7Received 05.05.2025. Revised 20.08.2025. Accepted 01.09.2025.
Acknowledgements. The research was carried out with the support of the Russian Science Foundation grant no. 24-28-01127 (https://rscf.ru/en/project/24-28-01127/).
Abstract. The COVID‑19 pandemic has not only exposed systemic weaknesses in global and national crisis response mechanisms, but has also significantly intensified competitive pressures in international relations. Health diplomacy is now integral to the foreign policy agendas of many countries. However, addressing global health challenges requires leaders capable of proposing effective initiatives while balancing diverse stakeholder interests. This article presents a comparative analysis of U.S. and Chinese approaches to global health leadership. It identifies the strengths and weaknesses of their strategies. The selection of these world powers stems from their strategic rivalry and distinct models of global engagement. Both nations prioritize low and middle-income countries through foreign aid, health system strengthening, and emergency response support, yet their approaches diverge fundamentally. The study examines some important dimensions: the historical evolution and institutional frameworks of their global health policies; preferences for bilateral versus multilateral engagement, and COVID‑19 response strategies, including vaccine diplomacy initiatives. Particular attention is given to the patterns of collaboration with the World Health Organization. The analysis reveals a core dichotomy: China’s pragmatic, bilateral, and sovereignty-focused model contrasts sharply with America’s rules-based, values-driven approach emphasizing multilateral coordination. These differences reflect deeper ideological and structural divisions in global governance. The findings contribute to contemporary policy debates by suggesting that an optimal global health architecture might synthesize elements of both approaches while addressing their respective limitations. Ultimately, the study demonstrates how global health has become both a contested arena and an indicator of evolving international power dynamics in the 21st century.
Keywords: USA, China, leadership, global health, health governance, diplomacy, foreign aid, pandemic
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