China unlikely to fill void left by US foreign aid cuts, new data reveals

Following the sharp reduction of US foreign aid under former President Donald Trump, global health programs are facing significant funding gaps. Hopes that China might step in to fill this void are fading, as new data reveals Beijing’s limited and strategic approach to foreign assistance.

According to AidData, a research lab at William & Mary, cited by Bloomberg, China’s total foreign aid commitments—including grants and loans—totaled just $9.76 billion from 2013 to 2022. That’s significantly less than the $12 billion the US spent on global health projects in 2024 alone. Moreover, unlike the US, which funded multilateral organizations and nonprofits through agencies like USAID, China prefers bilateral aid directly to governments, often tied to political alignment.

“China is very strategic in the way it uses its lending and assistance, even in the health space,” said Samantha Custer, AidData’s director of policy analysis. She noted that Beijing’s aid often comes with expectations of political support, including on contentious issues like human rights. A 2024 study found a correlation between medical aid from China during the COVID-19 pandemic and diplomatic backing from recipients on human rights matters.

While the US focused on diseases like HIV, tuberculosis, and malaria, China’s health aid has leaned heavily toward infrastructure. Its largest health-related project to date is an $850 million loan to Cuba for hospital development. Beijing has also shared expertise in infectious disease control, drawing on its experience with SARS and Ebola, and has contributed $319 million to 36 sub-Saharan African countries since 2000.

China’s involvement in global health began in the 1960s with medical missions to Africa and expanded during COVID-19, when it provided aid to over 120 countries in its Belt and Road Initiative, including 2 billion vaccine doses and commitments to train 1,300 practitioners of traditional Chinese medicine.

Still, experts are skeptical that China can replace the US in global health leadership. “What the US has been doing is not simply about money, but also building a network that is so precious that it can’t be measured in numbers,” said Wenhui Mao of Duke University’s Global Health Innovation Center. She also pointed to China’s lack of transparency, noting it doesn’t report its aid to global platforms like the OECD’s Creditor Reporting System.

While China may expand its presence in global health, challenges such as economic slowdown and worsening ties with the US could limit its role. “China doesn’t even need to do anything and it already has gained a narrative advantage,” said Custer. “But no one in the world, including China, can fully fill the gap left by the US.”

By Tamilla Hasanova