most of the conversation around China is really just the West talking to itself.

The framing is still stuck on what the West thinks China might think—rather than what China actually thinks, let alone consider what China really wants. Even less time, if any at all, is spent asking what the Global South wants.

Yes, China is indeed expanding its presence in global health, but it’s most definitely not a replacement.

Not because it can’t. Or that it lacks the ambition for it. But really because it doesn’t think about global health, development, or global power, in the way that the West does at all.

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The Myth of the Vacuum

Much of today’s system has been shaped by the cultural and institutional norms of Western donors, It grew out of a period shaped by post–Cold War ideals and a belief in global public goods. But that system is fraying. Global health is becoming more fragmented, less coordinated, and more influenced by regional politics and bilateral trade-offs, and China’s role is becoming increasingly prominent.

China is building a completely different set of institutions, with different tools, a different mindset, and a different sense of the problem it is trying to solve. This does not mean that we should ignore its strategic moves or political motivations in global health. In fact, we must remain clear that Beijing will absolutely seek opportunities to serve its own best interests, first and foremost. China’s expanding health diplomacy is steadily reshaping norms across the Global South, altering the future of access, standards and trust.

Profs Thomas J. Bollyky and Yanzhong Huang wrote in Foreign Affairs recently that, as Western programmes withdraw “abruptly and chaotically from strategic regions”, China’s focus is to use aid strategically (and even exploitatively) to build influence with developing partners. They point out China’s “skepticism of international global health bodies, including its complex relationship with the WHO”.

But we must come to terms with the fact that these values mirror that held by Trump and the US today. So, instead of asking who will replace past ideals, we should be questioning how global health is being reshaped altogether. The Center for Global Development has called this the Kindleberger Trap: a moment when no single power steps forward to provide global public goods, even though the need remains.

I argue that, rather than falling back on defensive alarmism about rivalries, we need clear-eyed analysis of technical engagement—what's actually being built, and what it enables—to make the most of what’s possible now and in the future in global health. That starts from looking closely, with care, at how China sees the world. And it means engaging with a willingness to step outside familiar frameworks and an openness for alternative ways of thinking and doing.

What does China want?

A huge part of the problem in understanding what China wants, as my policy friend and I discussed with each other, is that most China watchers do not spend enough (or any) time in China. I live and work across both China and the West, and I often hear the same second-hand narratives repeated without much interrogation. Without crucial on-the-ground context, it becomes easy, almost inevitable, for even the “experts” to be blinkered from recognising specific misunderstandings. And it’s even harder to notice when the wrong template is being applied altogether.

In global health, the contrasts run deep. Let’s break down the key differences at high level.

The Past “Traditional” Western Model:

Was anchored in multilateral institutions, with programmes held accountable to global norms

Was framed around universal ideals of moral duty and humanitarianism

Was structured as technical aid, often led by NGOs or UN agencies

Was separated (at least in rhetoric) from hard power and broader geopolitical aims

The US, UK, and other major donors have spent decades shaping global health around the logic of public goods. Their approach has focused on fixing weak systems through targeted aid, largely supported by multilateral programmes. But embedded within this model sits a familiar and often-paternalistic hierarchy, which positions donors as architects and recipients as passive beneficiaries.

China’s Alternative Development Logic:

Structured through state-to-state partnerships, mostly bilateral

Linked to broader trade and infrastructure alignment, especially through BRI and the Health Silk Road

Delivered through a mix of public and private channels

Emphasis on sovereignty, mutual benefit and political alignment

In contrast, China’s development partnerships rarely sit in a neutral or purely technical space. They come hand-in-hand with politics - whether hard-won through negotiation, or led by soft power. China’s equivalent of USAID is CIDCA, the China International Development Cooperation Agency. It operates under the State Council, the organ of CCP state power, as a deputy ministerial-level agency, which inevitably binds its work firmly to China’s broader political agenda.

Apart from its political enmeshment, CIDCA is also significantly smaller than its Western counterparts. In 2023, China’s development aid contributions reached only a fraction of the US, which provided 75% all international development assistance for HIV/AIDS (including PEPFAR), 40% for malaria, and >30% for tuberculosis, as well as the largest funder of WHO, GAVI and COVAX.

China’s capacity on the ground in the Global South also remains thin—staffing, funding, and operational depth all vary significantly. Part of this reflects the fact that China is still relatively new to the aid space. But more importantly, it reflects a different conception of influence, responsibility and reputation in global engagement:

But regardless of the strengths and weaknesses of China vs the West, in order to make progress in the Global South, we need to listen far more closely to the countries being courted—on their terms, not ours.

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What does the Global South want?

Media stories about health rivalry seem to imagine the world as a chess game of some sort, with pieces forcing one another into corners, eager to knock the weakest off the board. But people aren’t pawns, and the Global South isn't passively waiting to be led.

Today, governments across the African continent, Latin America and Southeast Asia are all shrewdly assessing what’s on offer. While concepts of “lift them out of poverty” still apply in many developing regions, others have become modern, and prosperous in the 21st Century, and have begun to rally against traditional, unsustainable Western aid models that come with hidden costs and stipulations of their own. And they have every right—to compare, negotiate and define the right health partnerships, in order to protect themselves and serve their populations in the most optimal way. This includes:

Who respects their sovereignty more?

Who can deliver at scale and speed, and without too many strings attached?

Whose models fit the challenges they actually face?

China is already answering. It is offering its own development experience, political philosophy and strategic interests within its Global South engagement. Many of these align closely with the recent and meteoric trajectory of its own development past. China readily brings what it knows well, which is how to scale under pressure—building systems quickly, navigating resource constraints, and effectively blending state coordination with local experimentation.

It makes sense that, in many settings, China’s contributions may very well feel more familiar to developing countries current working through similar challenges. And they very much arrive without the historical baggage that can shadow Western aid, whether colonial, racial, or ideological. Last November, at the 9th FOCAC summit (Forum on China-Africa Cooperation) President Xi Jinping made this clear, with language that placed China’s ties with its African “brothers” at the heart of the bilateral diplomatic agenda.

No country speaks for the rest, but many in the Global South are readily shaking China’s hand: rising up against dependency, speaking up for agency, and welcoming the USAID/Western donor gap not as a vacuum, but as an opportunity for change.

Five Areas Where China’s Approach Fits

In this section, I want to firmly set aside the rivalry narrative. The focus here is technical—because that’s where global health is built, and where it matters most.

My opinions here reflect my own experiences and observations. I eagerly welcome critical discussion from readers, to stay open to perspectives that push the thinking further. But I believe that when we centre the people delivering and receiving care—and measure outcomes by changes in health and actual lives—the noise tends to recede. Biases don’t quite vanish, but they somehow recalibrate. And that’s where better decisions can begin.

Over time, I’ve noticed specific points of alignment between China’s health system approaches and the needs of many countries across the Global South. Some stem from shared development pressures and the experience of building under constraint. Others point toward the future: how technology might reshape access, how public and private sectors can move together, and how traditional practices might be preserved within modern systems.

My goal is to highlight what I think is actually useful and what I believe can technically fit, rather than comparing, judging or chalking up more scores between China and the West. Here are five areas I’ve found especially relevant—each drawn from observation and grounded in delivery:

1. Care Without Clinics: China's Remote-First Health

2. Sovereign Health Data: Building Local Control

3. Integrated Power: Public–Private Health Expansion

4. Reinvented Community Care: China’s Barefoot Doctor Model

5. Respect for Traditional Knowledge: Blending Views of Medicine

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1. Care Without Clinics: China's Remote-First Health

A key area of divergence lies in how healthcare is built and delivered. Traditional Western health aid tends to begin with infrastructure: clinics, hospitals, outreach teams, and in-person service delivery, often led by health workers traveling village to village. China’s approach increasingly bypasses these physical entry points.

By now, China is well known for building infrastructure, extremely quickly and efficiently, in developing nations. Its Belt and Road Initiative has already sunk deep roots across the Global South. Roads, ports, factories, and hospitals now dot much of the African continent and Southeast Asia. But a quieter, and arguably more important, contribution is emerging in its global health footprint: the export of remote-first, digitally enabled care.

In its own rapid health system development over recent decades, China has pushed for remote-first solutions to reach its vast population and uneven geography. Digital platforms like internet hospitals now streamline the full continuum of care—from online consultation, to e-prescriptions and digital pharmacy fulfilment, to remote insurance reimbursement. During the COVID-19 pandemic, these services became essential. Lockdowns disrupted mobility, but demand surged, accelerating growth for platforms such as WeDoctor and Ping An Good Doctor, which delivered care to tens of millions under constrained conditions.

All of this makes sense for the Global South, where thin budgets, health worker shortages and geographical barriers make traditional systems hard to scale:

Internet hospital pilots and partnerships in Southeast Asia and East Africa

Telemedicine hubs deployed in rural districts where health workers remain scarce

AI diagnostic tools integrated into frontline triage in low-capacity health systems

This changes the game, reducing both cost and time while optimising for efficiency. But it also shifts the centre of gravity. Countries adopting these Chinese health tools are also (whether consciously or not) adopting China’s own frameworks for consent, transparency, data privacy and ownership, and absorbing China’s standards and assumptions about governance. These may offer operational efficiency, but they also define the rules around privacy, traceability, and long-term control, and don’t necessarily leave room for countries to shape their own needs.

2. Sovereign Health Data: Building Local Control

Western aid programmes have long championed open data standards, cross-border disease surveillance networks, transnational health security frameworks, designed to support collective resilience and scientific collaboration. These systems depend on transparency, interoperability, and the assumption that sharing sensitive data with multilateral bodies is both necessary and safe. Global South countries are expected to cede data control to Western institutions and multilateral bodies, and many are unwilling and resistant.

China’s approach is different—and in many ways, much more appealing. It recognises data as a national security asset, not a global commons, and sees prioritisation of national control over health information as a core element of public security and governance. China’s Health Silk Road initiatives offer bilateral partnerships to help to build sovereign digital health infrastructure. This promises modern digital health tools, without requiring full alignment with Western data transparency norms or multinational governance: data stays within national borders, rules are set by local governments, and international transparency is optional.

This can be a preferred model for governments wary of external oversight or skeptical of Western data governance norms. It offers digital tools without requiring alignment with global accountability frameworks. It echoes China’s own domestic philosophy, where health data is tightly integrated into broader systems of public security and political control.

But these strengths come with tradeoffs. While China’s approach protects formal sovereignty, it doesn’t guarantee insulation from influence. Bilateral data partnerships carry significant risks—particularly when Chinese companies or platforms manage system architecture, cloud infrastructure or AI diagnostics. Sovereignty may be preserved in principle, but it’s unclear whether it can become outsourced in practice.

There is obvious danger of exploitation by China, but it depends on whether the partner country sees China as a lesser, more worthwhile, or even more trust-worthy risk compared to Western counterparts. China’s offer may come with fewer ideological strings, and may also feel more predictable, or simply more respectful, than Western alternatives shaped by years of conditionality, surveillance anxieties, or postcolonial critique.

China navigates this dynamic with strategic precision. It employs warm language of friendship and brotherhood, drawing on shared values of development, and frames its digital health partnerships around mutual respect and non-interference. At the 2024 FOCAC, China signed an agreement with Ethiopia and UNIDO to establish a China-Africa-UNIDO Digital Health Demonstration Centre. The project aims to strengthen Ethiopia’s digital health infrastructure, including telemedicine services, and is being positioned as a regional model.

All of this is worrying for the West. Not only in terms of shifting power dynamics and influence on the world stage, but also in an increasingly narrow window for shared oversight and global accountability. As digital health becomes more central to care delivery, those risks extend beyond privacy and into the core functioning of public health itself.

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3. Integrating Power: Public–Private Health Expansion

Another major distinction in China’s global health approach lies in its blending of public and state financing with policy tools and private-sector execution, into a collective, coordinated system. Pharmaceutical companies, insurance platforms, logistics firms and hospital chains may all operate alongside state-led agreements. This diverts completely from the traditional Western approach, which has tended to channel health aid through multilateral agencies or NGOs, guided by public-sector oversight and institutional safeguards.

This is also why China’s lacking development funding, from CIDCA, or other, is less significant than it might seem. Yes, in 2023, China’s official bilateral health development assistance (funds that flow directly to recipients rather than through international organization) fell to its lowest level since 2010. But we need to stop calculating statistics with Western blinkers. Public sector and government isn’t the only source, and China’s numbers are very much made up in the private sector.

This blended model has underpinned some of China’s most visible efforts in the Global South. Chinese health companies, including pharmaceutical manufacturers, insurers, logistics providers, platform operators, work directly alongside Chinese government bodies. This leads to models that can move quickly, scale easily and embed long-term presence through trade, infrastructure, and standards.

China’s integrated models prioritises local production, because they reflect its own development logic: health security depends on domestic capacity. It’s no wonder that Global South partners are eager to adopt strategies which do not depend on external procurement and reduces long-term dependency on Western supply chains. Many developing countries were burned by vaccine nationalism during COVID-19, with lasting resentment and distrust of Western talk about ideology and global goods while protecting supplies for their own nations. China’s strategy feels less ideological and more practical: local production enables local control over standards, timelines and distribution. Even if they embed Chinese ideology and governance alongside them. Even if it creates China dependency and locks in Chinese standards across supply chains.

In Zambia in 2024, China's Jijia International Medical Technology Corporation has partnered with the Zambian government to build the country's first cholera vaccine manufacturing facility, aiming to produce three million doses annually. ​Across Africa and Southeast Asia, Chinese firms have co-invested in pharmaceutical plants in Egypt, Senegal, and Morocco; supported vaccine manufacturing hubs in Indonesia and Malaysia; and launched joint ventures to produce diagnostic tools and digital health platforms.

4. Reinvented Community Care: China’s Barefoot Doctor Model

One of the most overlooked features of China's global health strategy comes from its own past.

China’s barefoot doctor programme was launched in the 1960s under Chairman Mao, during a time of widespread poverty and an overwhelmingly rural population. Health professionals were scarce, hospitals were distant, and formal systems could not scale fast enough. The barefoot doctors were designed to fill that gap: offering coverage over perfection. These “peasant-doctors” were young people recruited from farming villages, who trained for three to six months in a mix of Western and Chinese medicine to deliver babies, administer antibiotics, teach hygiene, refer patients, and rely on herbal remedies when modern drugs were scarce.

Within a decade, over 1.5 million barefoot doctors served across the country. China’s ratio of health workers to population jumped from 1:8,000 to 1:760. The iconic programme became internationally emblematic of what decentralised, community-based care could look like. In 1978, the WHO’s Alma-Ata Declaration on Primary Health Care cited China’s approach as a best-practises model for developing countries. Brazil developed its Agente Comunitário de Saúde programme; Iran launched its Behvarz model and Thailand introduced village health volunteers. China had created a precedent: that community trust and local reach could outperform expensive, centralised systems for delivering basic health.

This logic continues to guide China’s health engagement abroad today. The same emphasis on scale, simplicity, and community trust appears in its support for frontline health worker programmes across the Global South:

Training large cadres of local health workers through short, focused programmes

Prioritising prevention and mass outreach over high-cost interventions

Delivering care through local institutions, often supported by digital platforms and public health campaigns

As far back as the 1970s, China sent doctors to Tanzania to train practitioners for rural health capacity-building. More recently, in Cambodia, China has helped strengthen rural health outreach and disease prevention for Children. These efforts often blend simplified technologies such as mobile diagnostic kits, solar-powered refrigeration with soft infrastructure like hygiene education and task-shifting from doctors to community health workers.

Of course, China’s barefoot doctor model was far from flawless. Training quality varied, supervision was inconsistent, and the pressure to improvise without proper equipment could all undermine safetyand limit scope. But the broader lesson remains: when the goal is mass access under constraint, systems built from below can work.

Western countries have not, at least in recent memory, built health systems under the same urgency,. The UK’s NHS stands out for its high-functioning primary care gatekeeping system, and as someone who has worked within it, I remain proud of its many strengths. But the reality is that much of it remains ill-suited to the conditions and priorities of low- and middle-income countries today.

For countries grappling with workforce shortages, rural-urban divides, and post-pandemic gaps in public trust, China’s comfort with scale, improvisation and non-elite delivery channels offers something trulydifferent. While Western models often prioritise formalisation and top-down control, China’s experience shows how improvisation and mass mobilisation—flawed as they may be—can deliver care when little else is in place.

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5. Respect for Traditional Knowledge: Blending Views of Medicine

Many developing countries hold rich cultural history, which applies very much also to their understanding of health and healing. Traditional medicine can play a central role in how people understand their bodies, how families recognise illness, and how patients seek care. But I do think that Western health systems have rarely engaged with this reality. I am sure that it’s not out of malice or intention, but very much through instinctive and institutional habits: scientific standardisation and evidence-based protocols for what can be measured, controlled and certified. This overlooks, or even erases traditional practices more familiar to many developing populations, particularly rural communities, whose longstanding herbal remedies, massage therapies or birth rituals, are all treated as secondary, unscientific or even dangerous. This means that the health systems that the West helps to build, are not built to acknowledge, let alone preserve acknowledge.

China’s approach is completely different, because Traditional Chinese Medicine (TCM) has always remained a central and formal part of its own national health system. China’s policymakers, system builders, doctors, and industry leaders are all more comfortable in working within pluralistic medical environments. Acupuncture and herbal therapy are practiced in public hospitals, taught in medical schools and reimbursable on public health insurance, whether for chronic pain, stroke rehabilitation or anxiety. These sit right alongside antibiotics and surgical care in Chinese hospitals every day.

This familiarity gives China more than a certain fluency when engaging with countries that also maintain strong traditions, leaving space for local roots to remain intact, whether in Africa or Southeast Asia. In Nigeria, for instance, herbal medicine and therapeutic massage remain widely trusted, especially in maternal care. Traditional birth attendants in Lagos blend spiritual and herbal practices that carry legitimacy within their communities.

China does not attempt to replace these systems with TCM. It offers a blended model that implicitly affirms their right to exist. In many of its partnerships, China’s health infrastructure arrives without demands for full biomedical conversion. That absence of conditionality allows space for countries to determine how tradition and modernity coexist, without being told which parts must be shed.

I have rarely, if ever, seen this point about traditional medicine being brought into the conversation about global health and development, but it’s definitely something I’ve thought about for a long time. As a Western-trained doctor raised with herbal remedies and traditional treatments passed down from grandparents, perhaps it makes sense that I sense these gaps and overlaps more instinctively. I recognise that my cross-cultural experience changes what questions feel important in the first place.

Of course none of this is simple. Traditional medicine has (many) limits, and I am often the first to stand up and request data about efficacy and outcomes. Some traditional practices have weak evidence, some resist accountability, and are some are actively harmful. Western-trained scientists and policymakers, myself included, aren’t not naturally taught to see this clearly. But in many places, legitimacy in healthcare comes not just from what works, but from what feels right. Trust, cultural legitimacy, and lived experience are essential in medicine – not only in building relationships, but in driving uptake, adherence and health outcomes.

Final Reflections

China’s approach to global health is evolving fast. Its delivery models feel more practical, and its partnerships more familiar to many governments navigating post-development transitions. In a world where multilateral cooperation is fraying, China’s offer holds clear appeal across the Global South.

But this coherence has limits. China’s development institutions remain underpowered. As mentioned, CIDCA operates on a fraction of USAID’s budget, and many programmes depend on ad-hoc coordination rather than sustained institutional partnerships. On the ground, projects often face bottlenecks, staffing shortages, and weak monitoring systems. Collaborations with private firms may bring speed and flexibility, it’s true, but their additional roles also significantly increase risks of fragmented delivery and competing agendas.

China’s official language casts recipients as “friends and brothers,” but its health assistance always tracks its broader political and economic goals. Multilateral programmes receive less attention. Cross-border disease threats and aid to the poorest countries are lower on the list.

And then there is the governance question. As China expands its influence, it brings political assumptions about data ownership, system control, surveillance and the role of the state. In some countries, China’s model offers pragmatic relief: tools that work under pressure. In others, it may entrench systems that limit reform or transparency down the line. Either way, it deserves more attention and more nuanced analysis than most headlines allow.

Global health needs to remain a technical domain where impact happens in hospitals, clinics and research labs. Meaningful outcomes depend upon true expertise, consistent funding, painstakingly built relationships and long term collaborations. Western institutions can do better, by first understanding what China and the Global South need and want, and then refine their own strategies in order to match expertise and relevance. Whatever comes next, whether China-led, Western-led, or otherwise, care must actually reaches the people who need it.

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🩺 The Vital Signs series provides essential explainers on key contexts and trends shaping health in China today. Today’s post focuses on China’s role in the rapidly evolving global health/development landscape.

Global health and development is really the area that I am most passionate about, above all. Thus far, the China Health Pulse Newsletter has covered geopolitics, technology and health industry market access, but I’m looking forward to writing more about the development space and the Global South in future posts. Stay tuned.

For this next essential explainer on key contexts and trends shaping health in China today, I turn my attention to the hottest topic out there right now: Biotech.

In the past weeks, China's biotech industry has been capturing huge amounts of attention around the world. From the Wall Street Journal to the Economist, international media are hailing biotech as China’s next “DeepSeek moment” — a breakout signal that Chinese innovation is not only real but potentially global in reach.

And no wonder: there are plenty of recent examples of groundbreaking drugs, major acquisitions and billion-dollar collaborations. Take ivonescimab, the landmark immunotherapy drug developed by Chinese drugmaker Akeso, which recently outperformed Merck’s Keytruda, the world’s top-selling medicine, in Phase III trials for non-small cell lung cancer. Or the FDA's greenlight for HuidaGene’s first-in-class CRISPR RNA-editing therapy targeting macular degeneration: the first of its kind.

But, as is often the case with China, there’s much more to the story.

Catherine Thorbecke recently wrote in Bloomberg about how Western biases still cloud perceptions of Chinese innovation—even as Silicon Valley copies Chinese platforms (hello, Instagram Reels vs TikTok). The tech world’s stunned, disbelieving reaction to DeepSeek laid that bare: beneath the headlines is an enduring belief in Western exceptionalism, and a discomfort (and sometimes xenophobia) with the very idea that China could genuinely lead.

These same biases now shape how people are talking about Chinese biotech.

The breakthroughs are very real, and the pace is definitely accelerating. But attention doesn’t always equal understanding, especially when the hype gets loudest. It’s very much worth pausing to look more closely at what’s driving it, and to remind ourselves of the real dynamics happening on the ground.

This post is not an exhaustive list of stats or dry policy bullet points. Instead, I offer four essential truths below.

Each of these are shaped by my own understanding, professional and personal experiences, whether as a doctor, programme director for China’s drug regulators, policy advisor, or strategy consultant advising foreign MNCs and pharma clients.

I hope that my perspectives can provide you with a grounding check when trying to make sense of where China’s biotech sector is really heading.

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1. China's biotech is not new.

Myth: “China's biotech emergence is a recent development.”

Reality: China’s biotech boom is decades in the making, founded on long-term policy vision and deliberate infrastructure-building.

China’s biotech sector has been framed in Western coverage as an overnight phenomenon. But China had recognised its strategic importance as far back as the 1980s. During the early years of Reform and Opening-Up, Deng Xiaoping witnessed firsthand the stark contrast between China’s labour-intensive factories and the advanced capabilities of foreign industry that had begun to enter. He understood that China’s long-term economic resilience would depend upon capacity-building in emerging science and technology sectors.

In 1986, Deng launched the “863 Program”, an ambitious national high-tech research initiative that, for the first time in China, explicitly prioritised the field of biotechnology alongside IT and advanced manufacturing. This directed funding into genetic engineering, biologics and cell therapies, and laid crucial early foundations for talent, infrastructure and early commercialisation.

However, though the intention and aspiration was clear, progress remained slow. China still lacked the commercial and structural research ecosystem for advanced drug innovation. Domestic talent pools were thin, policy support was fragmented, and clinical trial regulation was inconsistent.

Much of the early biotech effort therefore focused on basic manufacturing, of active pharmaceutical ingredients (APIs)—the building blocks of drugs—and China quickly scaled to become a leading global supplier. That dominance was starkly revealed in 2017, when an explosion at a Chinese factory producing the API for piperacillin-tazobactam, a widely used broad-spectrum antibiotic, triggered a global shortage.

At the time, I had just started working as a doctor in the UK, and I remember trying to google why every hospital in the country was suddenly short of Pip-Taz, as we called it, for patients presenting with severe infections — pneumonia, sepsis, febrile neutropenia — where time and antibiotic choice can be critical. China’s biotech footprint was already impacting patient lives in the UK and all around the world.

By 2015, with the launch of the landmark “Made in China 2025” initiative, biotech’s bottlenecks were taken seriously and tackled head-on: accelerating regulatory reform, incentivising returning talent, and expanding funding for R&D and early-stage companies. A year later, in 2016, the “Healthy China 2030” plan broadened the health systems lens: integrating biotech into a core part of improving population health and national resilience. Then, in 2017, the Priority Review and Approval Process began allowing accelerated regulations and market entry by sharply reducing approval timelines for innovative therapies.

All of this propelled the next, transformative decade, where China moved from producing APIs to innovating complex therapies. Companies like BeiGene, I-Mab and Innovent Biologics rose during this period, building strong pipelines, attracting international capital and pioneering global clinical trial strategies. National High-Tech Zones flourished in biotech hotspots like Shanghai, Suzhou and Shenzhen, providing grants and favourable tax regimes as well as thousands of km of dedicated real estate and subsidised infrastructure.

The pandemic further accelerated domestic capacity and global ambition, including for mRNA platform development and vaccine scale-up, and national policy continues to centre biotech as a strategic priority. The Two Sessions earlier this month further reaffirmed biotech as a national strategic asset (see my recent post). In China, that designation matters. It ensures continued access to policy levers, cross-sector integration, and long-term support. Biotech’s vibrant trajectory is most definitely set to continue.

Why it matters:

For industry leaders: Success in China requires more than capital. Long-term strategy, local alignment and the right relationships are all essential. Global playbooks rarely translate. The key, as ever, is to create and maintain local partnerships to leverage the right channels of influence.

For investors: China’s biotech sector is the product of deliberate, long-term planning. The commitment is real and growing. Recognising this will help identify the right entry points and anticipate future shifts.

For policy-makers: China’s biotech expansion needs to be factored into economic and geopolitical strategies. Understanding its top-down, policy-driven model is key to effective engagement, safeguarding standards and avoiding blind spots.

For researchers: China is now an indisputable core hub for biomedical research. Sustained engagement with its evolving ecosystem is essential for staying at the forefront of global science.

2. China’s biotech innovation has moved far beyond copying.

Myth: “Chinese biotech companies are still copying Western drugs, focusing on generics or modest biosimilars.”

Reality: China is now actively developing and pioneering cutting-edge innovation in advanced biologics, next-gen cancer therapies and gene editing.

The “copycat” narrative is outdated, but it’s stubbornly stuck. Historically, China’s pharma sector did rely heavily on generics, as it built up regulatory and manufacturing capacity. But the landscape today is dramatically different. In the past decade, Chinese biotech firms are now genuinely innovating, actively and rigorously developing highly sophisticated biologics and setting global benchmarks.

Earlier, I already mentioned Akeso’s bispecific and HuidaGene’s gene-editing therapies. In the field of CART-T, personalised cancer treatments that require complex engineering and manufacturing, Chinese firms are also leading. The biotech company CARsgen Therapeutics has produced promising Phase 2 outcomes for clinical trials in stomach cancer solid tumours (a notoriously difficult field).

What has enabled these leaps? Talent, infrastructure, and regulatory reform have all played roles. Capable Chinese scientists may have returned from top Western institutions, but China’s domestic research ecosystem has matured fast, and many of the best lab minds are now fully home-grown. China’s vast patient pool also allows for faster enrolment and more efficient clinical trials, and its regulatory landscape has accelerated so quickly that it is now setting standards and templates for other countries to follow. Chinese firms are increasingly designing trials with international endpoints, often registering as multi-regional clinical trials to align with global regulators.

The upward trend is only set to continue. China’s National Development and Reform Commission recently announced a 1 trillion RMB National Venture Capital Fund to support and propel deep innovation and technological advancement—and biotech is included in this umbrella. The recent Two Sessions further emphasised biotech as one of China’s “new quality productive forces” (新质生产力), enabling it to access serious capital: R&D tax breaks, IP protection, preferential procurement and venture channels that were once reserved and exclusive for other national assets.

Why it matters:

For industry leaders: Must view China not just as an opportunity but as a key partner and competitor in therapeutic innovation. R&D strategies simply must adapt to this new reality.

For investors: Track China’s biotech not just for opportunity, but for where it’s gaining ground—especially in emerging markets. Competitive pressure is rising fast, not just in developing countries, but in Western markets too.

For policymakers: Protective policies need to be balanced with engagement, to avoid losing access to critical innovation pathways that impact the global innovation landscape. Excluding China risks missing critical innovation while weakening global coordination.

For researchers: A mindset shift is overdue. Chinese institutions are now scientific peers, often leading in trial execution, data infrastructure and translational research. Collaboration requires openness, shared credit and mutual respect.

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3. China isn’t cheaper. The West is just more expensive.

Myth: “China’s biotech gains come from cutting corners on ethics, oversight or scientific quality.”

Reality: Many of China’s advantages stem from structural reforms, not shortcuts. Meanwhile, Western trial systems are bogged down by inflated costs and redundancy.

In terms of costs, comparing biotech to generative AI may actually be rather apt. DeepSeek wasn’t just a technical achievement for China. it was a pricing shock for the world. In biotech, China is also showing that high-quality clinical trials can be run faster and cheaper, than we could have ever imagined, and without compromising on quality.

China’s clinical research environment has moved quickly to align its trial processes with global standards. China’s National Medical Products Administration (NMPA), has been learning fast from regulators such as the US FDA, UK MHRA, EMA and others, and since it joined the International Council for Harmonisation (ICH) in 2017, it has adopted ICH-GCP protocols, revamped trial governance and cut unnecessary bureaucratic drag.

Apart from speed and quality, digital platforms in China have made trial participation more accessible and data collection more integrated. Patient recruitment is easier and often cheaper. Platforms like JD Health and DXY have been used to improve recruitment, remote monitoring, and trial communication, streamlining access across a vast and diverse population.

While processes, data transparency and ethics in China’s research ecosystem still warrant scrutiny, regulators in the US and EU have no choice but to accept Chinese trial data — especially when studies adhere to global protocols. China has doubled global commercial clinical trials since 2018 to now account for an impressive 18% of the global total. In contrast, the European Economic Area has seen disappointing declines in trial activity, associated with comparatively slower site start-up times and persistent recruitment bottlenecks. In developing countries, China is increasingly becoming a reference point, and countries across Southeast Asia and Latin America are already learning from China’s model.

I saw this transformation firsthand during my time as Head of Health for the UK government in China, where we worked with the UK MHRA regulators to deliver regulatory training programmes for China’s NMPA counterparts. At first, the sessions followed the expected format: UK trainers, Chinese trainees. But over time, that dynamic began to shift, and the exchange became more equal. By the end, Chinese regulators were confidently stepping forward to share their own best practices, no longer listening in the audience, but commanding the stage.

Why it matters:

For industry leaders: China is showing that trials can be faster, more scalable, and still meet high standards. Just as Deepseek forced OpenAI to take some good hard reflections, global biotech companies should review their own regulators and operational teams to adopt lessons where appropriate.

For investors: Should look more closely at the structural efficiencies driving China’s clinical acceleration — and reassess how those conditions affect risk, ROI, and exit timelines in both China and as well as their own (now slower-moving) Western markets.

For policymakers: Consolidated ethics reviews, defined regulatory timelines and tech-enabled recruitment can improve trial speed without lowering standards. Policymakers should stop dismissing China’s frameworks as behind, and start engaging properly — developing countries are already doing so.

For researchers: China’s evolving clinical research environment offers opportunities for faster data generation and broader patient access. But collaboration requires nuance: ethical standards, data sharing agreements, and study design must be carefully negotiated.

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4. Working in China means adapting to China.

Myth: “Foreign biotech can enter China on their own terms.”

Reality: Domestic innovation will almost always have structural advantages, so success requires aligning with China’s systems, priorities and ways of working.

China's vast population and high disease burdens make for seemingly rich data pools that continue to entice those looking in from the outside. The opportunities are significant for the biotech sector, but foreign actors often misunderstand how to engage. Whether you're a multinational company, a global health agency, or a research institute, acting independently or exporting external frameworks rarely works. Regulatory complexities, bureaucratic hurdles and fierce competition from well-supported domestic actors create a challenging landscape. Local institutions have inherent advantages, most importantly policy prioritisation and government support, as well as easier cultural alignment.

In China, relationships matter. Trust, reputation and alignment with local interests shape everything — from access to clinical sites and patient data, to regulatory timelines and hospital partnerships. Those who prioritise relationships first and profit second will be best positioned to navigate complexity and thrive.

But the type of relationship most appropriate for each scenario may differ according to needs, expectations and aims. What works for one project may stall in another if the structure isn’t well-matched to goals or expectations. A licensing deal may offer quick entry but no strategic depth. An acquisition may give control but provoke friction. Success depends not just on forming partnerships, but choosing the right form of partnership.

Whether in industry, academia, public health or regulatory engagement, the same principle holds for foreign stakeholders: success in China comes from building real relationships, embedding locally, and aligning with broader national goals, not applying external models as-is:

1. Equity-based partnerships

These include acquisitions, joint ventures and co-funding arrangements — common in industry but increasingly explored by research institutions and regional governments. e.g. GSK’s acquisition of Zhifei, Merck’s JV with Kelun-Biotech.
Pros: Long-term commitment and strategic alignment are clearer, shared risk and access to local insights.
Cons: Integration challenges slow things down, high costs, cultural friction and risk of misaligned strategy.

2. Project-based collaborations

Time-limited partnerships structured around a defined product, study or policy objective. Most common for global health or academic research e.g. the Gates Foundation’s work on vaccines in China.
Pros: Speed and focus and cost-efficiency. Risk is often shared.
Cons: Misaligned timelines, unclear IP/data ownership, dependence on local execution and fading interest post-project/lack of sustainable impact.

3. Capacity-building and exchange

Including regulatory training, joint fellowships, or R&D infrastructure co-development. Often used between government agencies or academic institutions.
Pros: Built trust, regulatory alignment, shared institutional learning.
Cons: Imbalanced power dynamics (e.g., donor–recipient framing) can undermine mutual trust.

4. Licensing and knowledge transfer

Used by foreign firms or institutions looking to scale through local partners.
Pros: Low barrier to entry, minimal resource requirement.
Cons: Limited influence and local insight, dependency on partner compliance, may miss deeper learning opportunities.

5. Embedded presence

Setting up local research labs, offices, or embedded teams within Chinese organisations.
Pros: Credibility, long-term integration, real understanding of local dynamics.
Cons: High costs, slow to scale, vulnerable to policy shifts, longer ROI timelines.

Choosing the right model requires clarity on goals, timelines and a readiness to adapt. What works for tech licensing may not work for clinical research, and what works today may not hold even in 12 month’s time.

Why it matters:

For industry Leaders: Quick wins don’t exist in China. Long-term strategic relationships with local partners, regulatory stakeholders and government actors are essential. Need to adapt the right collaboration model to specifically fit company strategy and aims.

For investors: Must appreciate the depth of relationship-building required for success in China. Investments that explicitly prioritise guanxi — fostering genuine local partnerships — will deliver better long-term returns than purely transactional approaches.

For policymakers: Bilateral and multilateral science diplomacy and regulatory cooperation need structures that support two-way learning and institutional trust. Focus less on symbolic agreements and more on building models that scale well, share risk and respect political sensitivities on both sides.

For researchers: It’s important to cultivate strong professional networks with Chinese counterparts. Academic collaborations require clarity on data use, authorship, funding, and institutional alignment, and all delivered with mutual respect for expertise and a willingness to both give and take.

So where does this leave us?

The global biotech landscape is shifting fast. Chinese biotech are no longer just serving the domestic market. Now equipped with a growing confidence in their own innovative capabilities, they’re looking hungrily outward to target consumers in developing countries, and increasingly ready to compete with Western pharmaceutical giants on their home turf.

But scientific breakthroughs are only the beginning. Many promising molecules coming out of China today — whether in oncology, immunotherapy or rare diseases —are still in early or preclinical stages. Even though China is fast and affordable, the leap from discovery to delivery is still extremely long and extremely expensive. Value and risk accumulate with each step along the full research pipeline. Many companies still lack expertise in late-stage trials, pharmacovigilance systems and market access strategies, and crucially, post-market surveillance.

At the same time, geopolitical tensions continue to complicate collaboration on the global stage. The US’s proposed Biosecure Act would require American firms to cut ties with Chinese biotech partners. Trade restrictions, tariffs, and broader mistrust in the US–China relationship risk slowing not just cooperation, but innovation itself. That would be a tragedy. If these divisions deepen, the consequences will not just be commercial. The resulting slower pipelines, duplicated efforts and delays to access will mean reduced treatments for diseases.

As a doctor, I care most about what it all means for patients. Like DeepSeek in generative AI, China’s rise in biotech is forcing the world to move faster and think harder. That pressure can feel uncomfortable. But just like with DeepSeek, the world can choose to react with fear — or learn, adapt and raise the bar.

The purpose of biotech and innovation isn’t dominance. Faster trials, smarter regulation and more affordable therapies are life-saving, life-extending gifts, in order to get the best treatments to the patients that need them the most.

🩺 This is a Vital Signs post: a series of essential explainers from China Health Pulse, where I lay out the key contexts and trends shaping health in China today.

If you enjoyed reading, please subscribe, share and comment. As always, I’d love to hear from you.

Next time, in part 2 of 2 on Health and the Two Sessions, I will be analysing the drivers behind the key trends at China’s biggest political event of the year, and what they mean for those living and working on health and China.

China holds a fifth of the world’s population. It is now a major global force in biotech, digital health and pharmaceuticals. Yet I see the same misconceptions about China’s healthcare surface again and again.

Some were once true. Some never were. The rest are artefacts of media narratives or political biases that have somehow hardened into conventional “wisdom”. But the biggest reason? Most people discussing China’s healthcare have never actually used it.

These mistakes matter. Flawed assumptions lead to bad policies, failed investments, and ultimately, worse outcomes for patients. Whether you’re a patient, doctor, policymaker, or industry leader, getting China wrong on health has real consequences well beyond its borders.

That’s where China Health Pulse comes in. I created this newsletter to cut through the noise, explore the big questions and bring clarity to one of the world’s most complex and fast-changing health systems - and how it is impacting all of our futures.

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A Familiar Conversation

A few days ago, at a policy event in London, a journalist leaned in after hearing I work on health and China.

"China’s health system is a mess, right?" they said, glass in hand, eyes expectant.

I paused. It was a familiar line I’d often heard before.

"What makes you say that?"

They barely blinked. "Well, hospitals are overcrowded. Services are patchy. Doctors are overworked. And patients mostly pay out-of-pocket…"

It wasn’t entirely wrong. But it wasn’t right, either.

China’s fragmented health system can be deeply unequal, but also extraordinarily efficient. The real question isn’t whether the system is good or bad. It’s: who gets care, how fast, and at what cost?

Healthcare in China is being transformed by technology, private capital, and a shifting social contract between doctors and patients.

Last month, when I was in China, I went for a hospital check-up. I booked a specialist appointment through my WeChat mobile app. A few taps on my phone and an online payment of 25 RMB (roughly £3) later, I had a slot within the hour.

Blood tests? Done immediately after the clinic.

MRI scan? Booked and completed few hours later that day.

Results? All images, numbers and reports available on my app on the same evening.

I turned to the journalist, "I’d been trying to get this appointment in London for months. I’m a UK doctor myself, but I ended up using China’s health system! It was faster, cheaper and easier. Pretty incredible, right?"

There was a pause, and we both laughed.

Cutting through the noise

I wasn’t surprised by the journalist’s reaction. I hear versions of this conversation all the time.

But the more I work in this space, the more I realise: most people discussing it have never actually interacted with it.

As a doctor and health consultant who has worked across government and industry, I translate clinical realities into strategy and regulatory jargon into insights. Born in China and raised in the UK, I’ve seen both sides - and the blind spots in between.

I’ve listened to executives dismiss China as a low-cost drug manufacturer while its biotech sector races ahead. I’ve watched policymakers generalise about the country’s public health system, even as private hospitals and self-pay models redefine patient care. These costly health mistakes impact lives well beyond China’s borders.

So for this first post, I’m setting the record straight.

Here are the five biggest myths about China’s healthcare system - debunked.

Let’s get into it.

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MYTH: “China’s health system is monolithic and government controlled.”

REALITY: Wrong. China’s healthcare system is not a top-down machine. it is a hybrid network of state control and market forces, with huge variation at the local level.

I often come across the assumption that China’s health system functions like its politics: a single, state-run entity. In reality, it’s less like the UK’s NHS or Canada’s single-payer model, and more a patchwork. Public hospitals, private clinics, employer-based insurance, and out-of-pocket payments are all tangled together in a system that shifts dramatically depending on where you live and what job you have.

Yes, national policies set broad goals, and China is working toward universal health coverage through initiatives like Healthy China 2030 (detail to come in future posts), but the private sector remains a major player, sustained by service fees and drug sales.

💡 Why this matters:

For policy analysis & IR specialists: Beijing does not dictate all. Local governments control key decisions like funding, hospital management, and policy implementation. Misjudging this decentralisation leads to bad policy recommendations and ineffective foreign engagement.

For global health engagement & technical research: International programmes often default to partnerships with national authorities and so miss provincial health departments and private providers. These are the real players who control implementation in budgets and policy enforcement.

For pharma, biotech & healthtech industry: You must understand how both local regulatory authorities and hospital funding models shape access. I tell my clients: China is not one market. It’s many. After approval from national regulators is only step one, drug pricing, procurement, and reimbursement all plays out at the provincial level. Hospitals, too, operate with financial independence, making decisions based on profitability, not just government mandates.

If China’s healthcare system isn’t fully state-controlled, then what about its innovation? Many assume it’s just copying the West - but that couldn’t be further from the truth.

MYTH: “China is just a generics manufacturer. It’s not a real innovator.”.

REALITY: that story is out of date. China is no longer playing catch-up. It’s leading.

For years, China was known for mass-producing generics and reverse-engineering Western copycats. But today, its health innovation sector is moving at an incredible speed. It is now a global leader in cell therapy, biologics, and precision medicine, propelled by an enormous patient base generating real-world data, an accelerated regulatory environment and government-driven R&D incentives.

There are over 3,000 internet hospitals in China, and telemedicine platforms like Ping An Good Doctor have over 420 million registered patient users. Digital health technologies including AI-assisted diagnostics, robotics and even augmented and virtual reality tools are increasingly utilised in health services and medical education. Chinese firms are filing record numbers of global patents and racing ahead in mRNA vaccines, CAR-T cancer therapies, and precision medicine.

💡 Why this matters:

For policy & IR: China is not just a manufacturing hub. It is now setting new regulatory standards in biotech, AI-driven healthcare, and digital medicine, with the potential to significantly influence global frameworks.

For global health & research: China is emerging as a vaccine and biotech powerhouse, filling gaps in affordable and innovative therapies. Low- and middle-income countries are turning to China over Western alternatives.International organisations focused on drug affordability, vaccine security, and global health equity need to engage because China has the potential to transform global access to care.

For industry: Chinese firms are developing drugs faster and cheaper than their Western counterparts are gaining ground in global markets. Those still dismissing China as a low-cost producer are missing an industry that is outpacing them in both speed and cost-efficiency.

With China now leading in biotech and digital health, it might seem like an easy market to enter. But size alone doesn’t guarantee access.

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MYTH: “China’s huge population equals a huge market.”

REALITY: The market is big, but access is not that simple.

With 1.4 billion people and a fast-growing middle class, China looks like an incredible market for drugs and medical devices. But opportunity alone is not enough. Even when the market potential is enormous, tight regulations and complex local policies create significant obstacles.

• Domestic companies tend to get priority in funding, partnerships, and procurement, making it extremely tough for foreign firms to compete.

• China’s Volume-Based Procurement (VBP) slashes drug prices so aggressively that foreign firms must accept deep cuts or risk being shut out of public hospital contracts.

• Even after national approval, securing hospital buy-in at the provincial level requires navigating separate pricing negotiations and procurement processes.

💡 Why this matters:

For policy & IR: China’s aggressive cost-cutting health policies are influencing global drug pricing models. VBP has driven drug prices down so aggressively that governments in Latin America, Africa, and Southeast Asia are considering similar models. Understanding how these policies develop will be key for predicting shifts in global health financing and access, particularly the emerging markets.

For global health & research: Data-sharing restrictions and research barriers complicate technical partnerships. Differences by province often create additional barriers – you cannot copy and paste across regions, and the additional time, effort and resource needs to be integrated into early planning.

For industry: Getting regulatory approval is just step one, and progress really depends on regional pricing differences, procurement rules, and hospital decision-making structures at the provincial level.

There’s another major misconception for those trying to break into the market: that China’s vast troves of health data are easy to tap into.

MYTH: “China’s health data is a goldmine.”

REALITY: Think again. China’s health data is heavily protected, and foreign access is tightly controlled.

I often meet foreign investors and researchers who are eager to tap into China’s vast health datasets. Surely 1.4 billion people, digitized hospitals, and a massive disease burden are ideal for clinical trials, AI-driven research, and drug discovery?

That used to be true. Fifteen to twenty years ago, foreign firms could access hospital records, genetic datasets, and clinical trial data with relative ease. Not anymore.

Data security laws like the Personal Information Protection Law (PIPL) and Data Security Law (DSL) now impose some of the world’s strictest controls on health data. Meanwhile, global restrictions are also tightening. The US Biosecure Act and similar foreign policies are blocking collaboration with China on genomics, AI-driven healthcare, and other “sensitive” research areas. Scientific partnerships are becoming harder on both sides, even when global health challenges demand cooperation.

💡 Why this matters:

For policy & IR: China’s strict health data approach is influencing global trends. Governments worried about AI security and digital sovereignty are watching closely, and some may follow China’s lead in restricting cross-border flows of health data. This risks complicating international collaborations.

For global health & research: You cannot work with Chinese datasets the same way you do in other countries. Partnerships depend on deep integration with China’s research ecosystem and workaround adaptations including indicator-based research models rather than raw data access.

For industry: China’s data environment is not a barrier, but a reality to work within. Companies that secure strong local research partnerships, align with China’s data storage rules, and engage regulators early will still be able to thread the needle and find opportunities – and even longer-term market stability.

Strict data controls make collaborations challenging, but rural healthcare presents another surprise. Many assume wrongly that poor infrastructure means poor access to care.

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MYTH: “Rural healthcare in China is severely underdeveloped.”

REALITY: Disparities persist, but China’s rural healthcare is transforming fast - with lessons for other countries.

China’s 120 million rural seniors over the age of 60 need better healthcare. Rather than relying on expensive hospital expansion, China is leapfrogging brick-and-mortar expansion and scaling skillsets by focusing on AI-driven diagnostics, telemedicine, and new insurance models. Rural healthcare might still lag behind major cities, but technology is rapidly closing the gap:

• AI-powered imaging tools help rural doctors diagnose diseases faster.

• Remote healthcare platforms connect patients with top-tier specialists.

• Free medical school tuition programmes incentivise young doctors to work in rural areas.

• Insurance reforms reduce out-of-pocket costs for rural residents.

💡 Why this matters:

For policy & IR: Rural health doesn’t always require costly hospital expansion. China’s rural strategies could be a model for other resource-constrained countries in leveraging technology and innovative service delivery models – and not just in healthcare.

For global health & research: The challenge for global health teams is to collaborate within a rapidly evolving system that may not align with traditional Western-led public health initiatives.

For industry: China’s rural market is now a fast-growing healthcare sector. Pilots in AI-driven diagnostics, decentralised clinical trials, and digital health innovations have the potential to shape the next generation of health solutions for emerging markets worldwide.

Final thoughts: Unknown unknowns

China’s healthcare system defies easy narratives. Misconceptions reveal a lot about the assumptions that individual bring to the table, based on experiences and biases.

From inequalities to innovation, and from market opportunities to data barriers, behind every myth lies a much bigger story - this newsletter is just getting started!

I’ll be covering the real shifts happening with China’s health - the policies and market trends reshaping care, the overlooked players driving change, and the global impact of what comes next.

What do you want to know next? What aspects of China’s health interest (or puzzle) you most? Which areas of this post shall I dive deeper? Please leave a comment or send a message.

I’d love to hear from you.

🩺 This is a Vital Signs post: the first in a series of essential explainers from China Health Pulse, where I lay out the key structures and systems shaping health in China.

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