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Curated by Marc Reverdin |
Pharma between America First and the Health Silk Road
On April 7, Reverdin Consulting will attend the One Health Summit in Lyon, which emphasizes a planetary, holistic vision of global health. Against this backdrop, we are seeing a retreat of multilateralism, as the United States and China appear to be swapping health diplomacy playbooks and competition in the pharmaceutical sectors ramps up between the two.
For decades, the US was the indispensable backbone of multilateral global health and the largest WHO contributor. China, meanwhile, worked through bilateral channels to maximize its leverage and minimize accountability to international norms. That dynamic is now reversing.
The US once provided more than $204 billion in foreign health assistance since 2001, nearly a third of all global health aid worldwide. However, the Trump administration's approach to global health can be easily summarized: dismantle, withdraw. The United States formally exited the WHO in January 2026. Its new America First Global Health Strategy, unveiled in September 2025, outlines the shift to bilateral agreements. By March 2026, 24 countries had signed bilateral memoranda of understanding (MOUs) with the US under this framework. The deals come with requirements and strings attached, often mandating US access to strategic resources.
China's trajectory runs in the opposite direction. Historically, Beijing has been a reluctant multilateralist, preferring bilateral health aid tied to Chinese strategic and economic interests. The Health Silk Road, officially launched in 2017 as an extension of the Belt and Road Initiative, is the clearest expression of this model.
But with the US vacating multilateral spaces, China has moved to fill them. At the May 2025 World Health Assembly, Beijing pledged $500 million to the WHO over five years, becoming its largest state donor, and voted in favor of the landmark WHO Pandemic Agreement. The question is whether this represents a genuine strategic shift or an opportunistic moment. A study of Chinese health diplomacy published in January 2026 suggests China is pursuing a dual strategy: maintaining multilateral engagement where it serves its interests, while continuing to build bilateral health partnerships outside the WHO framework.
It is against this backdrop of accelerating realignment that the 79th World Health Assembly (WHA79) will convene in Geneva in two months. It will be the first session held without the United States following their formal withdrawal in January 2026. Member states will be called upon to address the organization's financing gap, advance governance reform in the post-American era, and finalize the PABS (Pathogen Access and Benefit-Sharing) annex to the Pandemic Agreement, negotiations for which are entering their final stretch with substantial divergences between country blocs still unresolved. This annex will govern manufacturers' obligations on pathogen sharing and benefit repatriation during future health emergencies. It sits precisely on the fault line between the logic of national sovereignty championed by Washington and the logic of global public goods now espoused by Beijing. WHA79 will be the first test of the new global health architecture.
Where does the pharmaceutical industry fit into this? Between a Washington that is coercing and a Beijing that is attracting, the pharmaceutical industry is being pulled in two directions at once. In effect, China supplies roughly 40% of the active pharmaceutical ingredients in US generic drugs. Under the threat of Trump’s 100% tariffs, drugmakers including AstraZeneca, Pfizer, and Johnson&Johnson have collectively pledged over $370 billion in US manufacturing investments. Yet experts warn these pledges will not reduce US dependence on Chinese APIs; they will simply add domestic capacity on top of an unchanged global supply web.
Meanwhile, the same companies signing US investment pledges are simultaneously deepening their China ties: AstraZeneca committed to a $15 billion investment in China for cell therapy; Takeda staked over $11 billion on Chinese cancer drugs; and licensing deal average sizes have already reached $1.3 billion in 2026 — up 76% from 2025. Big Pharma is, in effect, pledging allegiance to both flags.
As WHO Director-General Tedros warned in February 2026, global health systems are "at risk", countries are being pushed toward self-reliance and the medicines most critical in a future outbreak run through the very supply chains at threat of being severed. What is clear is that the world cannot afford a leadership vacuum, but neither power is a reliable steward of a system that depends on trust, continuity, and genuine cooperation. And the next pandemic will not wait for geopolitics to resolve itself.
To circle back to the One Health approach, it includes animal and planetary health, involving a broader coalition of stakeholders and therefore being necessarily multilateral. The United States, which released its first National One Health Framework in January 2025 under a bipartisan congressional mandate, has since moved to dismantle the very federal agencies — CDC foremost among them — that were to lead its implementation, while China has explicitly embedded One Health principles in its Country Cooperation Strategy with the WHO and enshrined them in the May 2025 Pandemic Agreement.
The Lyon summit is not a retreat from geopolitics but an opening onto them: in a world where the infrastructure of multilateral health is under strain, the One Health agenda offers both a test of whether genuine cross-border cooperation remains possible, and a reminder of what is at stake when it does not.