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Three major crises – the Covid-19 pandemic, funding withdrawal and geopolitical power shifts – have exposed systemic weaknesses. WHO reform and a new 3x3x3 approach are urgently needed to redefine the future of health Global health transformation 3x3x3 G lobal health is undergoing a period of profound and irreversible transformation. Many of the proposals for improvement, innovation and change that are now debated at length should have been tackled head on 10 years ago. But organisations rarely move out of gridlock without a crisis. Ilona Kickbusch founding director, Global Health Centre, Graduate Institute of International and Development Studies
THREE CRISES FOR GLOBAL HEALTH Since 2020, global health has been hit by three consecutive crises. First, the Covid-19 pandemic exposed long-standing structural limitations and inequities in global health. Second, the United States abruptly withdrew financial and political support from global health efforts in early 2025, so the decades-long system of hegemony and financing of global health could no longer be maintained. And third, we have the hard reality of a major geopolitical powershift, along with growing deadly conflicts. The world is in a multipolar moment. Countries are testing and reshuffling alliances and dependencies as well as priorities and ideologies. One thing is clear: the Global South – a politically applied term for very different actors and interests – wants to define the future. Recent statements by the G20, the BRICS and the Shanghai Cooperation Organization make this very clear. THREE SYSTEMIC ISSUES MUST BE ADDRESSED These global health challenges will not be resolved by better managerial solutions like incremental, ‘more for less’ changes. Every crisis leaves a trail of destruction – real deaths of real people, most of them in the poorest countries. A Lancet HIV report suggests that anticipated international aid reductions may lead to 10.8 million additional new HIV infections by 2030 and 2.9 million HIV-related deaths in children and adults by 2030. And it also brings the death of institutions and organisations as well as accepted norms, rules and goals. A wide range of organisations in the global health ecosystem – which got very cosy, despite the funding competition – are affected. Even the United Nations has said the Sustainable Development Goals are “disappearing in the rear-view
mirror, as is the hope and rights of current and future generations” – the death of the SDGs. Stopping the destruction requires addressing three key systemic issues – and understanding they cannot be solved overnight and are not for the faint of heart. First is the challenge of weakened global solidarity amid shrinking trust, reflected most prominently in the response to past and prospective pandemics but also in the hegemonic systems established for global development finance, leading to the death of development aid. The multipolar world is less controllable, and the agenda is being changed by the Global South, from money to the power of definition. This will play out in the negotiations on the Pathogen Access and Benefit Sharing System, still to be negotiated for the Pandemic Agreement to take the next step in acceptance and ratification. The second big challenge is the lack of intersectoral and systemic action to address the consequences of the climate–health interface, in relation to resurging vector-borne diseases and their global spread and also to non-communicable diseases. Perhaps global health should be redefined as planetary health. Moving from silos to systems is essential. This, of course, is hampered by the third challenge: the institutional fragility of international health organisations, starting with the World Health Organization, which is confronting a 20% cut in funding for 2026–2027. The WHO is at the core of the global health ecosystem and critical for coordinating health action at the international level. It is where the negotiations of how the three crisis and the three challenges intersect – and what systemic responses should be found in a difficult geopolitical climate.
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Health: A Political Choice – The Future of Health in a Fractured World
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