China Took Centre Stage at This Year's World Health Assembly
With the US absent from WHA78 in Geneva, China stepped forward with its own vision for global health: selective multilateralism.
🔬This is a Real Diagnosis post at China Health Pulse, where I dive deeper into key topics and current trends.
While much of the world’s attention is currently on US–China tariffs and trade friction, last month’s 78th World Health Assembly provided a subtler, health-focused stage for the same tensions.
The WHA takes place every May in Geneva. It is the World Health Organisation’s highest decision-making body, where 194 member states discuss and vote on resolutions, funding decisions and treaty endorsements to set out global health for years to come.
This year, however, for the first time since the founding of the WHO in 1948, the United States was both financially and diplomatically absent. In contrast, China arrived with a greater presence, a louder voice and significantly more funding: its 500 million USD pledge now makes it the biggest state donor to the WHO, and it brought the largest ever WHA delegation in history.
Most headlines about this year’s WHA did not focus on technical breakthroughs. Instead, predictably, they chose to highlight politics: namely, that “the US has stepped back from global health”, and that “China is stepping in to fill the vacuum”.
I’ve written before about why this binary is altogether misleading.
China’s engagement in global health has always followed a different logic. It has never sought to replicate the Western models of public goods and technical neutrality, instead favouring bilateral cooperation for its strategic control, pace of returns and political alignment. For China, health is folded into trade, infrastructure, diplomacy and power, delivered through a mix of public and private mechanisms.
This year, China used the WHA to intentionally articulate specific priorities, amplify preferred narratives and deliberately consolidate its position within key technical domains.
But these crucial points have received little attention in mainstream, English-language coverage. I’ve yet to see a comprehensive summary of China’s movements at WHA out there. And so, today’s post aims to address this gap.
Here at China Health Pulse, I combed through all available sources in English and Mandarin, and repeatedly quizzed colleagues who attended the event, to answer three key questions: what was China actually doing at the WHA this year? What messages did it want to send? And most importantly, has it succeeded?
World Health Assembly 101
Formally, the WHA sets the global health agenda. It approves WHO’s work and budget, reviews technical progress, debates resolutions and endorses strategic plans that define how countries respond to shared health challenges. But its informal functions are just as significant. It is a performative, yet necessary stage, where countries test alliances, promote domestic models and signal how they believe global cooperation should work, and who they think should lead it. After all, showing and telling is just as (and sometimes even more) important as the doing.
This year marked the 78th Assembly (WHA78), and in his opening speech, UN Secretary-General António Guterres spoke of both the extraordinary progress made in global health since the WHO’s founding, and the fragility of those gains. He pointed to falling child mortality and rising life expectancy, but warned that war, climate disruption and pandemic aftershocks now risk reversing decades of development.
WHO Director-General Tedros Adhanom Ghebreyesus echoed in his own address: “The world’s expectations of WHO have increased,” he said, “but its resources have not.” He described the current landscape as one of growing need and diminishing stability: "The road is winding and rugged, but the goal is unwavering."
Member states reviewed over 75 agenda items across a marathon eight days of formal plenary sessions, technical committees and side events. Technical frameworks and priority actions covered mental health, rare diseases, access to controlled medicines, antimicrobial resistance and climate-related health risks. As in recent years, politically charged and persistent debates re-emerged: Russia’s war in Ukraine, Israel’s actions in Gaza and Taiwan’s contested observer status.
Two major milestones defined the WHO’s institutional response to the US retreat. First, member states agreed to raise assessed contributions by 20%, alongside a 5% increase in mandatory dues (measures aimed at stabilising WHO’s funding base after years of dependence on earmarked donations). Second, the long-negotiated Pandemic Agreement was formally adopted, although in diluted form, following three years of difficult negotiations.
WHA78 had the (perhaps overly) optimistic theme of “One World for Health”. I was told by colleagues who attended, that the atmosphere felt markedly less cohesive than previous rounds. While technical milestones were acknowledged and many thematic discussions moved forward, the sense of fragmentation was hard to ignore. Between retreating funds, scaled-back programming and geopolitical rivalries, this “One World” concept seemed to be very much under strain. Indeed, Richard Horton, Editor of The Lancet, has (jokingly) questioned whether this year’s WHA was actually a “funeral for what global health used to be”.
A Misleading US v. China Narrative
No senior US official attended WHA78, following President Trump’s executive order to withdraw from the WHO. The legal exit takes effect in 2026, but its consequences are already being felt. The US has withheld 260 million USD in assessed dues for the 2024–2025 cycle, and no new funding commitments have been made. In turn, WHO has revised 2026–2027 base programme budget from 5.3 to 4.2 billion USD. This year, member states approved a 20% increase in assessed contributions (90 million USD annually) but the gap remains substantial.
Indeed, the only US presence this year was an ill-received video message from US DHHS Secretary Robert F. Kennedy Jr, recorded for Fox News and played to a mostly silent audience of WHA diplomats and ministers. In it, he urged countries to cooperate with the US “outside of the WHO”, which he slammed as "mired in bureaucratic bloat, entrenched paradigms, conflicts of interest and international power politics."
China, by contrast, arrived in stupendous force. This year, it sent the largest delegation in WHA history: over 180 representatives from the National Health Commission, Foreign Ministry, National Healthcare Security Administration, Chinese CDC, state-owned biotech firms and embassy teams, led by Vice Premier Liu Guozhong and Health Minister Lei Haichao.
In addition, the headline news was of China’s pledge of 500 million USD to the WHO over five years. If fully realised, this would make it the largest state donor. According to official statements, this includes increased assessed dues under the new 20% hike, voluntary programme contributions, and South–South health development financing.
Some public health analysts have argued that this pledge remains modest, given China’s relative economic size and rising geopolitical ambition. It also falls short of past US contributions. They call for greater flexibility, urgency and discretionary support, but such critique misses China’s core strategy, which is about control, not volume, and intentionally designed to serve its own national interests.
This distinction is important. China’s is not a discretionary cash injection in the style of past US funding. So far, it appears to blend routine dues with earmarked project support and in-kind contributions. It remains unclear how much will be channelled through the WHO versus China’s own development platforms.
On the surface, China may now seem be more publicly aligned with multilateral mechanisms than previously, but in practice, its approach remains strategically hybrid and bilaterally focused. Nevertheless, there are several important motivations for signalling its expanding presence at the WHA this year. The next section explores what these are.
What China Actually Signalled
China is not “funding the WHO” in the traditional Western sense, because it is funding its own version of the WHO. Beyond its headline cash pledge and record-sized delegation, it has made a series of deliberate moves this year, ranging from norm-setting and technical agenda influence to strategic engagement with the Pandemic Agreement and a more assertive play for institutional legitimacy within WHO systems.
Below, I analyse each of these domains of influence, in terms of China’s intent and positioning, and how they come together as a coordinated strategy to position China as a rule-shaper in the evolving architecture of global health.
Norm-setting and Legitimacy
This year, we saw the WHO signal strong institutional endorsement for China, repeatedly and publicly. This is a big deal: China’s relationship with the WHO has not always been so smooth (particularly during the pandemic). Director General Tedros Adhanom Ghebreyesus and other WHO leaders highlighted China’s leadership in key health areas, endorsed new cooperation agreements, and linked China’s actions to the WHO’s future direction. All of this helps China to reinforce its image as a responsible and central actor, and even standard-setter, in global health governance.
“China has made strong contributions to global public health and to the work of WHO. We are grateful for your support and look forward to deepening cooperation in key areas such as digital health and health system transformation.”
— WHO Director-General Tedros, meeting with Vice Premier Liu Guozhong, 22nd May“We welcome China’s continued role in promoting South–South cooperation and equitable access to health technologies.”
— DG Tedros, WHA78 plenary, WHO Secretariat briefing, 22nd May
China was eager to accept all of this enthusiastic recognition from the WHA, but its responses were direct and strategic. Senior leaders welcomed and amplified WHO praise as international validation, but they also pushed for norm diffusion, promoting ideas around China’s own preferred concepts of sovereignty, equity and mutual respect.
In what was perhaps a subtle rebuke to the US, Vice Premier Liu urged countries to “resist unilateralism and power politics” and look to the WHO as a “professional, science-based authority”. Health Minister Lei linked China’s domestic successes to global legitimacy, including life expectancy and health access.
“At present, faced with the shock of unilateralism and power politics, global public health security faces serious challenges. Only through mutual support and solidarity can humanity create a healthier world. China has firmly fulfilled this commitment through concrete actions.”
— Vice Premier Liu Guozhong, WHA78 plenary address, 20th May“China continuously contributes Chinese wisdom and strength to building a global community of health for all.”
— Lei Haichao, Minister of Health, WHA78 remarks, 21 May
Leverage Through Side Events
WHA78 was an opportunity for China to showcase its technical prowess in health. Through side events, technical roundtables and bilateral meetings, it sought to promote models it believes to be globally exportable and systemically influential: including digital-first primary care and Traditional Chinese Medicine. In addition, it targeted specific under-addressed areas that the WHO has prioritised, like mental health and rare diseases, where it knows it can demonstrate both policy leadership and implementation strength.
1. Digital Health x Primary Care
This year, China’s forum on “Empowering Primary Health Care with Digital Intelligence” drew over 200 delegates, with many more attendees apparently queuing outside. Presentations described how China’s 1.4 billion residents are now covered by a unified digital infrastructure. Officials showcased smart hospitals, AI diagnosis, integrated payment systems, and public health surveillance. China has long pitched its own evolution from rural barefoot doctors to 5G-enabled tiered referral networks as a success story worth sharing. Chinese speakers framed these systems as adaptable mechanisms for LMICs through standard templates, shared digital norms and transferable infrastructure.
No wonder the forum was so popular: this was a very smart move. Digital health is a global topic with bipartisan excitement and minimal geopolitical baggage, and an area where China is now a global leader (I’ve written about this many times already, including here, here and here). Showcasing prowess in digital health governance at the WHA brought China significant credibility.
2. Mental Health, TB, Rare Diseases
These are disease areas with real unmet need across much of the world. Mental health and TB have long been WHO priorities, and China has recently moved fast on both: expanding community-based services, training its health workforce, and trialling digital triage tools. Rare diseases, meanwhile, sit at the intersection of China’s biotech ambitions and health equity goals. Officials highlighted alignment with WHO’s new 10-year roadmap, citing expanded orphan drug lists, fresh reimbursement policies and major state investment in genetic screening.
By co-hosting sessions in domains the WHO is actively advancing, China positioned itself as a practical partner. It showed it can engage with real substance, as a valuable technical contributor as well as a supportive financial donor.
3. Traditional Chinese Medicine
Traditional Chinese Medicine (TCM) has long been a national priority under President Xi’s administration: enshrined in law, backed by budget and reinforced through political will. This first-ever TCM-focused WHA side event, co-hosted by countries from both Asia and African, was a strategic move to elevate TCM from soft-power branding to hard-power legitimacy. The forum spotlighted clinical research centres, IP showcases, standardised pharmacopoeia and export-ready wellness products, all designed to emphasise the scientific credentials of TCM.
This WHA78 event marked a notable step forward. China deliberately aligned its messaging with WHO language around “integration” and “pluralism,” carefully framing TCM as complementary rather than oppositional to biomedicine. I previously wrote about China’s ambitions to position TCM on equal footing with biomedical models. The very fact that this forum took place at the WHA, under the auspices of the WHO, represents a clear win for China in reshaping the global epistemology of health. It offered institutional validation for traditional knowledge systems that have often been hotly contested by some (particularly the Western) member states.
Pandemic Treaty and Global Governance
After three years of intense negotiation, the WHA finally adopted the Pandemic Agreement, marking a symbolic milestone in reaffirming the WHO’s convening power. This is a non-binding framework to strengthen global preparedness through shared surveillance, rapid response and equitable access to treatments. However, the deal is still incomplete: the critical Pathogen Access and Benefit-Sharing (PABS) system ,implementation timelines and financing are all still under negotiation.
Nevertheless, after years of pandemic-related disputes between WHO and China, including on virus origins, this Agreement has now offered China the opportunity to shape multilateral rules on this topic, while asserting red lines. It backed the final text but did so on sovereignty-first terms, repeatedly framing its contributions as central to the final adoption, and through language of “fairness, equity and digital security.”
Thanks to China’s efforts, all parties agreed to focus monitoring on emerging infectious diseases, clarify responsibilities in data sharing, reduce burden on member states, and safeguard the interests of developing countries.”
— Hu Guang, Director, National Disease Control and Prevention Administration (NDCPA)
Funding for Institutional Influence
With greater WHO funding and participation, we are now seeing China use its growing institutional influence to advance sovereignty-sensitive agendas. This year, Taiwan’s long-running bid for WHA observer status was removed from the WHA agenda during a closed-door committee vote. Chinese state media has described this outcome as both a legal necessity and a diplomatic success. For China, multilateralism is a means to institutionalise its worldview, not to dilute it.
“Taiwan's participation in the WHA must be handled in strict accordance with the one-China principle, as established by the UN General Assembly. We firmly oppose any Taiwan-related proposals. Any technical exchanges involving Taiwan that comply with the one-China principle can proceed smoothly.”
— Chen Xu, Permanent Representative of China to the UN in Geneva, WHA
China’s Selective Multilateralism is Redefining Global Health
WHA78 showed us the clearest signals yet, of what China plans to do, and how, in global health. Separate from Western models of global goods, it is building a development framework where health links directly with infrastructure, governance, cultural legitimacy and commercial ecosystems. Health becomes a channel to build trust in Chinese vaccines, AI tools and TCM systems. It finds a way to normalise sovereignty-first principles across data, drug regulation and digital platforms. It enables the kind of bilateral engagement that blurs diplomacy, development, and industrial strategy — selective multilateralism, where it pays off.
Alongside its public-facing pledges and formal statements, China promoted a series of bilateral objectives: holding diplomatic meetings with Brazil, Indonesia, South Africa, Tunisia and Morocco to advance joint CDC partnerships, surveillance systems and talent exchanges which were all framed within its own broader diplomacy: the Global Development Initiative, the Global Civilisation Initiative and others, which are all very much separate from the WHO.
In addition, today’s global health architecture is no longer shaped by governments alone. Biopharma and digital health industry actors have played increasingly visible roles at WHA. This year, many deployed so-called “commercial colonisation” to coordinate shiny side events, invite-only roundtables and champagne breakfasts. While some public health traditionalists still balk at brands and the very idea of public-private partnerships, others see the value of industry in injecting much-needed capital, energy and speed into global health. And China knows exactly how to operate smoothly in this integrated ecosystem, with its hybrid financing, industrial tech alliances, and vertically integrated delivery models already competing across political, financial as well as commercial fronts.
It’s understandable why many member states, particularly lower and middle income countries (LMICs), are turning toward China. They are navigating a world of shrinking Western aid and fractured alliances. Just this week, DHHS Secretary RFK Jr. dismantled and replaced the CDC’s main vaccine advisory group, ACIP, sparking public health outcry. Meanwhile, last month, China’s multilateral lender, the AIIB, partnered with GAVI to offer up to $1 billion in financing for vaccines in LMICs. China’s alternative offer to the once US-dominated vaccine space, is yet another representation of its expanding and distinctive grip on the future of global health writ large.
WHA78 may not have been a “funeral”, exactly. But it certainly marked the end of an era in global health, and the beginning of a new dawn. China is reinventing what power looks like, and showing up with hard cash, sophisticated strategy and selective ambition. And more importantly, as I’ve written before, the Global South seems to like this, very much.
🔬This is a Real Diagnosis post at China Health Pulse, where I dive deeper into key topics and current trends. Today’s post covered China’s central role at this year’s World Health Assembly, and was recently featured in Bill Bishop’s Sinocism newsletter:
For more on this topic, please see my post detailing how China is reshaping development aid, infrastructure-first diplomacy and public health partnerships:
Excellent and thoughtful analysis
To be frank, US "discretionary " injections were just so because the US controlled the discretionary spending through it's enormous clout over the mandarins running the WHO, through joint funding through organs run by US interest like Bill Gates Foundation, etc. China not only doesn't have those people looking after it's interests, they'd do their best to hijack them. Hence the difference in spending models.