China’s New Role in the World Health Organization

After the U.S. withdrawal from the organization, China – WHO relations may have reached a turning point. This article explores the potential moves of the “Middle Kingdom” — analyzing its global and domestic health policy.

Introduction

In January 2026, the US officially withdrew from the World Health Organization (WHO) after President Trump’s previous announcement on his first day in office in 2025. This decision is part of a broader plan for the US to withdraw from UN agencies, as had already occurred during the first Trump administration (Trump I, 2016–2020). America’s absence creates a substantial financial vacuum for the WHO’s budget. Several projects (>1000 per WHO numbers), especially in developing countries, are reportedly being halted. This disruption could have catastrophic consequences, especially for the dissemination of vaccines against diseases such as malaria and tuberculosis, as well as for prevention practices. Consequently, a frequently recurring question among observers is whether the People’s Republic of China (PRC) could succeed the United States in assuming a leading role in both regulation and budgeting.

How is the WHO financed?

The WHO’s funding system is divided into two types of contributions: assessed and voluntary. Assessed contributions are dues that each member pays to be part of the organization. These are calculated based on their demographic and health indicators. For example, in 2023, the US contributed $218 million while China contributed just under $115 million. Voluntary contributions are funds that each member decides to allocate independently to support the organization’s programmatic projects. These can be specific, thematic, or core. In this case, the US contributed over $1 billion in 2023 and China contributed just $41 million. The problem arises when 88% of the WHO’s total budget comes from voluntary contributions, 60% of which come from just nine donors, including the United States. China, with its small contribution, ranks 23rd.

This is no coincidence. In fact, China’s role in global health policy also involves secondary routes. For example, during the Covid-19 pandemic, despite having helped distribute vaccines to over 120 countries through WHO institutional channels, Beijing also operated bilaterally through the New Silk Road (Health sector, Health Silk Road) to reach member countries with medical supplies, thus departing from the COVAX initiative, established by the WHO jointly with the Gavi Foundation and UNICEF from 2020 to 2023. This choice, combined with the accusations of having generated the virus in the Wuhan laboratory, which led Donald Trump to call the coronavirus the “China Virus,” has led the People’s Republic to receive harsh criticism from the United States. However, the WHO, through its Director General, Dr. Tedros, has repeatedly praised China’s attitude in global health policy.

China-WHO History at a Glance

Contacts between China and the WHO began after obtaining UN recognition with Resolution 2758 in 1971, with the PRC joining the organization in 1974. Ties strengthened after the regional office opened in Beijing in 198., The People’s Republic appointed its first representative to the organization (Arthur W. Chung) and joined the Global Influenza Surveillance Network (GISN) in 1981. The office coordinates China’s health aid activities worldwide and, in recent years, has focused on health emergencies in Yemen and Syria. Through its collaboration with the Centre for Disease Control and Prevention and the National Health Commission —the country’s key decision-making bodies—China was also the first country to respond to the emergency in West Africa following the Ebola outbreak in 2014.

China’s international commitment links to an ambitious 29 chapter national health plan, “Healthy China 2030”. President Xi aims to improve national healthcare levels, achieving a life expectancy of 79 years across the country and strengthening prevention and control services. However, as of 2022, the percentage of GDP invested in health (5.37%) remained somewhat lower than that of the US (16.5%) and Japan (11.42%), as did per capita spending. The national plan aligns with China’s vision of the “One Health” concept promoted by the WHO, according to which human health also requires respect and attention for environmental and animal health. This principle has existed in China since the Warring States Period (475–221 BC). In this regard, Shanghai Jiaotong University launched a consortium in 2021 to discuss the practical application of the One Health concept. In parallel, a group of Chinese researchers created the “One Health Index,” highlighting serious shortcomings compared to G20 countries in key areas such as: tuberculosis control, living conditions in rural areas, the effectiveness of climate change responses, air quality, food economics, and antimicrobial surveillance.

Current Chinese Moves and Future Ahead

The first step toward a shift in China’s leadership role at the WHO was at the last World Health Assembly, held in Geneva in May 2025. Beijing accepted (albeit with recriminations) a 20% increase in its assessed contributions and decided to donate $500 million in voluntary contributions spread over five years. This contribution is more symbolic than substantial, given that the void created by the US would require a greater effort, especially in the immediate future (the US has provided for $958 million in the period 2024–2025). This is an effort Beijing appears unwilling to make, given its domestic objectives, which appear to be a priority.

These facts do not imply that Beijing will withdraw from the WHO or that it does not intend to assume a more visible role. President XI committed to the China-WHO Country Cooperation Strategy 2022–2026, which features the Triple Billion Goal:

1. One billion more people with access to universal health insurance
2. One billion more people protected from health emergencies
3. One billion more people enjoying good health and well-being

Will China Replace the US at WHO?

It is likely that the People’s Republic will gradually increase its involvement within the WHO. China will play a significant role in tandem with other states, including India which gave $68 million in voluntary contributions by 2023 but only $8 million in fixed contributions. Why even discard a more utopian hypothesis, that of a coalition of countries neighboring China, which could jointly try to satisfy its economic needs?

At the same time, it’s clear that the Triple Billion Goal set by the WHO is somewhat vague, as is the structural criticality of the funding. If the organization wants to continue playing a central role in planning global health policy and preventing future epidemics and pandemics that will increasingly impact our planet due to climate change, it can use the US withdrawal to rethink its approach. For example, during the next rounds of negotiations, which will inevitably lead to a further increase in assessed contributions, the WHO needs to ensure that its budget depends primarily on these, rather than on unpredictable voluntary donations. Without the US at the negotiating table, China could become the new mediator and attempt to forge a new cross-state majority that cares about the WHO’s role.

Simply put, Beijing is called upon to do its part, as is the WHO.

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^[1] The author acknowledges the help and support offered by Mr. José Martínez-Aragón, former WHO Ombudsman from 2015 to 2022.