What if the era of “Global Health” (as a working system of agreed-upon and supported patchwork of commitments, norms, treaties, and organisations) is in fact over? The threat of the United States of America (US)'s pull-out from the World Health Organization (WHO) has shone the spotlight on an ecosystem that was already out of balance but moved on after the COVID pandemic without addressing the need for change.
The present conversations around global health are too focused on the shortfall created by the withdrawal of US funding from the WHO – which despite its deep impact on the organisation is just a drop in the bucket of overall global health funding. While the current dismantling of USAID has compromised the Western-led global health infrastructure for the delivery of preventive and curative services in low-income countries, much of the regional, bi-lateral and alliance-based health cooperation still continues and is presently being strengthened, such as China’s health foreign policy and partnership programmes in Africa.
The global power shift demands that we must also shift our focus from the global actors financed mainly by Western development aid, such as the Global Fund to Fight AIDS, TB and Malaria (GFTAM), GAVI or UNAIDS. The pandemic experience showed the limits of North-South solidarity, and also eroded trust in the global health system as a whole. A new set of “leaders” has yet to emerge. It will not be sufficient to just tweak the current “architecture” and to hope for “innovative financing” from high-net-worth individuals and foundations that are already exercising oversized influence on global health priorities and approaches.
Recent developments point to a multipolar world intertwined with a techno-polar order with new power centers and new agendas that include competition for research and technological innovation and production sites, weaponisation of supply chains and access and benefit sharing to name but a few. The global health consensus appears to be splintering and the current crisis in Global Health, symbolised by the US withdrawal from WHO, only a symptom of this geopolitical reordering and transactional approach to diplomacy.
The above raises a number of questions:
- What ecosystem could emerge in a post Global Health era?
- What are the minimum levels of global cooperation (functions) that must be salvaged, e.g. normative work? Epidemic intelligence sharing? Pandemic response? etc.
- What organisational approaches are emerging in new political constellations? What is the role of geopolitical blocks?
- Is there still a role for international treaties and multilateral agreements?
- What might be new lines of international convergence in an era of what is likely to be largely transactional global health diplomacy?
