Hours after his second inauguration, President Donald Trump announced that the United States would withdraw from the World Health Organization (WHO). To justify the decision, Trump cited both the organization's alleged susceptibility to China's "inappropriate political influence" and the disproportionate financial burden on the United States, noting that despite China's population being three times larger, Beijing's contributions to the WHO remain nearly 90% smaller.
Yet even the staunchest supporters of Trump's decision find themselves contemplating an uncomfortable truth: Washington's withdrawal could inadvertently pave the way for Beijing's expanded influence in global health governance.
The notion that China must—or will—fill the United States' shoes at the WHO, however, fundamentally misreads Beijing's approach to global health leadership. China's strained relationship with the WHO and its clear preference for bilateral aid give it little appetite for matching U.S. contributions. Yet this might hardly matter.
Through its Health Silk Road initiative, strategic personnel placement, and growing influence among developing nations, Beijing is carving a path to global health leadership that doesn't require writing big checks to Geneva. As Trump pursues a potential G2 arrangement with China and retreats from international institutions and commitments, he could help Beijing achieve precisely what his WHO withdrawal aimed to prevent: China's dominant influence in the international health agency.
China's Approach to Aid Funding
Beijing's approach to international health funding reveals a strategic preference to maximize diplomatic leverage through direct bilateral assistance over multilateral commitments. Despite publicly advocating for strengthening the WHO's role, China has shown a lack of interest in significantly increasing its multilateral funding. The country's response to the COVID-19 pandemic illustrated this approach: Only 8% of China's vaccines distributed internationally went through the WHO-supported multilateral COVAX mechanism. Even President Xi Jinping's ambitious pledge at the World Health Assembly in May 2020, when he promised $2 billion for global pandemic control over two years, allocated just $100 million to COVAX—though this is China's largest voluntary pledge to an international organization to date.
Washington's withdrawal could inadvertently pave the way for Beijing's expanded influence in global health governance
On the surface, filling the WHO funding gap does not appear insurmountable for China. The United States is slated to give $261 million in assessed contributions (membership dues calculated based on a country's GDP) for the 2024–25 budget period. China's promise is $175 million for the same time frame. China's swift response during previous funding uncertainties—such as in April 2020 when it pledged an additional $30 million on top of its earlier $20 million commitment following Trump's funding halt—suggests readiness to step up.
The reality, however, is more complex when considering the WHO's complete funding structure. Assessed contributions represent only a fraction of the organization's operating budget, with voluntary donations accounting for more than 80% of the total budget. China's approach to voluntary contributions has shown only modest increases despite significant growth in its assessed contributions. The disparity is striking: Whereas the United States provided approximately $700 million in voluntary contributions for 2024, China's voluntary funding amounted to less than $30 million. The total funding gap is substantial: China's combined contributions of $202 million pale in comparison with the United States's $959 million. This places China eighth among all donors, trailing nations such as Germany and the United Kingdom as well as private entities such as the Gates Foundation.
China and the WHO
The evolution of China-WHO relations provides important context for understanding Beijing's funding decisions. China's 2020 funding commitments coincided with what many considered a honeymoon period in China-WHO relations. During its initial COVID outbreak, China viewed the WHO favorably for its support and defense against Western criticism. This goodwill was reflected in Chinese netizens affectionately nicknaming Director General Tedros Adhanom Ghebreyesus "Secretary Tan," a term typically reserved for Communist Party officials. This warmth, however, cooled following the release of the WHO-China joint study on the origins of the COVID-19 pandemic in March 2021.
Facing widespread criticism, the WHO adjusted its stance on the origins investigation and Tedros urged Chinese cooperation. In response, the Chinese media's tone also changed dramatically, accusing Tedros of becoming "America's mouthpiece" and abandoning scientific neutrality. This strained relationship influenced funding discussions, China grudgingly accepting a 20% increase in assessed contributions in 2023 while criticizing the adjustment as "unfair" and "unacceptable."
Despite those challenges, China could enhance its WHO influence without matching U.S. contributions by leveraging its support from countries part of the Belt and Road Initiative and championing the goal of universal health coverage by 2030. China's recent $50 billion commitment to African development for 2025 through 2027, which includes establishing joint medical centers, deploying 2,000 medical personnel, and supporting the Africa Centres for Disease Control and Prevention, marks a $10 billion increase from 2021. That funding also makes headway on achieving universal health coverage. By contrast, the new Trump administration appears to be retracting its international commitments. Secretary of State Marco Rubio ordered a funding freeze for nearly all U.S. foreign aid programs in late January 2025.
China can also capitalize on opportunities to place its citizens in WHO positions vacated by departing U.S. personnel and contractors following Trump's decision to withdraw. China's systematic preparation for international leadership is evident in its educational initiatives. By 2020, 90% of China's top universities had established specialized programs training students for careers in international organizations.
Furthermore, the U.S. withdrawal from various international commitments could create opportunities for a new form of bilateral cooperation between the United States and China, amplifying Beijing's global influence. Trump's recent statements suggest potential openness to this approach. In December 2024, as president-elect, he expressed optimism about U.S.-China collaboration "to solve all of the problems of the world." His January 2025 conversation with President Xi emphasized the importance of cooperation between the world's two largest economies. A leading Chinese think tank scholar views these developments as a potential sign of the emergence of a G2 global governance structure, particularly given Trump's retreat from other international commitments.
Other Avenues of Influence
As this article is being written, DeepSeek's arrival at the top of the app store charts is shaking the belief that Silicon Valley will remain at the forefront of artificial intelligence (AI) development. Despite U.S. restrictions on high-tech components, such as Nvidia's processing chips, the Chinese company succeeded by developing competitive AI technology at a fraction of the cost of U.S. companies' enormous capital investments. This mirrors a common misconception about China's potential role in global health governance—that expanding its influence would require matching U.S. funding levels at the WHO.
China's approach to global health leadership suggests that closing the WHO funding gap with the United States might be neither necessary nor likely
Just as DeepSeek demonstrated that innovation born of necessity can produce transformative results, China's approach to global health leadership suggests that closing the WHO funding gap with the United States might be neither necessary nor likely. Instead, Beijing appears poised to reshape global health governance through alternative channels: strengthening bilateral health partnerships, expanding its Health Silk Road initiative, and strategically placing personnel in key positions within international organizations.
This suggests a broader pattern in how China approaches global leadership—not by following established Western models or meeting traditional metrics of influence, but by crafting alternative approaches that leverage its unique strengths and relationships with the developing world. As the United States steps back from multilateral commitments under Trump 2.0, the question becomes not whether China will fill the United States' shoes at the WHO, but how it might reshape the very nature of global health governance to better serve its strategic interests.
