China unlikely to fill void left by U.S. aid pullback, data shows

Japan Times

23-04-2025

Charities and developing nations are grappling with funding shortfalls in public health programs after U.S. President Donald Trump slashed U.S. foreign aid commitments.
But those hoping that China might step in to fill the gap are likely to be disappointed, as exclusive data analyzing its foreign aid commitments of the last two decades show.
For one, China's total grant and loan commitments of $9.76 billion in the decade up to 2022 are less than the $12 billion that the U.S. spent on global health projects in 2024 alone, according to data provided by William & Mary's AidData research lab.
And while the U.S. largely gave to public health programs organized by nonprofits or multilateral organizations, China's aid is dominated by bilateral loans and donations directly to individual governments.
"China is very strategic in the way that it uses its lending and assistance dollars, even in the health space,' said Samantha Custer, AidData's director of policy analysis. "There's either reputational, strategic or geopolitical benefits.'
Beijing often ties access to assistance to backing China's preferred policy positions, she added.
A 2024 study found that support for China on human rights issues was "significantly related' to medical assistance from Beijing during the COVID-19 pandemic. Also, one of the main guiding principles since China first started providing foreign aid in the 1960s was "mutual benefit' by which it never regarded assistance as unilateral.
One reason it will be difficult for Chinese money to fill the funding void is that the U.S. and China provide health assistance in very different ways.
The United States Agency for International Development (USAID) prioritized public health issues such as HIV, tuberculosis, malaria and family planning, providing grants to nonprofits and the private sector or multilateral organizations like the Global Fund or Gavi.
The majority of U.S. financing came from the Department of State and USAID. Most of those initiatives have now been terminated or put on hold after Trump in January ordered a pause to all U.S. foreign aid, with some exceptions, arguing that it's not aligned with American interests.
Those hoping that China might step in to fill the gap left by the U.S. are likely to be disappointed. |
REUTERS
Beijing, meanwhile, prefers direct bilateral assistance. China's health-related foreign aid has come in fits and starts and disclosure has been spotty at best, a far cry from the systemic and sophisticated approach spearheaded by the U.S., according to Wenhui Mao, assistant director of programs at Duke Global Health Innovation Center. It is dominated by lending and loan guarantees extended to governments, mainly focused on building infrastructure. China's largest health-aid project was a $850 million loan to Cuba over several years for the construction and renovation of hospitals.
Although China is unlikely to fill the gap, Karen A. Grepin, associate professor at the University of Hong Kong's School of Public Health, said Beijing is likely to "take advantage of the situation to establish itself as a more important donor and powerful agent in this space.'
Besides the building of infrastructure, China now also has a deep reserve of its own public-health experience it can share, from training of personnel to capacity development and skills around the monitoring of and responding to infectious diseases, Grepin said.
China has shifted its funding priorities in recent years, data shows, from infrastructure to other projects including combating infectious diseases — especially after the outbreaks of SARS and Ebola.
China has also drawn upon its efforts in eradicating malaria to help other countries battle the mosquito-borne infection. Between 2000 and 2021, the country provided $319 million to 36 sub-Saharan African countries through hundreds of projects.
China first began providing global health assistance in the 1960s when it dispatched medical teams to Africa. While its aid to the continent continues to this day, China has shifted more of its attention over the decades to Asian countries and members of its Belt and Road Initiative. During COVID-19, China provided health assistance to more than 120 BRI countries by donating 2 billion vaccines, and has vowed to train 1,300 health workers in traditional Chinese medicine over the next few years.
The sudden U.S. withdrawal from much of the global public-health sphere has offered China a unique opportunity to improve its soft power.
"China doesn't even need to do anything and it already has gained a narrative advantage,' said Custer "The sidebar is that it is a much more reliable and attractive partner than the U.S.'
While China will likely keep expanding its international influence in public health, it also faces challenges that could hamper its ability to be an outright leader in the sector — from domestic issues, such as the slowing economy, to geopolitical uncertainties posed by its increasingly fraught relationship with the United States.
Further complicating matters is that — unlike other major international donors — it doesn't report its overseas financing to the platforms that track countries' foreign aid, such as Creditor Reporting System, the primary database for global aid flows.
"What the U.S. has been doing is not simply about money, but also building up a network that is so precious that it can't be measured in numbers,' said Mao. "No one in the world, including China, can fill the gap.'