China’s first batch of emergency humanitarian support to Myanmar is loaded onto an airplane in Beijing in March, 2025. In response to a request from the Myanmar authorities, China gave emergency humanitarian support to help earthquake aid efforts.
Chen Yehua/Xinhua through Getty Photos
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Chen Yehua/Xinhua through Getty Photos
Overseas support has lengthy been a method for the US and China to achieve tender energy and affect—offering public companies in low-income international locations that assist them sort out poverty and illness, and fascinating with individuals to construct cooperation over the long term.
For many years, the 2 international locations had adopted separate worldwide support methods. However the Trump administration has dismantled a lot of the US’ conventional international support methods and is charting a brand new path, whereas China has additionally been adjusting its strategy—stepping up seen contributions to international establishments whereas scaling again among the massive infrastructure tasks that when outlined its technique.
The result’s a second of convergence and competitors: the U.S. is transferring towards a extra transactional mannequin lengthy related to Beijing, and China is positioning itself to turn into a much bigger presence in international well being and growth.
The three phases of Chinese language support
China’s post-World Struggle II international support technique goes again to the Fifties when it supported the rising communist states North Korea and Vietnam. In these days, China itself was receiving support from the Soviet Union, says Carrie Dolanan knowledgeable on Chinese language well being support on the School of William and Mary.
“Part one was this anti-imperialism solidarity,” Dolan says. Then, within the Nineteen Nineties, China shifted.
“Part two, we noticed support supporting Chinese language growth,” says Dolan. China framed its international support as mutually helpful with international locations within the international south, selling financial cooperation and growing commerce.
Within the 2010s, with Xi Jinping’s rise to energy, China sought international management and competitors with the U.S., says Dolan.
“After which part three, we’re actually seeing them transition to this tender energy, nice energy competitors.”
The best way China has given out support on this third part has largely been by way of bilateral agreements just like the Belt and Highway Initiativein keeping with Yanzhong Huanga world well being knowledgeable with the Council on Overseas Relations. Meaning government-to-government offers, typically with massive loans from China.
“(The initiative) was extra centered on massive scale infrastructure like ports, railways, energy vegetation, financed primarily by way of the bilateral loans to construct bodily connectivity and safe financial returns for China,” Huang says.
Till not too long ago, China’s strategies stood in distinction with the U.S. on numerous ranges, in keeping with Samuel Brazysprofessor of worldwide growth at College School Dublin.
China most well-liked working instantly with governments, whereas the U.S. spent tens of billions of {dollars} funding support teams and worldwide organizations just like the United Nations to sort out points like poverty and illness.
U.S. international support grants, Brazys says, additionally tended to concentrate on long-term options and got here with circumstances for governments, similar to bettering human rights, democracy and corruption. China typically didn’t impose restrictions on its support.
China has been adjusting its technique not too long ago
China’s international support was topic to tons of criticismtogether with from the U.S. and recipient international locations, in keeping with Huang.
Dolan’s analysis in Kenya and Sierra Leone on the efficacy of Chinese language support confirmed blended reactions from native medical officers, support and well being staff. Whereas her research confirmed individuals appreciated Chinese language support, they had been additionally involved that China wasn’t all the time contemplating native wants, and that it did not put assets into preserving the longevity of its tasks.
“We might see China purchase MRI machines, after which they arrive in, after which they set up MRI machines,” Dolan says, however as soon as the machines broke down over time, there was no system in place to get them fastened.
For example, Dolan says, she was in what was as soon as a state-of-the-art hospital financed by China in Kenya. Now she says, weeds had been rising by way of the ground.
Dolan says many individuals additionally felt that the big loans from China had been predatory and made international locations economically susceptible. There have been additionally suspicions that China’s financial curiosity was the true motivation behind the help. Finally, Dolan and Huang say, this methodology undermined China’s aim to construct optimistic affect.
“Subordinating support to business curiosity actually eroded belief and tender energy,” Dolan says. “And we had actually opaque bilateral negotiations that enabled corruption, actually sidelining public well being.”
Which is why, Huang says, China, over the previous 5 years, has slowly moved away from the large bilateral offers and is now funding small tasks in low revenue international locations and getting extra concerned with the United Nations.
In 2021, President Xi Jinping introduced a brand new initiative—known as the International Improvement Initiative—modeled extra intently after what the U.S. had been doing, in keeping with Huang.
China started doing what it calls “small and delightful” tasks to handle poverty and well being points.
Previously few years, it refurbished a maternity ward in Zimbabwe, despatched medical gear to Panama, and employed locals to construct a bridge on the island of Kiribati.
Will China step into the US international well being management position?
Because the Trump administration’s overhaul of U.S. international support, consultants and lawmakers alike have voiced a standard concern: U.S. pullback would give its rival China a possibility to step up its affect.
Taking a look at China’s strikes in 2025, consultants say the image is extra sophisticated. Jennifer Boueychair of the International Well being division at Georgetown College and co-author of the analysis challenge with Dolan, has checked out official paperwork and coverage papers from China and says there is a sense of alternative after the U.S. support cuts.
“China is now considering, ‘Okay, now the US is retreating from the U.N., retreating from WHO. It is a time for China to construct its international affect, dominating the worldwide organizations, and on the identical time to have a platform to develop its financial footprint,’ ” Bouey says.
In February 2025, because the Trump administration was dismantling USAIDChina’s support company mentioned it could be doing extra of the “small and delightful” tasks. In March, when a significant earthquake hit Myanmar, China pledged 137 million {dollars} in supportin comparison with about $9 million from the U.S. In Could, China introduced a $500 million donation to the World Well being Group, along with its yearly dues.
These strikes permit China to posture because the grownup within the room, in keeping with Nadege Rollandfellow on the Nationwide Bureau of Asian Analysis.
“You are displaying the face of a benevolent energy that’s liable for mankind, principally,” Rolland says. “Which aligns very nicely with Xi Jinping’s imaginative and prescient for a world order that has China on the heart of it.”
Nonetheless, China spent about the identical total on international support in 2025 because it did in earlier years, says Bryan Burgesswho tracks China’s support spending on the School of William and Mary
“They’re doing quick time period measures to win over hearts and minds, however they are not investing within the kind of infrastructure and sustainability that huge illnesses must get eradicated,” Burgess says.
Each he and Rolland say China will not be dashing to fill the hole left by the U.S.
“I do not assume it is totally able to take that position of a world well being supplier, and it is in all probability began feeling the stones. That is a Chinese language expression to say, ‘we’re advancing very prudently in that route.'” Rolland says.
Nevertheless, it is clear that China will attempt to improve its affect by way of international support, as the united statespresence seems to wane, she says.
The U.S. is altering its mannequin too, and it rings a bell for some
Final fall, U.S. Secretary of State Marco Rubio introduced the brand new America First International Well being Techniqueclaiming the outdated international support mannequin led to a waste of taxpayer cash and wasn’t furthering U.S. political and financial pursuits.
As a substitute, the State Division says it has remodeled a dozen bilateral agreements with low revenue international locations. The administration says it is hoping to create entry to assets like minerals in Africa and alternatives for American companies.
“(The U.S.) appears to be converging towards the Chinese language preexisting mannequin, on the time when China appears to be transferring away from its preexisting strategy,” Huang says.
Huang and Dolan say by commercializing support, the U.S. may face the identical pitfalls that China did.
“I believe that the US ought to concentrate on precise well being and resist attempting to over-commercialize,” says Dolan. “As a result of this commerce first strategy, it solely compromises well being outcomes.”
