Health: A Political Choice FHFW

Health: A Political Choice – The Future of Health in a Fractured World is a flagship global health publication examining how political leadership, cooperation and innovation can reshape health systems in an increasingly divided world. Produced in collaboration with the World Health Organization, it brings together senior policymakers, international institutions, scientists and industry leaders to address the intersecting pressures of conflict, climate change and economic instability on global health. Edited by Ilona Kickbusch and John Kirton, this seventh edition in the series explores how stronger governance, scientific progress and cross-sector collaboration can close critical gaps in preparedness, equity and resilience. With a particular emphasis on elevating Global South leadership and advancing new models of multilateral cooperation, the publication offers a timely, authoritative perspective for decision-makers seeking to build a more inclusive and sustainable global health architecture.

Health: A Political Choice

Edited by Ilona Kickbusch , Global Health Centre, Geneva and John Kirton , Global Governance Program, Toronto

The Future of Health in a Fractured World

2021 Hevolution, a global non-profit, launched to pro- vide early-stage investments that extend healthy years of life for everyone .

August 2022 Hevolution’s $8.5M grant kick-started the New Investi- gator Awards to support early-career researchers with the American Federation for Aging Research (AFAR). the New Investi- gator Awards to

August 2022 Hevolution’s $8.5M grant kick-started support early-career researchers with the American Federation for Aging Research (AFAR).

May 2023 Hevolution’s $115M grant for the Geroscience Research Oppor- tunities Program funded interna- tional pre-clinical projects in aging biology.

November 2023 Inaugural Global Healthspan Summit (GHS), united 2500 global leaders in Riyadh, unveiling ~$100M in grants/ partnerships to propel the aging biology field. partnerships to propel the aging biology field.

November 2023 Inaugural Global Healthspan Summit (GHS), united 2500 global leaders in Riyadh, unveiling ~$100M in grants/

December 2023 Hevolution makes first impact investment - Aeovian to advance selective MTORC1 inhibitors to address age-related diseases.

There’s a wide gap between healthspan and lifespan. Hevolution Foundation was founded to fill it. There’s a wide gap between healthspan and lifespan. Hevolution Foundation was founded to fill it. There’s a wide gap between healthspan and lifespan. Hevolution Foundation was founded to fill it.

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Hevolution makes two additional impact invest- ments: Rubedo (to target pathologic senescent cells); and Tune (to sup- port creating epi-editing drugs that target com- plex chronic diseases).

Hevolution makes two additional impact invest- ments: Rubedo (to target pathologic senescent cells); and Tune (to sup- port creating epi-editing drugs that target com- plex chronic diseases). Hevolution makes two additional impact invest- ments: Rubedo (to target pathologic senescent cells); and Tune (to sup- port creating epi-editing drugs that target com- plex chronic diseases).

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Hevolution reached a milestone of $400M+ in funding, grants, and investments , supporting research institutions to advance breakthroughs in aging science. in funding, grants, and investments , supporting research institutions to advance breakthroughs in aging science. Hevolution reached a milestone of $400M+

Hevolution reached a milestone of $400M+ in funding, grants, and investments , supporting research institutions to advance breakthroughs in aging science.

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July 2024 Hevolution makes fourth impact invest- ment: Vandria SA (developing novel ther- apeutics that target mitophagy). July 2024 Hevolution makes fourth impact invest- ment: Vandria SA (developing novel ther- apeutics that target mitophagy).

February 2025 Hevolution hosts 2nd GHS in Riyadh, world’s largest, convening nearly 3,500 global leaders from over 74 countries.

February 2025 Hevolution hosts 2nd GHS in Riyadh, world’s largest, convening nearly 3,500 global leaders from over 74 countries. February 2025 Hevolution hosts 2nd GHS in Riyadh, world’s largest, convening nearly 3,500 global leaders from over 74 countries.

CONTENTS

The Future of Health in a Fractured World Health: A Political Choice

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WELCOME Fragmenting consensus in a fragmenting world Axel R Pries, president, World Health Summit 1 INTRODUCTIONS 1.1 From dependency to self-reliance: A new chapter in global health Tedros Adhanom Ghebreyesus director-general, World Health Organization 1.2 Health at the heart of a fairer future Amina J Mohammed, deputy secretary-general, United Nations 1.3 Reclaiming momentum – delivering health in a world of risk Achim Steiner, former administrator, United Nations Development Programme 1.4 Compounding threats, collective response: Why health must drive Europe’s future Enrico Letta, president, Jacques Delors Institute, and dean, IE School of Politics, Economics and Global Affairs, IE University

A Global Governance Project Publication

Published by: GT Media

CEO and Publisher: Khaled Algaay Co-Editor: Ilona Kickbusch Co-Editor: John Kirton Editor: Madeline Koch Managing Editor: Jacqueline McGhie Contact: LOCATION-CIRCLE White Collar Factory, 1 Old Street Yard, London EC1Y 8AF, United Kingdom Phone +44 207 9812579

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Health: A Political Choice is an official publication of the Global Governance Project. The Global Governance Project is a joint initiative between GT Media , a publishing company based in London, the Global Governance Program, based at the University of Toronto, and the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva. The Global Governance Project provides a vital function for private and public sector organisations in support of their governance responsibilities. As a project it publishes content on how we can all demonstrate better collective governance, via independent platforms, for the world’s largest intergovernmental organisations, governments, NGOs, multilateral and bilateral summits, and the private sector’s leadership.

© 2025. The entire contents of this publication are protected by copyright. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher. The views and opinions expressed by independent authors and contributors in this publication are provided in the writers’ personal capacities and are their sole responsibility. Their publication does not imply that they represent the views or opinions of the Global Health Centre, the Graduate Institute, the Global Governance Program, the University of Toronto or GT Media Group and must neither be regarded as constituting advice on any matter whatsoever, nor be interpreted as such.

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3 PLANETARY HEALTH & CLIMATE CHANGE 3.1 Better decisions with better data Gordon G Liu, Peking University BOYA Distinguished Professor of Economics and dean, and Bernhard Schwartländer, co-chair of the Governing Board and Distinguished Research Professor of Global Health, Peking University Institute for Global Health and Development 3.2 Bridging climate and health to heal a fractured world Abdulla Al Mandous, president, World Meteorological Organization, and director-general, National Center of Meteorology, United Arab Emirates 3.3 Integrating animal health into a fractured world: A One Health approach to climate resilience Emmanuelle Soubeyran, director-general, World Organisation for Animal Health 3.4 Beyond political choice: A legal mandate for planetary health in a fractured world Alexandra L Phelan, professor, Johns Hopkins Bloomberg School of Public Health, and senior scholar, Johns Hopkins Center for Health Security 3.5 A new playbook for global health: Investing in infrastructure for planetary health Ajay Bhushan Pandey, vice president, Investment Solutions, and Erik Berglof, chief economist, Asian Infrastructure Investment Bank

PROMOTED CONTENT Healthspan: A global imperative for humanity’s future Mehmood Khan, CEO, Hevolution Foundation SPOTLIGHT Universal coverage at the heart of global health Interview with Pakishe Aaron Motsoaledi, minister of health,

3.6 Health as a political choice: From overshoot to well-being societies Rüdiger Krech, director, Environment, Climate Change, Migration and One Health, a.i., World Health Organization PROMOTED CONTENT The unfinished agenda: Why NTD elimination remains a political choice Kelly Zongo, Vincent Okungu and Carol Karutu, The End Fund SPOTLIGHT Reimagining the global health architecture: An African roadmap for shared security Jean Kaseya, director-general, Africa Centres for Disease Control and Prevention 4 PANDEMICS 4.1 The Pandemic Agreement is a major achievement Precious Matsoso and Roland Driece, former co-chairs, Intergovernmental Negotiating Body for a Pandemic Agreement 4.2 It’s time to leap to a new global health architecture Sania Nishtar, chief executive officer, Gavi, the Vaccine Alliance 4.3 Building vaccine sovereignty: Africa’s path to resilient health security Nicaise Ndembi, Africa Regional Office, International Vaccine Institute

South Africa 2 EDITORS’

INTRODUCTIONS 2.1 Global health transformation 3x3x3 Ilona Kickbusch, founding director, Global Health Centre, Graduate Institute of International and Development Studies 2.2 Fostering a fine future for global health in a fractured world John Kirton, director, Global Governance Program PROMOTED CONTENT The equity bias in cardiovascular care we Head of the European Specialty Business Unit at Daiichi Sankyo Europe SPOTLIGHT Protecting planetary boundaries Interview with Johan Rockström, director, Potsdam Institute for Climate Impact Research, and Virchow Prize Laureate 2024 can’t ignore Oliver Appelhans,

Health: A Political Choice – The Future of Health in a Fractured World

5 SCIENTIFIC INNOVATION, RESEARCH AND TECHNOLOGY

4.4 Strengthening national public health institutes: Fiocruz’s perspective Mario Santos Moreira, president, Oswaldo Cruz Foundation (Fiocruz), Paulo Marchiori Buss, former president, and João Miguel Estephanio 4.5 Licensing for equity: Why access to medicines needs a new global approach Charles Gore, executive director, Medicines Patents Pool 4.6 UN HLM on Non-communicable Diseases and Mental Health – A case of same old, same old? C James Hospedales, chair, executive committee, Defeat-NCD Partnership, and founder, EarthMedic and EarthNurse Foundation for Planetary Health PROMOTED CONTENT The Catalyst Effect: Unlocking innovation for global NCD care through cross-sector collaboration Jon Fairest, head of Global Health Unit, Sanofi SPOTLIGHT From dialogue to direction: Enabling partnerships to drive the future of health Balvir S Tomar, founder and chancellor, NIMS University

5.5 The only way is forward together Soumya Swaminathan, chair, MS Swaminathan Research Foundation, and Harkabir Singh Jandu SPOTLIGHT American anti-science activism is globalising Peter Hotez, professor of paediatrics and molecular virology and microbiology; co-director, Texas Children’s Hospital Center for Vaccine Development; and dean, National School of Tropical Medicine, Baylor College of Medicine 6 INFORMATION INTEGRITY 6.1 Health in the age of disinformation: Protecting truth, protecting democracy Alain Berset, secretary general, Council of Europe 6.2 The Health with Science Programme experience: Information integrity in the Global South Ethel Leonor Maciel, former secretary of health and environmental surveillance, Brazil 6.3 Belief in science has eroded, but we can rebuild it Aviva Philipp-Muller, Beedie School of Business, Simon Fraser University 6.4 Now more than ever: We need quality health information for all Scott C Ratzan, co-chair, Nature Medicine Commission on Quality Health Information for All

5.0 Introduction Jeremy Farrar, assistant director-general, Health Promotion, Disease Prevention and Care Division, World Health Organization 5.1 A shift in the centre of gravity and a shift in opportunity Jeremy Farrar, assistant director-general, Fatima Serhan, executive officer, Health Promotion, Disease Prevention and Care Division, and Thidar Pyone, technical officer, Office of the Chief Scientist, World Health Organization 5.2 On being unapologetically pro-regulation Bilal Mateen, chief AI officer, PATH 5.3 Poor, sick and unconnected: The paradox of digital health Cesar Victora, professor emeritus of epidemiology, Federal University of Pelotas, Brazil 5.4 Science and solidarity: A new paradigm for global health Yasmine Belkaid, president, Institut Pasteur, Mario Santos Moreira, president, Pasteur Network, and Rebecca Grais, executive director, Pasteur Network

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6.5 The collaborative future of public health intelligence Oliver Morgan, head, WHO Hub for Pandemic and Epidemic Intelligence, and Rithika Sangameshwaran, CPC Analytics SPOTLIGHT Health: A political choice Interview with Dan Smith, former executive director, SIPRI 7 SECURITY FROM WAR, CONFLICT AND CRIME 7.1 Safeguarding the right to health in crisis Volker Türk, United Nations High Commissioner for Human Rights 7.2 Health at the margins: Displacement and the global promise we must keep Filippo Grandi, United Nations High Commissioner for Refugees 7.3 Health and human security: Core to national and global stability Esperanza Martinez, professor of practice, Australian National University, and commissioner, The Lancet Commission on Health, Conflict and Forced Displacement 7.4 Finding alignment in a multi-aligned world David Miliband, president and CEO, International Rescue Committee

7.5 The health and well-being of women and girls in a fractured world Pascale Allotey, Inka Weissbecker and Alanna Galati, Department of Sexual, Reproductive, Maternal, Child and Adolescent Health and Ageing, and Department of Non-communicable Diseases and Mental Health, World Health Organization 7.6 Strengthening biosecurity at the health and security interface Greg Hinds, director, Counter-Terrorism, Interpol SPOTLIGHT Passing the torch: From West to East Kishore Mahbubani, distinguished fellow, Asia Research Institute, National University of Singapore 8 IMPROVING GLOBAL HEALTH INSTITUTIONS AND INSTRUMENTS 8.1 From crisis to consensus: The historic gavel of the Pandemic Agreement Teodoro J Herbosa, secretary of health, the Philippines, and president, 78th World Health Assembly 8.2 Health and multilateralism: Brazil’s political choice in a fractured world Alexandre Padilha, minister of health, Brazil

8.3 Promoting health, preventing illness Interview with Budi Gunadi Sadikin, minister of health, Indonesia 8.4 China’s approach to global health governance and its adherence to multilateralism Jin Jiyong, distinguished professor (Shanghai Oriental scholar), School of International Relations and Public Affairs, Shanghai International Studies University 8.5 From crisis to cohesion: A new mandate for health and multilateralism Dinesh Arora, principal health specialist, Asian Development Bank 8.6 Catalysts for change: The evolving role of philanthropy in global health Interview with Gabriel M Leung, executive director (charities and community), Hong Kong Jockey Club 8.7 Beyond traditional aid: Redirecting billionaire philanthropy to health outcomes Raj Kumar, president and editor-in-chief, Devex 8.8 Dying too young: How worsening health and loss of trust in politics gives us the worst possible governments Martin McKee, professor of European public health, London School of Hygiene and Tropical Medicine

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Health: A Political Choice – The Future of Health in a Fractured World 5

WELCOME

As global power structures shift and trust in science erodes, multilateral cooperation and shared values face growing strain, threatening progress on urgent global health challenges. Rebuilding consensus means protecting academic freedom, improving science communication and reinforcing collective responsibility Fragmenting consensus in a fragmenting world

Axel R Pries president, World Health Summit

by ideology, they may even become sources of disinformation themselves.

TRUSTED INFORMATION AND TRUST IN SCIENCE A further challenge to trustworthy and fact-checked information emerges from social media. Increasingly, the individual freedom of speech, even including misinformation and disinformation, is not balanced by proven and accepted information from academic and institutional bodies that follow strict requirements for the accuracy of information. The Covid-19 pandemic showed how such an environment can lead to the erosion of public trust. Personal experiences, worries and the lack of clear evidence created a platform for the spread of misinformation. This situation was exploited by malevolent actors who started disinformation campaigns motivated by commercial or political interests. According to a Dutch proverb, ‘trust arrives on foot and leaves on horseback’. Without the willingness of politicians, health providers at all levels and the public to accept evidence provided by trusted sources on a solid factual basis jointly, global health suffers severe consequences. Consequently, people are falling victim to preventable diseases such as measles and campaigns against health insurance systems may leave millions without coverage. Preventing this and rebuilding trust require a joint effort by all players in international and national health systems, including academia, politics, the private sector and civil society. SCIENCE AS A BASIS FOR CONSENSUS Science can play a unifying role. While academic activities are strongly influenced by their societal environment, scientific insights need to become independent of a political and cultural context as they are repeatedly examined, tested, and discarded or validated, in the quest to gradually approximate a universal ‘truth’. Such insights are represented in natural laws, which are, for example, not only the basis for all wireless communication (a fact that is accepted universally) but also for the human-made global climate crisis (which is denied by many). No person or society can argue with natural laws, and this should provide a basic consensus on which to build trust. To prevent and manage global challenges – such as pandemics, conflict and the climate crisis

T he globalised world stands at a crossroads. International partnerships and multinational institutions are weakened, former allies are turning into competitors, and new alliances are emerging. This shift reflects a growing mismatch between the ever-evolving global distribution of power and the structures of our international systems and organisations. Addressing this mismatch requires a deliberate renegotiation of multilateralism without undue delay, particularly where institutional rigidity prevents smooth adaptation to changing realities. However, the current moment of change is accompanied by an alarming breakdown of fundamental principles key to a sustainable and prosperous international community: shared humanitarian values, freedom of movement, free trade and strong multilateral organisations. The disintegration of multilateral mechanisms goes hand in hand with the fragmentation of consensus on what constitutes facts, evidence, knowledge and who can provide them. Institutions once regarded as guardians of scientific integrity and evidence-informed recommendations are now under attack. If their basis in scientific evidence is replaced

Health: A Political Choice – The Future of Health in a Fractured World 6

– societies and decision makers must thus understand and implement scientific evidence. To allow scientific insight to progress, policymakers and society must protect academic freedom as a public good. ACADEMIC FREEDOM AND RESPONSIBILITY Academic freedom is certainly not a licence for scientists to follow their own projects with public money without any responsibility for societal progress. It means freedom from ideological manipulation of results and their interpretation. History gives ample evidence that states that provide such academic freedom and reliable support for research are successful and more resilient to cope with unforeseen challenges. This requires sustained financial support for ambitious science projects as well as for societies and decision makers that translate scientific recommendations into action. In return, academia has the responsibility to improve research quality and uphold scientific protocols and standards. The scientific community relies on trust in its processes, its capacity for self-correction and the integrity of its practitioners. SCIENCE COMMUNICATION Academia and the media should become more invested in bidirectional communication with policymakers and civil society. The media plays a crucial role in making complex issues accessible and providing high-quality, trustworthy information for the public. Fact checking alone is not enough. What is needed is a cultural shift in the communication of scientific approaches and results – including uncertainties, possible mistakes and corrections. Scientists and journalists must work together to develop research communication that reaches beyond academic circles. People sometimes need reminders of the tangible benefits that science delivers for their daily lives. After all, humanity’s greatest achievements have always been built on trusted information and science. SHARED RESPONSIBILITY FOR GLOBAL HEALTH ‘Building Trust for a Healthier World’ was the theme of last year’s World Health Summit. This year’s focus, ‘Taking Responsibility for Health in a Fragmenting World’, builds on that foundation. Both speak to our shared responsibility – as scientists, practitioners and citizens – to remain active and engaged for progress in an increasingly complex world. The World Health Summit is committed to fostering this process by providing the platform for generating and exchanging trustworthy information and by convening all who are engaged in assembling the fragments and laying stronger, more sustainable foundations for global health. ▪ “ Without the willingness of politicians, health providers at all levels and the public to accept evidence provided by trusted sources on a solid factual basis jointly, global health suffers severe consequences”

AXEL RADLACH PRIES Axel Radlach Pries became president of the World Health Summit in 2021. He was the dean of Charité from 2015 to 2022, having been head of the Charité Institute for Physiology from 2001. He has chaired the Council for Basic Cardiovascular Science and the Congress Programme Committee basic section in the European Society of Cardiology, was president of the Biomedical Alliance in Europe and CEO of the Berlin Institute of Health. He has received the Malpighi Award, the Poiseuille Gold Medal and the Silver Medal of the European Society of Cardiology.

X-TWITTER @ WorldHealthSmt | @ChariteBerlin  worldhealthsummit.org | charite.de

Health: A Political Choice – The Future of Health in a Fractured World 7

1.0 1

In an increasingly fractured world, health remains a unifying force. The post-war vision of global cooperation is being tested, but it is far from broken. The new Pandemic Agreement marks a turning point in building more resilient, equitable and self-reliant health systems From dependency to self-reliance: A new chapter in global health

I n the aftermath of World War Two, the countries of the world came together in the recognition that the only alternative to global conflict was global cooperation. In 1945 they formed the United Nations and, in 1948, the World Health Organization. The WHO Constitution became the first instrument of international law to affirm that the highest attainable standard of health is a fundamental right of all people, without distinction. But it went further, saying that health is also fundamental to the attainment of peace and security. That conviction remains as relevant today as it was 77 years ago. In these divided and divisive times, health is one of the few areas in which countries that are otherwise political and economic rivals can work together to build a common approach to common threats. Exhibit A is the Pandemic Agreement, which WHO member states adopted at the World Health Assembly in May this year. After three and a half years of negotiation, the countries of the world showed that it is still possible for countries to work together, and to find common ground for a common purpose. The adoption of the Pandemic Agreement was truly historic. It showed that multilateralism is alive and well. HEALTH AS COMMON GROUND IN A DIVIDED WORLD The agreement came at an especially significant time. Around the world, dramatic reductions in aid are having severe impacts

Tedros Adhanom Ghebreyesus director-general, World Health Organization

on health services in many developing countries, as billions of dollars in aid disappeared virtually overnight. We see disruptions affecting millions of people who are missing out on life-saving services and medicines, including vaccines; health facilities are being forced to close; and supply chains and information systems are breaking down. Although this is an acute crisis now, it is a crisis long in the making. Many health systems around the world have long suffered from chronic underinvestment. As a result, out-of-pocket spending is the main source of health financing in many low-income countries and communities. At the same time, debt servicing costs restrict countries’ ability to invest in health. In fact, many countries spend more on debt interest payments than on education and health combined. These conditions have contributed to a system of heavy aid dependency. Much aid does not flow through treasuries, but through parallel systems set up by donors. This makes forward planning and budgeting difficult or impossible. This has created a deep vulnerability that has now been exposed. TURNING CRISIS INTO A CATALYST FOR CHANGE At the same time, in every crisis there is an opportunity. Many leaders from developing countries have told me that they also see this current crisis as a chance to leave behind the era of aid dependency and transition towards sustainable self-reliance. The WHO is supporting countries to make that transition by identifying tools to improve efficiency and generate new revenues and benefits for health from domestic sources,

Health: A Political Choice – The Future of Health in a Fractured World

1.1

INTRODUCTIONS

“ In these divided and divisive times, health is one of the few areas in which countries that are otherwise political and economic rivals can work together to build a common approach to common threats” TEDROS ADHANOM GHEBREYESUS Tedros Adhanom Ghebreyesus was elected director-general of the World Health Organization in 2017 and re-elected in 2022. He was the first person from the WHO African Region to serve as WHO’s chief technical and administrative officer. He served as Ethiopia’s minister of foreign affairs from 2012 to 2016 and minister of health from 2005 to 2012. He was elected chair of the Global Fund to Fight AIDS, Tuberculosis and Malaria Board in 2009, and previously chaired the Roll Back Malaria Partnership Board, and co-chaired the Partnership for Maternal, Newborn and Child Health Board. X-TWITTER @DrTedros  who.int

including through pooled procurement, public health insurance, and ‘health taxes’ on tobacco, alcohol and sugary drinks. Since 2022, at least 116 countries have introduced or increased such taxes, and in July this year, the WHO launched the ‘3 by 35’ initiative, which aims to support countries to increase the real prices of these three health-harming products by at least 50% by 2035. Let me close by highlighting three major priorities going forward. First, the mindset of aid dependency has to stop. Now is the time for leadership from governments to shake off the yoke of aid dependency and chart the path to self-reliance by mobilising domestic resources to support primary health care as the foundation of universal health coverage. Second, we need leadership from lenders, in the form of concessional lending, at fair terms. And third, we need leadership from generous donors, to

help build capacity for health programmes so countries can run them themselves, rather than setting up parallel systems of salaries and operating costs. Self-reliance means national systems, national budgets and national priorities, in alignment with the Lusaka Agenda and the principles of ‘one plan, one budget, one report’. The WHO stands ready to support all countries, and to work with all partners to turn this crisis into an opportunity. The choices we make now will shape the future of global health financing. Ultimately, health is not a cost to be contained. It is an investment to be nurtured – an investment in people, stability and economic growth, so that we can achieve Health for All and build a healthier, safer and fairer world. ▪

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INTRODUCTIONS 1.2

of humanitarian assistance we must elevate mental health and psychosocial care in humanitarian settings where the pressures are immense and the needs often overlooked and underfunded. The Covid-19 pandemic revealed the fragility of even the strongest systems, and misinformation corroded trust in science and institutions. Immunisation programmes were disrupted, non-communicable diseases increased unchecked and preventable deaths in conflict zones mounted. These cascading crises show that health is both the mirror of our crises and the foundation of our future. Yet there has been progress: since 2015, the world has seen a 14% decline in maternal mortality and a 16% drop in under-five mortality – clear signs that collective investment in health saves lives and moves us closer to achieving SDG 3. This year has also brought pivotal developments. In May, World Health Organization member states adopted the Pandemic Agreement, a landmark in global health governance. After difficult negotiations, this showed that cooperation is possible when urgency is matched with solidarity. It must now be implemented with ambition and equity, ensuring that preparedness, response and access to tools are not determined by geography or income. In July, governments gathered in Seville for the Fourth International Conference on Financing for Development, where they adopted the Sevilla Commitment. It reaffirms that closing the financing gap for the SDGs is inseparable from realising universal health coverage. The commitment calls for predictable financing, stronger domestic resource mobilisation and reforms to the international financial system so countries can build resilient health and social protection systems. UNIVERSAL COVERAGE AS THE FOUNDATION OF RESILIENCE What is needed is solidarity-based investment, a reset of the global health financing system that works hand in hand with national governments – aligning behind their priorities and strengthening the resilience of their health systems to respond to critical challenges, ensuring no community is left behind.

Health at the heart of a fairer future From conflict to climate shocks, inequality to misinformation, the choices made today will decide whether universal health coverage is an unfulfilled promise or becomes a reality

H ealth is an inalienable still denied their basic right to medical care and well-being. As 2025 draws to a close, we find ourselves at a crossroads. Climate shocks, violent conflict, economic instability, disinformation and widening inequalities are fragmenting societies and slowing progress towards the Sustainable Development Goals. The choices leaders make now will determine whether health becomes imperative for sustainable development or remains a casualty of systemic failure. right and the foundation of human dignity and global security. Yet in every corner of the world, millions are

Amina J Mohammed, deputy secretary-general, United Nations

The evidence is clear. The climate emergency is driving food insecurity and spreading disease. Conflicts are destroying health infrastructure, displacing millions and leaving populations without access to vaccines and essential medicines. Too often the world forgets that the head is attached to the body – with more than 300 million people in need

Health: A Political Choice – The Future of Health in a Fractured World

“ Cascading crises show that health is both the

At the heart of these global efforts lies the principle of universal health coverage, anchored in strong primary healthcare systems. Accessible, community-based and preventive primary health care is the most effective and equitable path forward. It ensures continuity of care, allows societies to respond swiftly to outbreaks while maintaining essential services and provides support for mental health. By linking health to food security, clean air and climate adaptation, primary health care helps communities withstand the pressures of a changing environment. Investing in such systems is not only a technical decision. It is a political choice that reflects whether leaders are willing to build inclusive, resilient and sustainable health systems that put people first. But resilience depends on more than services. It requires trust. The pandemic exposed the dangers of disinformation, as falsehoods about vaccines and public health measures cost lives and deepened divides. Rebuilding confidence in science and institutions is therefore essential. This means strengthening inclusive governance, expanding health education and ensuring that communities have a voice in shaping the services they rely on. Women and young people must be central in this effort. Still, trust alone will not bridge the inequities that persist. Vast disparities remain in access to vaccines, diagnostics, digital tools and mental health care. In many low- and middle-income countries, funding cuts and debt burdens are weakening fragile systems. This inequity undermines not only development but also global security. No one is safe until everyone is safe. THE TIME IS NOW The urgency of this moment cannot be overstated. For women denied maternal care, for young people living with untreated mental health conditions and for families struggling to access basic medicines, the stakes are immediate and personal. For leaders, the stakes are generational. Choices made today will determine whether the coming decades are defined by repeated cycles of crisis, or by resilient systems that protect the most vulnerable and unlock human potential.

In an age when multilateralism is under strain, health must be our common ground. The future of health lies in our ability to choose cooperation over fragmentation, equity over exclusion and prevention over crisis. Leaders must recognise that investing in universal, people-centred systems is not only a moral imperative but also a strategic choice for peace, prosperity and planetary sustainability. Health is the thread that weaves together our shared aspirations for dignity, well-being and security. As this decisive year comes to an end, the world cannot afford hesitation. Health must be the political choice that unites us. It must be the promise we make to every woman denied care, to every young person demanding a future free of preventable disease, to every community caught in the crossfire of conflict or climate disaster. Health is not a privilege for the few. It is a right for all. The upcoming World Social Summit in Doha and UN climate conference in Belém are moments to carry this promise forward. Both will test whether we are prepared to put solidarity at the heart of multilateralism and to treat health as the foundation of resilience, justice and peace. By placing health at the centre of sustainable development, and by empowering women and young people as agents of transformation, we can turn today’s fractures into the foundation of a fairer, safer and more resilient future. The moment to act is now. ▪

mirror of our crises and the foundation of our future”

AMINA J MOHAMMED Amina J Mohammed is the deputy secretary-general of the United Nations and chair of the United Nations Sustainable Development Group. Previously she served as minister of environment of Nigeria. She first joined the UN in 2012 as special adviser to former secretary-general Ban Ki-moon with the responsibility for post-2015 development planning. In Nigeria, she served as an advocate focused on increasing access to education and other social services, and advised four successive presidents on poverty, public sector reform and sustainable development.

X-TWITTER @AminaJMohammed  un.org/sg/en/dsg

Health: A Political Choice – The Future of Health in a Fractured World

1.3

INTRODUCTIONS

Reclaiming momentum – delivering health in a world of risk

U ntil recently, HIV was a death sentence, smallpox scarred lives and bacterial infections were often fatal. Breakthroughs such as vaccines, antibiotics and HIV treatment – alongside crucial investments beyond the health sector, from sanitation to urban planning – have transformed health, paving the way for broader development gains. Now, a new wave of innovation – from mRNA platforms to artificial intelligence – offers unprecedented promise. But any advances will only matter if every country is equipped to harness them. Yet, health progress is increasingly overshadowed by multiplying risks. Pandemic threats are rising. Diseases once in steady retreat – malaria, tuberculosis and cholera – are resurging. Antimicrobial resistance, mental health conditions and non-communicable diseases continue to grow. Climate shocks, conflict and ecosystem collapse push more people into crisis. Even hard-won gains in responding to HIV risk erosion in the face of declining funding and political will. The gravest threat is the erosion of what has made progress possible: sustained, deliberate global cooperation. To secure lasting gains and ensure health and opportunity for all, we must confront breakdowns in health systems and strengthen inclusive governance and systems to deliver for everyone, everywhere. INNOVATION WITHOUT ACCESS IS NOT PROGRESS Health systems have always reflected power. Your chances of living a healthy life are often shaped by who you are,

To build resilience, life-saving tools must become public goods: resources or services accessible to everyone, regardless of income or location, and provided equitably without exclusion. This requires investing in public health systems, local manufacturing and digital public infrastructure, and ensuring technology improves lives, not just boosts profits. The collaboration between the Global Health Innovative Technology Fund and the Access and Delivery Partnership, led by the United Nations Development Programme and supported by Japan, shows how working across the innovation-to-access value chain can help health technologies reach those most in need. For example, through the World Health Organization’s prequalification of a paediatric medicine for schistosomiasis, millions of children in Africa could potentially receive a treatment that will free them from health impacts including anaemia, stunting and impaired cognitive development, which hamper education and productivity, and perpetuate poverty. TRUST IS THE HIDDEN INFRASTRUCTURE Trust is the foundation of public health. Without it, even the most advanced tools and systems cannot deliver. Covid-19 fractured this trust – unequal access, politicised responses and broken promises eroded public confidence. Disinformation has worsened vaccine hesitancy, fuelling the resurgence of preventable diseases including measles and polio. Emerging risks from AI, as highlighted in UNDP’s Human Development Report 2025, raise additional concerns: automated

Achieving health and well-being for all requires long-term investment, global cooperation and effective governance. From pandemics to climate shocks, only resilient and equitable systems can deliver global health in an era of compounding crises

Achim Steiner, former administrator, United Nations Development Programme

where you live and what you can afford. Medicines and services that have worked well for decades – such as insulin and safe childbirth – remain beyond reach for millions. Now innovation is accelerating faster than ever, from long-acting HIV prevention to malaria and diagnostics powered by AI. Digital tools hold immense potential for telemedicine, research and development supply chains, and the delivery of services to the last mile. But access lags far behind. AI in health advances rapidly in some high-income settings, while many low-income countries struggle with inadequate infrastructure and biased tools. The Covid-19 pandemic underscored this hard truth: breakthroughs alone do not change outcomes. Systems capable of delivering them equitably at scale are essential.

Health: A Political Choice – The Future of Health in a Fractured World

medical advice risks diminishing trust in healthcare providers. AI holds promise for expanding access to knowledge, but also necessitates placing human knowledge at its core, alongside rigorous safeguards against misinformation. Rebuilding trust requires more than fact checking. It demands delivery and equity. Consider the Global Fund’s partnership model, which has saved over 65 million lives since 2002 by uniting governments, the private sector and civil society to fight AIDS, tuberculosis and malaria. Pulling back threatens to dismantle the very infrastructure and trust we have spent decades building. Instead, we must demonstrate that sustained, collective action delivers tangible results and saves lives. Pandemics, conflicts and climate shocks are interconnected crises, yet our systems to address them remain fragmented and weak. A pandemic response without inclusive governance or social protection falters. In conflict zones, health care collapses without reliable energy or communication infrastructure. In climate emergencies, unprepared systems leave communities vulnerable. Health cannot remain siloed but must be integrated across systems shaping climate, nature and biodiversity outcomes, including One Health approaches and planetary health

ACHIM STEINER Achim Steiner served as the administrator of the United Nations Development Programme from June 2017 to June 2025. He was also the vice-chair of the UN Sustainable Development Group, which unites 40 entities of the UN system that work to support sustainable development. Prior to joining UNDP, he was director of the Oxford Martin School and Professorial Fellow of Balliol College, University of Oxford. Mr Steiner led the United Nations Environment Programme (2006–2016) and was also director-general of the United Nations Office at Nairobi. He previously held other notable positions including director-general of the International Union for Conservation of Nature and secretary-general of the World Commission on Dams. X-TWITTER @asteiner

strategies. Indeed, some of the greatest returns still come from the basics: clean water, sanitation, air quality and adequate nutrition – the critical determinants of health. Vast global resources exist but they are poorly aligned with the Sustainable Development Goals, including those on health. Moreover, as official aid continues its downward trajectory, we must link financing better to the SDGs and the Paris Agreement and unlock more innovative financing. That includes increasing domestic financing for health through domestic resource mobilisation and taxation and exploring innovative funding models and partnerships for more effective, sustainable financing. For instance, UNDP’s Tax for SDGs Initiative has supported Armenia to raise tobacco excise taxes, expecting to generate $130 million in additional revenue, which could be invested in achieving its health and development goals.

WHAT IT WILL TAKE The past decade has radically transformed our world, intensifying the challenges in advancing the SDGs. Global health now includes new players such as technology companies and philanthropic actors, even as multilateralism remains in flux. Yet what is needed to achieve health and well-being for all remains unchanged: long-term investment, global cooperation, effective governance, and a focus on impact and those left behind. The adoption of the Pandemic Agreement by WHO members is driven by this objective: to make the world’s future pandemic response more effective and equitable. This leadership reminds us that advancing health equity requires collective, universal action. Complexity may define our present, but it remains a diagnosis, not an incurable condition. By aligning the forces shaping health, strengthening inclusive governance and building resilient systems, we can realise a world where our collective immune system – of solidarity, innovation and action – can withstand any crisis and ensure well-being for all. ▪

“ To build resilience, life-saving tools must become public goods: resources or services accessible to everyone, regardless of income or location, and provided equitably without exclusion”

Health: A Political Choice – The Future of Health in a Fractured World 13

INTRODUCTIONS 1.4

Compounding threats, collective response: Why health must drive Europe’s future

As Europe confronts intertwined crises, from pandemics to climate change to antimicrobial resistance, health must move to the heart of integrated policymaking. A coherent, cross-border strategy is essential to protect lives, drive innovation and build a resilient European health agenda

H ealth can no longer be considered a peripheral issue in European policymaking. It must be assumed to be a central political choice. The Covid-19 pandemic made it clear that when health systems fail, societies and economies falter with them. Europe’s health sector is not only facing multiple risks, but it is facing risks that increasingly reinforce each other. Antimicrobial resistance

make it harder to absorb shocks and sustain services. The challenge is compounded by the digital transformation. New technologies such as artificial intelligence, genomics and telemedicine promise greater efficiency and innovation, but they also expose divides in access and raise concerns over data governance. Without trust and interoperability, digital health could deepen inequalities rather than reduce them. A COMPREHENSIVE APPROACH What links all these threats is the need for a coherent resilience strategy that works across borders.

continues to warn of an inevitable ‘disease X’, although its calls do not always receive the attention they deserve. Climate change amplifies these vulnerabilities by spreading vector-borne diseases and placing health infrastructure under severe strain. At the same time, Europe’s ageing populations, combined with a shrinking health workforce, Enrico Letta, president, Jacques Delors Institute, and dean, IE School of Politics, Economics and Global Affairs, IE University Enrico Letta, Jacques Delors Institute, and dean, IE School of Politics, Economics and Global Affairs, IE University

threatens to undo decades of medical progress, making even routine procedures dangerous. The World Health Organization

Health: A Political Choice – The Future of Health in a Fractured World

ENRICO LETTA Enrico Letta served as prime minister of Italy from 2013 to 2014. He is currently the dean of the IE School of Politics, Economics and Global Affairs at IE University and president of the Jacques Delors Institute. In September 2023 the European institutions tasked him with producing a Report on

Health cannot be treated as a silo; it must be embedded into Europe’s broader climate, industrial and digital agendas. This requires investment in prevention and vaccination, the development of climate-smart and digitally enabled health systems, and, above all, the political will to coordinate at the European level. Fragmented national responses can no longer match the scale of the risks. The first priority is to ensure Europe’s capacity to prevent and respond to crises collectively, since preparedness is non-negotiable. Swift, unbureaucratic protocols and clear chains of command are essential when a new threat emerges. Antimicrobial resistance deserves particular attention. Stimulating antibiotics research requires a balance of push incentives for early discovery and pull incentives to make late-stage development commercially viable. Prevention is equally important. Vaccination campaigns, especially among children, the elderly and the frail, are among the most effective tools to reduce the burden of viral and bacterial infections that drive resistance. A second priority is to restore a degree of strategic sovereignty in medicines and technologies. Europe’s dependence on external suppliers for active pharmaceutical ingredients has risen dramatically, with production inside the European Union having fallen from more than half two decades ago to less than a quarter today. This leaves patients vulnerable to shortages and weakens Europe’s innovation capacity. Targeted incentives for European production can reduce dependence without sliding into protectionism. A third priority is to harness digital and data-driven innovation responsibly. The European Health Data Space has the potential to make patient data accessible across borders and to unlock vast research opportunities. Yet harmonised rules and safeguards are vital to ensure public trust. AI, telemedicine and robotics can improve efficiency and care delivery, but they must be deployed in ways that reduce inequalities rather than exacerbate them. Public investment and an innovation-friendly regulatory framework are essential to ensure equitable uptake. Finally, the One Health approach must become central to European policy. With most emerging diseases originating in animals, health security requires better surveillance of zoonotic diseases, stronger coordination between human, veterinary and environmental authorities, and closer cooperation between agencies. Climate adaptation and biodiversity protection are therefore part of the same resilience agenda as pandemic preparedness.

the Future of the Single Market. From 2015 to 2021, he was dean of the Paris School of International Affairs at Sciences Po Paris. X-TWITTER @EnricoLetta  www.ie.edu/school-politics-economics- global-affairs | institutdelors.eu/en

reality is that Europe still lacks a true single market for health. Marketing authorisations remain partly national, access to medicines is uneven and structural disparities persist in healthcare outcomes. Citizens expect the EU to deliver security in health, yet fragmentation undermines trust. Europe must deepen health integration, from harmonised clinical trials to interoperable digital health records, so that innovation benefits all citizens equally. Europe must also invest in prevention and resilience, blending EU and national funding to support screening centres, long-term care and climate-smart infrastructure, particularly in peripheral regions. This implies embedding solidarity at the core of the health agenda, avoiding a two-speed Europe in which smaller or poorer member states are left behind. Inspiration can be drawn from Europe’s Beating Cancer Plan, which showed how political ambition, scientific innovation and strategic investment can be mobilised for a common cause. Similar determination is now required for antimicrobial resistance, mental health and neurodegenerative diseases. These challenges, if left unaddressed, could fragment societies and erode Europe’s resilience. Europe’s healthcare sector is at a decisive moment. Compounding threats cannot be met with fragmented responses. They demand a coherent, cross-border strategy that strengthens resilience, restores self-sufficiency and deepens integration. By choosing to invest in resilience and solidarity, Europe will not only protect its citizens but also reinforce its strategic autonomy and unity. In a turbulent global environment, a stronger European Health Union is more than a public good. It is a cornerstone of Europe’s security, prosperity and credibility. ▪

SOLIDARITY IN ACTION None of these priorities will be realised without decisive political choices. The

Health: A Political Choice – The Future of Health in a Fractured World 15

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