The Absent Partner

When the World Health Organisation was established in 1948 as a specialised agency of the United Nations, the People’s Republic of China was not yet represented. During these formative years, the Republic of China (Taiwan) held China’s seat at the WHO, while mainland China built its own healthcare systems in isolation, focusing on rural barefoot doctors and mass public health campaigns to address widespread infectious diseases.

Recognition and Early Integration (1972-1979)

China’s entry into the WHO in 1972 marked a diplomatic breakthrough that paralleled its broader international recognition. Dr. Ma Haide (George Hatem), an American-born physician who had become a Chinese citizen, played a crucial early role in bridging Chinese and Western medical approaches at the WHO. Initially, China’s participation was cautious and limited, focused primarily on receiving technical assistance rather than setting agendas.

“Our first WHO conferences were challenging experiences,” recalled Dr. Zhang Wenkang, who would later become China’s Health Minister. “We were observers more than participants, learning the international health diplomacy language that had developed during our absence.”

From Recipient to Participant (1980s-1990s)

Throughout the 1980s and 1990s, China’s relationship with the WHO evolved alongside its opening to the outside world. The country received significant technical support for immunisation programs, maternal and child health initiatives, and healthcare system development. China’s health officials gradually became more active in WHO technical committees, though its financial contributions remained modest.

The WHO’s support proved crucial in China’s successful elimination of diseases like polio (eradicated in 2000) and implementation of primary healthcare reforms. By the late 1990s, Chinese medical journals increasingly published studies adhering to WHO protocols, and Chinese health administrators had begun adopting WHO standards in national guidelines.

PART II: TRANSFORMATION (2001-2019)

The SARS Catalyst (2002-2003)

The SARS outbreak of 2002-2003 represented both a crisis and a turning point in China’s relationship with the WHO. Initial delays in reporting and information sharing drew international criticism, including from WHO officials who struggled to gain early access to outbreak sites.

Dr. Jiang Yanyong’s whistleblowing about the true extent of SARS cases in Beijing military hospitals placed enormous pressure on the relationship. The WHO took the unprecedented step of issuing travel advisories against visits to affected Chinese regions, bypassing government approval. This move strained relations but ultimately pushed China toward greater transparency.

The aftermath brought substantive reform. China overhauled its infectious disease reporting systems, established the Chinese Centre for Disease Control and Prevention, which was partly modelled on international standards, and developed new protocols for working with WHO emergency teams.

“SARS taught us that concealing outbreaks is futile in a connected world,” noted Dr. Gao Fu, who would later direct China’s CDC. “It was a painful but necessary lesson in modern global health governance.”

Growing Confidence and Contribution (2003-2015)

In the post-SARS era, China’s engagement with the WHO grew more confident and assertive. The country substantially increased its voluntary contributions, supported WHO initiatives in Africa as part of its broader diplomatic outreach, and began promoting the international recognition of traditional Chinese medicine.

During the 2009 H1N1 pandemic, China demonstrated improved coordination with WHO protocols, implementing rapid response measures and information sharing. When the 2014 Ebola outbreak struck West Africa, China deployed its largest-ever medical assistance team abroad and coordinated its response through WHO frameworks, signalling its growing capacity as a global health actor.

Chinese health officials increasingly occupied senior technical positions within the WHO bureaucracy. In 2016, Dr. Margaret Chan completed her second term as WHO Director-General—although as a Hong Kong physician, her rise predated Hong Kong’s return to Chinese sovereignty.

New Ambitions: Health Silk Road (2016-2019)

By the late 2010s, China had begun explicitly linking its health diplomacy to its broader Belt and Road Initiative. The “Health Silk Road” concept, first articulated by President Xi Jinping in 2016, envisioned China taking a leading role in building health infrastructure and capacity across Asia, Africa, and beyond.

A 2017 memorandum of understanding between China and the WHO formalised this concept. The WHO lent legitimacy to China’s health outreach efforts while gaining access to Chinese funding for development projects. China’s annual contributions to the WHO had grown tenfold since 2000, though still well below American and European levels.

During this period, China successfully advocated for the inclusion of traditional Chinese medicine in the influential International Classification of Diseases (ICD) of the WHO, a diplomatic victory that recognised TCM’s global spread while drawing criticism from some Western medical scientists.

PART III: PANDEMIC AND POLARIZATION (2020-2025)

COVID-19: Crisis and Controversy (2020-2021)

The COVID-19 pandemic placed the China-WHO relationship under unprecedented scrutiny. Early interactions between Chinese officials and the WHO during the critical initial weeks in Wuhan became the subject of intense global debate.

WHO Director-General Tedros Adhanom Ghebreyesus initially praised China’s transparency and decisive measures, including Wuhan’s unprecedented lockdown. However, subsequent investigations revealed delays in information sharing during the crucial early phase of the outbreak.

As geopolitical tensions escalated, the WHO found itself caught between Chinese insistence on controlling the narrative and access, and Western demands for greater independence and investigative authority. The Trump administration’s decision to withdraw from the WHO in 2020 created a power vacuum that China moved quickly to fill, increasing its financial support and diplomatic backing for the organisation.

Chinese vaccine diplomacy—distributing hundreds of millions of doses globally, particularly to developing nations—was partially channelled through WHO mechanisms like COVAX, further cementing China’s role as a critical WHO partner during the emergency.

Realignment and Recovery (2022-2025)

In the aftermath of the pandemic, China’s position within the WHO strengthened considerably. With the Biden administration temporarily rejoining the organisation but facing domestic constraints on funding commitments, China steadily expanded its financial contributions and technical presence.

The 2021-2022 negotiations over a new pandemic treaty and International Health Regulations reforms revealed the growing Chinese influence. China successfully advocated for sovereignty protections and pushed back against automatic investigation triggers while simultaneously positioning itself as a champion of multilateralism.

By 2023, China had become the second-largest WHO donor after the return of US partial funding. Chinese medical initiatives, including the Health Silk Road, became increasingly integrated into WHO regional strategies, particularly in Africa and Southeast Asia. More WHO collaborating centres were established in Chinese research institutions, and Chinese health officials occupied an unprecedented number of technical leadership positions.

The 2024 US election and subsequent second Trump administration withdrawal from WHO funding created another inflexion point. China’s May 2025 announcement of $500 million in additional WHO funding over five years represented both a practical necessity for the organisation and a symbolic assertion of Chinese leadership in global health governance.

PART IV: THE PERSONAL STORY – DR. LIU YANHONG’S JOURNEY

Early Career and WHO Introduction (2010-2019)

Dr. Liu Yanhong completed her medical training at Peking Union Medical College in 2010, specialising in infectious disease epidemiology. Her early career coincided with China’s increasing engagement with global health institutions.

In 2015, Liu secured a competitive position as a technical officer at WHO headquarters in Geneva, working on antimicrobial resistance surveillance—one of a growing number of Chinese professionals entering the international health bureaucracy. During this period, she navigated the complex dynamics of being a Chinese national in a Western-dominated institution.

“There was always an unspoken expectation that I represented China, even when I was working on purely technical matters,” Liu later reflected. “I learned to balance my national identity with my professional role, sometimes having to prove my scientific objectivity more than my European colleagues.”

Liu returned to China in 2018 to take a position at the Chinese Centre for Disease Control and Prevention in Beijing. She brought her international experience to China’s rapidly evolving public health system, and her WHO connections made her a valuable asset, particularly as China sought to strengthen its global health diplomacy.

The Pandemic Crisis (January-March 2020)

When reports of a novel pneumonia emerged from Wuhan in late December 2019, Liu was assigned to the emergency response team at the China CDC. Her experience with WHO protocols positioned her at the critical interface between Chinese authorities and incoming WHO experts.

The early weeks tested her professional and personal ethics. While committed to scientific transparency, she also faced intense pressure from superiors to project confidence and control. When the first WHO team arrived in Beijing in late January, Liu served as a technical liaison.

“Those meetings were the most challenging of my career,” she later told colleagues. “I had data showing concerning human-to-human transmission patterns that hadn’t been fully acknowledged in official statements, but raising these directly with the WHO team could have been seen as undermining our national response.”

Liu made the difficult decision to ensure the WHO team received complete epidemiological datasets, even when these suggested more serious transmission than publicly acknowledged. This quiet act of professional integrity helped the WHO experts develop more accurate risk assessments, though their public statements remained diplomatically calibrated.

When Wuhan locked down on January 23, Liu volunteered to join the field response, arriving on a near-empty government flight. For the next six weeks, she worked with local hospitals to implement isolation protocols and data collection systems compatible with WHO standards, preparing for the eventual arrival of international experts.

Building Bridges (April-December 2020)

By April 2020, as Wuhan began its recovery, Liu was appointed to the official joint WHO-China investigation team examining the origins of the virus. Her dual experience with Chinese health systems and WHO methodologies made her an ideal intermediary, though she also found herself in politically sensitive terrain.

“I remember one particularly tense meeting where a senior official wanted certain sites excluded from the investigation itinerary,” she confided to her journal. “I argued that following standard WHO protocols would actually strengthen China’s credibility. Sometimes the best patriotism is ensuring we meet the highest international standards.”

Liu’s approach eventually prevailed in several key procedural matters. However, the investigation remained constrained by political considerations from both Chinese authorities and the WHO itself, which was navigating intense geopolitical pressures.

In September 2020, Liu was promoted to help coordinate China’s vaccine distribution through COVAX, the WHO-led initiative for equitable vaccine access. This role placed her at the centre of China’s health diplomacy, as Chinese vaccines became critical resources for many developing nations.

New Responsibilities (2021-2025)

As relations between China and the WHO deepened following the US withdrawal, Liu found her career accelerating. In 2021, she was appointed as a senior advisor to the WHO Regional Office for the Western Pacific, becoming one of the highest-ranking Chinese nationals in the organisation’s regional structure.

Liu helped shape implementation strategies for the Health Silk Road initiative, aligning Chinese bilateral health programs with WHO standards and frameworks. Her work focused particularly on strengthening disease surveillance systems across Southeast Asia and the Pacific Islands, regions of strategic importance to China.

“There’s a delicate balance in this work,” she explained to new Chinese colleagues entering the WHO system. “Our technical contributions must be unimpeachable, even as we understand the broader strategic context of China’s health diplomacy.”

By 2023, as negotiations intensified around reforms to the International Health Regulations, Liu was seconded to the Chinese Ministry of Foreign Affairs as a health advisor for multilateral negotiations. She helped craft China’s positions on sovereignty protections and reporting obligations, working to find acceptable compromises between Western demands for greater WHO authority and China’s emphasis on national control.

When China announced its landmark $500 million commitment in May 2025, Liu was present at the World Health Assembly in Geneva. The moment represented both personal and national transformation—a journey from WHO outsider to central player, mirroring China’s own evolution from health aid recipient to global health leader.

“Twenty years ago, we were learning WHO protocols,” she observed to a colleague after the announcement. “Now we’re helping write them. The challenge ahead is ensuring we use this influence responsibly, for genuine global health security rather than narrow national advantage.”

As Liu watched Vice-Premier Liu Guozhong deliver China’s funding commitment, she reflected on how far she and her country had come in their WHO journey and the complex responsibilities that accompanied their new leadership role in global health governance.

PART V: FUTURE HORIZONS (2025-2035)

Institutional Transformation

The years following China’s landmark funding commitment are likely to accelerate changes already underway in WHO governance and priorities:

Leadership Diversification: With China’s financial leverage increasing, the 2027 WHO Director-General election may well see the first serious Chinese candidate for the position, potentially accelerating the organisation’s eastward shift.
Structural Reform: China’s approach to WHO reform emphasises strengthening country offices and regional structures where its influence is most significant, particularly in Africa and Southeast Asia, potentially creating a more decentralised organisation.
Digital Health Governance: China’s advanced health technology applications, from AI diagnostics to digital contact tracing, will increasingly shape WHO technical standards, creating new areas of both cooperation and tension with Western approaches to data privacy.

Emerging Cooperation and Competition

Several key areas will define the evolving China-WHO relationship:

Traditional Medicine Integration: By 2030, WHO treatment guidelines for chronic conditions will likely incorporate more elements of traditional Chinese medicine, reflecting both scientific evaluation and China’s successful promotion of TCM as a cultural export.
Pharmaceutical Innovation: Chinese pharmaceutical companies, increasingly producing novel treatments rather than generics, will seek WHO prequalification and recommendation for their products, challenging Western dominance of global pharmaceutical standards.
Health Security Architecture: China’s approach to biosecurity and pandemic prevention, emphasising sovereignty and state capacity over independent international authority, will continue to shape WHO emergency mechanisms, potentially limiting the organization’s investigative powers during outbreaks.

Geopolitical Implications

The health sphere will increasingly reflect broader geopolitical realignments:

Multipolar Health Governance: If American engagement remains inconsistent, a tripolar influence structure may emerge with China, the European Union, and philanthropic actors like the Gates Foundation as the primary shapers of WHO priorities.
Development Paradigms: China’s health aid model, emphasising infrastructure development and bilateral relationships alongside multilateral WHO mechanisms, will increasingly compete with Western approaches that prioritise governance reform and civil society engagement.
New Health Silk Road: By 2035, China’s health diplomacy initiatives could evolve into a comprehensive alternative health governance framework, operating alongside but sometimes in tension with WHO structures.

CONCLUSION: NAVIGATING THE TRANSITION

The evolution of China’s relationship with the WHO reflects the broader transformation of global governance in the 21st century. From outsider to integral partner, China’s journey within the organisation embodies both the promise of more inclusive global health leadership and the challenges of navigating divergent values and interests.

For the WHO itself, China’s increased engagement offers critical financial stability and expanded reach into developing regions, while raising questions about the organisation’s independence and normative standards. For China, the WHO provides an essential platform for projecting soft power and shaping global health frameworks in ways that accommodate its domestic priorities and international ambitions.

The ultimate impact of this evolving relationship will depend on how successfully both China and the WHO can balance competing imperatives: between sovereignty and collective action, between diverse medical traditions and evidence-based standards, and between health as a technical domain and health as an arena of strategic competition.

The promise of this relationship lies in its potential to create truly global health governance that transcends the Western-centric frameworks of the 20th century. The risk lies in the politicisation of health cooperation and the subordination of scientific evidence to geopolitical advantage. The challenge for both China and the WHO in the decades ahead will be navigating between these possibilities to build health systems that serve humanity’s shared vulnerability to disease.

Singapore’s Strategic WHO Engagement Under PM Wong

PM Lawrence Wong’s $24 million pledge to the WHO Investment Round represents more than just financial support—it signals Singapore’s deliberate positioning within global health governance. This commitment aligns with Singapore’s broader strategy of establishing itself as an influential middle power through multilateral institutions.

The timing is particularly significant. By being “among the first” to pledge, Singapore demonstrates forward-thinking leadership during a period when the WHO faces both funding challenges and questions about its future direction. The pledge specifically targets the WHO’s core work from 2025 to 2028, a critical period for implementing post-pandemic reforms.

Alignment with WHO’s Strategic Transformation

Singapore’s commitment directly supports the WHO’s ongoing Strategic Transformation agenda, which has several key pillars:

Enhanced Emergency Preparedness: Following COVID-19, the WHO has prioritised building stronger early warning systems and rapid response mechanisms. Singapore’s support helps fund these critical infrastructure improvements.
Digital Health Transformation: The WHO has been advancing digital health solutions for service delivery, surveillance, and data analysis. Singapore, with its advanced digital infrastructure, offers both financial support and expertise in this domain.
Universal Health Coverage: The WHO continues its push for equitable healthcare access globally. Singapore’s hybrid healthcare system offers potential models for sustainable financing that balance public and private sectors.
Diplomatic Bridge-Building: By highlighting how countries reached consensus on the Pandemic Agreement “despite deep differences,” PM Wong emphasises Singapore’s value as a diplomatic bridge between various global health positions.

Singapore’s Regional Health Leadership Aspirations

The WHO initiative positions Singapore as a regional health leader in Southeast Asia, where it can:

Leverage its experience in pandemic management and healthcare system efficiency
Serve as a knowledge hub through institutions like the Singapore Global Health Security Consortium
Facilitate ASEAN-wide health coordination mechanisms

The Philanthropy Asia Summit Connection

PM Wong’s mention of hosting the Philanthropy Asia Summit reveals a sophisticated multi-sector approach. Singapore is not just supporting the WHO directly but creating platforms for private capital to address health system resilience. This reflects the WHO’s own strategic shift toward engaging non-state actors and diverse funding mechanisms.

Future Trajectory of WHO-Singapore Relations

Looking forward, Singapore’s substantial investment positions it to:

Influence WHO Governance Reform: As a reliable financial contributor, Singapore gains leverage in discussions about the WHO’s decision-making structures and emergency powers.
Expand Regional Coordination Mechanisms: Singapore could become a hub for the WHO’s regional health emergency coordination efforts.
Shape the Implementation of the Pandemic Agreement: Having supported the diplomatic process, Singapore is positioned to play a key role in how the agreement is operationalised.
Export Healthcare Expertise: Singapore’s healthcare model, which emphasises efficiency and technological innovation, may influence WHO’s technical guidance.

Alignment with the WHO’s Vision Transformation

PM Wong’s initiative connects directly to the WHO’s evolving vision from its traditional focus on disease control toward a more comprehensive approach to health security as part of the global security architecture. This shift is evident in:

The WHO’s expanded conceptualisation of health threats to include climate change impacts and antimicrobial resistance
Greater emphasis on health system resilience rather than just disease-specific interventions
Movement toward “One Health” approaches that recognise interconnections between human, animal, and environmental health

Singapore’s participation in this vision transformation is strategic. It positions the country as both a contributor to and beneficiary of a more robust global health system capable of managing complex, interconnected threats.

WHO’s Evolving Vision and Singapore’s Strategic Position in Global Health

The WHO’s Transformative Vision: Present to Future

Current Strategic Transformation (2023-2025)

The World Health Organisation is undergoing a profound evolution, moving beyond its traditional disease-control mandate toward a more comprehensive conception of global health security. This transformation, accelerated by the COVID-19 pandemic, encompasses several interconnected pillars:

Integrated Health Emergency Architecture: The WHO has been constructing a more robust global health emergency system with enhanced surveillance capabilities, rapid response mechanisms, and coordinated action protocols. The establishment of the WHO Hub for Pandemic and Epidemic Intelligence in Berlin and the continued development of the WHO Emergency Operations Network exemplify this direction.
Universal Health Coverage as Security Infrastructure: Rather than viewing UHC as merely aspirational, the WHO increasingly frames resilient national health systems as critical security infrastructure. The organisation’s investment in primary healthcare strengthening now explicitly connects to global health security objectives.
“One Health” Paradigm Integration: The WHO has formalised collaborations with the Food and Agriculture Organisation, the World Organisation for Animal Health, and the UN Environment Programme through the One Health Joint Plan of Action. This represents a fundamental shift from treating human health in isolation to recognising the complex interplay between human, animal, and environmental systems.
Digital Health Transformation: The WHO’s digital health strategy has evolved from supporting basic telehealth to creating global digital health architectures. The organisation now promotes interoperable systems for disease surveillance, clinical decision support, and health workforce optimisation.
Equity-Centred Approach to Health Security: The WHO has conceptually reframed equity not just as a moral imperative but as fundamental to adequate health security. This includes mechanisms for ensuring equitable access to medical countermeasures during emergencies.

Future Trajectory (2026-2030)

The WHO’s emerging vision for the remainder of the decade builds upon these foundations while adding critical new dimensions:

Operational Independence Enhancement: Following criticism during COVID-19, the WHO is working to secure more sustainable, flexible funding to reduce dependence on earmarked voluntary contributions that constrain its operational autonomy. Singapore’s contribution to the Investment Round represents a key mechanism for this transformation.
Climate-Health Integration: The WHO is positioning itself as a leading voice on climate change as a health determinant. Its climate-health nexus strategy integrates climate considerations into all aspects of global health governance.
Pandemic Agreement Implementation: The WHO will take centre stage in operationalising the Pandemic Agreement reached in April 2025, balancing sovereignty concerns with the imperative for coordinated action.
Global Health Workforce Sustainability: The organisation is developing more comprehensive approaches to health workforce development, addressing chronic shortages exacerbated by the pandemic.
AI and Emerging Technology Governance: The WHO is expanding its normative work on AI, synthetic biology, and other emerging technologies with health implications, working to establish frameworks that maximise benefits while minimising risks.

Singapore’s Strategic Position in WHO’s Evolving Vision

Singapore’s Current Health Diplomacy Posture

Singapore has methodically positioned itself as an influential middle power in global health through several strategic approaches:

Financial Credibility: The $24 million pledge to the WHO Investment Round represents approximately $4.20 per capita, a proportionally significant contribution that exceeds many larger economies. This positions Singapore as a reliable financial partner during a period of WHO funding uncertainty.
Technical Excellence Leverage: Singapore strategically projects its healthcare system strengths—particularly in healthcare digitalization, disease surveillance, and health system efficiency—into global health discussions. The National Centre for Infectious Diseases and integrated health information systems serve as demonstration models that the WHO frequently references.
Diplomatic Bridge-Building: Singapore has cultivated a reputation as an honest broker in global health negotiations, exemplified by its contributions to the Pandemic Agreement negotiations. Its diplomatic approach emphasises pragmatic solutions rather than ideological positions.
Knowledge Diplomacy: Through institutions like the Duke-NUS Medical School’s SingHealth Duke-NUS Global Health Institute and the Saw Swee Hock School of Public Health, Singapore projects thought leadership in global health security, influencing WHO policy directions.

Singapore’s Comparative Advantages in Global Health

Singapore brings distinct advantages to its WHO engagement:

Pandemic Management Expertise: Singapore’s COVID-19 response demonstrated capabilities in maintaining healthcare system functionality during the crisis, balancing public health measures with economic considerations, and deploying digital tools effectively.
Healthcare System Efficiency: Singapore’s hybrid financing model achieves universal coverage with relatively low expenditure (approximately 4.9% of GDP compared to OECD averages exceeding 8.8%), offering potential models for sustainable health financing.
Biomedical Research Infrastructure: Singapore’s investments in biomedical sciences have created capabilities in emerging infectious disease research, vaccine development, and diagnostic innovation that contribute to the WHO’s technical knowledge base.
Strategic Geographic Position: Singapore’s location at the crossroads of Asia positions it as a natural coordinator for regional health security initiatives and a sentinel site for emerging health threats.

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China’s Evolving Relationship with the WHO