The Western Pacific is the key region for China to propose economic cooperation through the BRI, public health governance is a critical factor that affects the harmonious development of the economy and society in this region [7]. Traditionally, this region is part of the Western sphere of influence, but some PICs have begun to seek benefit from the rivalries between the major powers. Fiji and Samoa are the first two PICs to establish diplomatic relations with China, with a positive attitude towards the BRI. However, most PICs hold a cautious wait-and-see attitude. Therefore, the previous public health cooperation between China and PICs was mainly based on medical assistance and multi-form cooperation and exchanges between the authorities (Table 1). After the in-depth implementation of the BRI, China’s National Health Commission launched the BRI-supported three-year implementation program for health exchange and cooperation in 2015, which defined new cooperation mechanisms and extend the scope of bilateral and multilateral cooperation to the prevention and control of infectious diseases, training of public health personnel, traditional medicine, reform of the health system and policy, and development of the health industry, further enriches the public health partnership model. Since 2018, 10 island countries in this region have signed agreements with China to jointly build the BRI. Some achievements have been made, such as the aid construction of medical institutions (Samoa National Medical Center, Fiji NAVUA Hospital), the regular dispatch of medical personnel and material donations. Furthermore, the BRIMEA was an academic organization established in 2018, and currently has 86 medical education institutions from 23 countries as members. With the support of the BRIMEA, medical schools, healthcare institutions, and medical talents in PICs can get more opportunities for international exchanges and cooperation. Scientific research and exchanges with the members [8]. In addition, health tourism is also one of the main areas of cooperation between countries along the BRI around the big health industry, PICs have rich tourism resources for investment and development. It is foreseeable that under the BRI framework, in addition to providing medical assistance, cooperation in medical services, such as equipment and infrastructure construction, medical education, scientific research, loans, and financial input, will be further strengthened. In other words, the public health cooperation between China and PICs is most likely developing from a single field of health cooperation to diversified cooperation.

Like most countries, the motives for foreign aid are complex, the difference is that as an emerging economy, China now leans more toward commerce and trade and has relatively limited partners, and simple cooperation models and the progress is still in its early stage. Since the outbreak of COVID-19, China has carried out numerous medical and health cooperation with PICs, such as video dialogue meetings between leaders and experts, health medical supplies, and product donators [9]. The Chinese government chooses this region to carry out frequent actions to establish a responsible image of emerging international governance and play a beneficial role in promoting its BRI in other regions and countries. Given the historical legacy of colonialism in the PICs, the U.S. government and its allies have placed a premium on maintaining dominance in this region. The U.S. has already begun re-engaging economically in the Pacific. In 2022, Fiji, one of China’s significant partners in PICs, became the first PIC to join President Biden’s Indo-Pacific Economic Framework (IPEF). In addition, risks of political changes, debt repayment ability, concerns about the transparency of Chinese companies, and concerns about increasing regional imbalances and geopolitical competition are among the topics discussed around the BRI [10]. But it is worth noting that, the presence of BRI has provided an alternative to continued dependence on ex-colonial powers, providing these countries with “greater bargaining power”, enabling them to diversify their sources of aid and support, as well as provide more development opportunities for public health governance.