Global health has moved from an area of mutual cooperation to one dominated by “high politics” and division, observed Ilona Kickbusch at the European Health Forum Gastein (EHFG) last Friday (2 October).

Leading the closing panel, the founder of the Global Health Centre at the Graduate Institute in Geneva, highlighted how recent voting at the UN General Assembly demonstrates that nation-states increasingly split and vote instead of searching for consensus.

Gathering 420 health leaders, pharmaceutical executives, and multilateral diplomats in the alpine town of Bad Hofgastein, Austria, this year’s annual forum took place against the backdrop of this escalating historic shift in multilateral governance

Across its four-day agenda, the conference crossed critical policy domains – from climate change and vector-borne diseases to de-risking late-stage biotech innovation, tackling venture capital shortages, and addressing youth mental health.

Faced with new security threats and the geopolitical fallout of the war in Ukraine, panellists directly confronted persistent patient access divides, the upcoming EU budget trade-offs favouring military defence over health infrastructure, and friction surrounding health sovereignty.

While participants in the closing session unanimously agreed that the post-World War II status quo is collapsing and that “things must change,” the debate over what a future health architecture should look like remained fundamentally unresolved.

The struggle over ‘health sovereignty’

Framing this year’s conference around health as a strategic pillar of European unity, outgoing EHFG President Clemens Martin Auer issued a stark warning against the rise of far-right extremism and anti-EU rhetoric across the continent.

Auer cautioned that these political movements are co-opting the concept of “sovereignty” to promote short-term nationalism, isolationist agendas, and a retreat from European integration and multilateralism.

“They have a different concept of sovereignty. They use it to go back to the old, good days – they think that they were wonderful days – of nation-states, of the sovereignty of nation-states,” Auer warned, calling on the health community to actively fight against that notion. “It is of utmost importance that we do talk about sovereignty and reclaim this term,” he added.

In contrast to strict nation-state control, health leaders defined true health sovereignty as collective capability built on cross-border cooperation, pooled resources, and trust –  arguing that no single nation can independently defend against pandemic threats, supply chain disruptions, or global health crises without European solidarity.

“When we talk about health, no country, no matter how large or powerful or rich it is, can be absolutely sovereign if we take it from a power and control perspective,” underscored Natasha Azzopardi Muscat, director for health systems in the World Health Organization’s (WHO) Europe Region, adding that “interdependence, solidarity, and sharing is not charity, it’s survival.”

EU pragmatism: Mutual interest over philanthropy

Faced with a fundamentally changing geopolitical landscape and budget constraints, European Commission officials stressed that future international health engagement must be driven by mutual political interest rather than charity. This comes as the EU reframes its own strategic posture around competitiveness and strategic autonomy – key themes that dominated discussions throughout the Gastein forum.

“We are not a philanthropic organisation. We are a political organisation, and we gauge our success or failure politically,” stated Martin Seychell, deputy director-general for international partnerships at the European Commission.

Seychell argued that health sovereignty must not be misunderstood as an inward-looking retreat or a denial of solidarity, but as a commitment to capacity building and resilience. He emphasised that fostering external dependency offers Europe no strategic advantage, as dependency reduces Europe’s own political manoeuvrability and forces impossible moral choices when budgets shift.

To build local capability, he highlighted EU initiatives under the Global Gateway framework which have mobilised €2 billion to support local vaccine, medicine, and health technology biomanufacturing in South Africa, Rwanda, Ghana, and Senegal. However, he cautioned that international aid budgets alone cannot meet global health needs, urging a move from “addition to multiplication” by using public funds to de-risk private investment and support domestic resource mobilisation in partner countries.

Demands for a global power overhaul

While this call for cooperative sovereignty and pragmatic partnership found broad intra-European consensus, the concept implies something entirely different from a Global South perspective. The core problem lies in global power dynamics that have remained fundamentally unchanged since World War II, stressed Magda Robalo, president of the Institute for Global Health and Development and former health minister of Guinea-Bissau.

Referring to the “Accra Reset” initiative aimed at securing health sovereignty for African nations, Robalo rejected traditional donor-recipient paradigms. “We are not going to continue begging,” she said. “Solidarity and charity are not the same. And what the Accra Reset is saying is enough of charity. We want to work together on equal terms.”

Addressing the frequently invoked concept of trust, Robalo pointed out that during COVID-19, countries like South Africa and Botswana were denied vaccine access despite having the money to purchase them. She stressed that genuine health sovereignty in developing nations cannot rely on trust alone without fundamentally revising international trade rules, post-WWII financial architecture, and intellectual property (IP) regimes – systemic boundaries that European funding initiatives and investment toolboxes continue to leave unaddressed.

Realpolitik and the rise of blunt transactionalism

Turning back inward into the logic of EU strategic posture, panellists framed global health policy as increasingly shaped by realpolitik and transactionalism.

Citing the shifting diplomatic tone at the UN General Assembly, Maltese Foreign Affairs Minister Chris Fearne pointed to US President Donald Trump’s assertion that “to the victor go the spoils” as emblematic of the current global order.

In this zero-sum environment, health is no longer insulated from geopolitical bargaining, forcing policymakers to navigate an arena where alliances are negotiated on transactional terms rather than shared humanitarian ideals.

Fearne raised this warning specifically to ensure that health policy remains a core pillar of EU strategy amidst competing political demands.

Pointing to upcoming negotiations on the EU’s next long-term multi-annual financial framework (MFF) budget, he cautioned that health infrastructure budgets risk being severely reduced to fund military defence and industrial competitiveness.

He urged health advocates to break out of their policy bubble and take political initiative, stressing that “your voice needs to come out beyond this beautiful village into the wider world.”

One of the most urgent frontiers where health leadership is currently required is the governance of artificial intelligence. Ricardo Baptista Leite, director of Health AI, warned that governments selling citizen health data for short-term financial gain are “betraying the trust and mandate given by the people” and creating dangerous new forms of external dependency.

Cautioning that AI will either become the world’s greatest equaliser or its greatest divider, Baptista Leite stressed that states and civil society must build sovereign capability to govern the technology locally rather than ceding control to tech corporations.

WHO dilemma in an unresolved global health architecture

Navigating this increasingly transactional and polarised landscape leaves international bodies in a precarious position. WHO’s Muscat articulated the fundamental governance dilemma currently confronting the world’s prime health organisation: “Do I dilute principles around human rights for the sake of consensus, or do I stick with them even if this means that consensus is not possible?”

Muscat pointed to a shifting climate where health negotiations – particularly around human rights, gender equality, and sexual and reproductive health – have become deeply politicised.

Synthesising this breakdown as the session drew to a close, chair Kickbusch observed that “money doesn’t solve the problem of power,” emphasising that neither increased financial aid nor recycled diplomatic formulas can resolve the structural crisis of global health governance.

As the Gastein forum came to an end, the closing debate exposed an objective structural contradiction between the Global South’s demand for a fundamental redistribution of power and the EU’s approach of managing international cooperation through existing instruments based on mutual interest while reorienting its internal policy toward industrial competitiveness and regional sovereignty.

See related topic:

European Union Must Seize Opportunity to Create Equitable Health Systems 

Image Credits: Felix Sassmannshausen/HPW, Felix Sassmannshausen.