On April 7, Reverdin Consulting will attend theOne Health Summitin Lyon, which emphasizes aplanetary, holistic vision of global health. Against this backdrop, we are seeing aretreat of multilateralism, as the United States and China appear to be swapping health diplomacy playbooks andcompetition in the pharmaceutical sectorsramps up between the two.
For decades, the US was the indispensablebackbone of multilateral global healthand thelargest WHO contributor. China, meanwhile, worked throughbilateral channelsto 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 newAmerica First Global Health Strategy, unveiled in September 2025, outlines the shift to bilateral agreements. By March 2026,24 countrieshad signed bilateral memoranda of understanding (MOUs) with the US under this framework. The deals come with requirements and strings attached, often mandatingUS access to strategic resources.
China's trajectory runs in the opposite direction. Historically, Beijing has been areluctant multilateralist, preferring bilateral health aid tied to Chinese strategic and economic interests. TheHealth 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. Astudy of Chinese health diplomacypublished in January 2026 suggests China is pursuing adual strategy: maintaining multilateral engagement where it serves its interests, while continuing to buildbilateral health partnershipsoutside the WHO framework.
It is against this backdrop ofaccelerating realignmentthat the79th World Health Assembly (WHA79)will convene in Geneva in two months. It will be thefirst session held without the United Statesfollowing their formal withdrawal in January 2026. Member states will be called upon to address theorganization's financing gap,advance governance reformin the post-American era, and finalize thePABS (Pathogen Access and Benefit-Sharing) annexto the Pandemic Agreement, negotiations for which are entering their final stretch with substantial divergences between country blocs still unresolved. This annex will governmanufacturers' obligations on pathogen sharing and benefit repatriationduring future health emergencies. It sits precisely on the fault line between the logic ofnational sovereigntychampioned by Washington and the logic ofglobal public goodsnow espoused by Beijing. WHA79 will be thefirst 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 roughly40% of the active pharmaceutical ingredientsin US generic drugs. Under the threat ofTrump’s 100% tariffs, drugmakers includingAstraZeneca, Pfizer, and Johnson&Johnsonhave collectively pledged over$370 billion in US manufacturing investments. Yet experts warn these pledges willnot 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 simultaneouslydeepening their China ties: AstraZeneca committed to a$15 billion investment in China for cell therapy; Takeda staked over$11 billionon Chinese cancer drugs; andlicensing deal average sizeshave 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 towardself-relianceand the medicines most critical in a future outbreak run through the verysupply chains at threat of being severed. What is clear is that the world cannot afford aleadership 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 includesanimal and planetary health, involving a broader coalition of stakeholders and therefore beingnecessarily multilateral. The United States, which released its firstNational One Health Frameworkin January 2025 under a bipartisan congressional mandate, has since moved todismantle the very federal agencies—CDCforemost among them — that were to lead its implementation, while China hasexplicitly embedded One Health principlesin itsCountry Cooperation Strategy with the WHOand enshrined them in the May 2025 Pandemic Agreement.
TheLyon summitis not a retreat from geopolitics but an opening onto them: in a world where theinfrastructure of multilateral health is under strain, the One Health agenda offers both atest of whether genuine cross-border cooperation remains possible, and areminder of what is at stake when it does not.