When America catches a cold, the world sneezes. Thus, the US withdrawal from the World Health Organisation (WHO), along with the gutting of USAID, PEPFAR and other aid programmes, has put the entire global health community in disarray. 

Across the world, healthcare services for some of the most vulnerable people have been shut down. Public health programmes are being defunded.

This global health crisis is part of a wider attack by the world’s most powerful nation on multilateralism and the hopes and values embedded in the United Nations Charter. Among other things, the US has blown a hole in the Paris climate agreement, snubbed international efforts to ensure that artificial intelligence develops responsibly and sustainably, and reinstated the Global Gag Rule.

This rupture in the international order also marks the end of US-backed neo-liberal globalization and the ascent of explicit US nationalism. Concurrently, the US itself appears to be lurching further towards autocratic and plutocratic rule, while the social foundations of a rights-based universalism and the rational and scientific foundations for informed, inclusive and democratic discourse erode under pressure from cynicism, fear and mistrust grown over decades of neoliberalism, and now amplified by a form of populism that thrives on misinformation and social division.  

But anti-global sentiment, populism and attacks on international solidarity and rational discourse are not confined to the US. Other nations are cutting their aid budgets and threatening to withdraw support from the UN. 

It looks likely that official development assistance (ODA) contributions will be pegged to the 2023 Organisation for Economic Co-operation and Development (OECD) average of about 0.37% of GDP rather than the 0.7% target set in 1970, effectively slashing development assistance by more than half. 

At the same time, civic space and freedoms have been shrinking in many other countries, as the digital revolution risks ushering in new and potent forms of social control and oppression; and ethnic, racial and religious enmity, and a backlash against the rights and freedoms of girls and women appear to be growing in many parts of the world.

Ambitious response

These are challenging times for those working in global health where equity, universal human rights, peace and international cooperation are foundational building blocks. How then should we respond? 

Some will focus on damage-limitation and preserving as much as possible the complex of global health structures, initiatives and programmes that mushroomed in the so-called golden age of global health of the 2000s. 

But a much braver, and more ambitious and comprehensive response is needed.

First, we must reaffirm the moral and political foundations of ‘health for all’. In doing so, we must recognize the error of those who dismissed the bold agenda of the 1978 Alma Ata Declaration and sought instead to narrow the scope of global health to technocratic, bio-clinical and apolitical approaches. 

In parallel, we must avoid the use of technological solutions to disease and premature mortality as an excuse for neglecting the social determinants of health. And we must recognize the limits of aid or charity to health improvement and instead bind global health to social, economic and political justice and those social movements striving for universal rights and freedoms, gender equity and socio-economic fairness.

Second, we must get out of our silo and engage with economic policy and governance. This includes understanding the history of the past 50 years of neoliberal globalization that has resulted in a highly destructive, hyper-financialized and neocolonial form of capitalism that has, among other things, driven humanity towards ecological catastrophe and produced astonishing and dangerous levels of inequality. 

Incredibly, in 2024, 2,769 individuals (predominantly men in the global North) command a combined wealth of $15 trillion while billions of people remain mired in poverty.

One target of global health professionals should be the tax abuse by transnational corporations and ultra-wealthy individuals, facilitated by tax havens and a banking system with the help of prestigious legal, accounting and consultancy firms. 

This is a social pathology that is every bit as lethal as any imagined viral pandemic. Conversely, ending tax abuse and accelerating the current momentum behind a universal wealth tax would generate billions of dollars for public goods and services, reduce corruption, improve economic productivity, and re-democratise society. Current UN tax treaty negotiations provide an opportunity to establish a meaningful International Tax Convention.

New modalities of aid

Third, in reacting to the collapse of foreign aid, we must acknowledge and correct the deficiencies, fragmentation and inefficiency of the entire donor-driven system of aid. Although much foreign aid has been used to fund essential services for hundreds of millions of people in poor countries, it has too often served the economic and foreign policy interests of donor countries and their corporations. 

While development finance from wealthy countries is still needed, now is the time to adopt new modalities of aid based on the principles of shared funding, governance and delivery as proposed by the Global Public Investment initiative. 

Now is also the time to convert the multiplicity of vertical, narrow and selective global health agencies and programmes into a more coherent and socially accountable model of development assistance that builds from the bottom up rather than imposes from the top down.

Fourth, we must not allow the current crisis in health financing to further expand the incursion of private finance without first committing to raising levels of public expenditure by ending illicit financial flows, tax abuse and unjust debt burdens, and ensuring that the use of private finance for health and development is done appropriately and with effective public-interest regulation. 

Too often, public private finance initiatives are designed poorly  and act as a means by which public money subsidises excessive and abusive profiteering.

Rally around WHO

Finally, we must rally around the World Health Organization (WHO) and its dual role as an inter-governmental organization with the mandate to coordinate and facilitate global and cross-border health cooperation (including through the making of treaties), and a specialised agency that produces scientific and technical norms, standards and guidance. 

We must ask our governments to reaffirm the core normative mandate of WHO but in doing so, we must help the general public understand how WHO will always be compromised by national and international politics (as we are seeing now), as well as by powerful private actors with a vested interest in weakening WHO’s full public health mandate. 

Crucially, we must ensure that WHO’s budget deficit is not an excuse for even more dependence on unaccountable and non-transparent private financing, or for core responsibilities being ceded to private institutions or multi-stakeholder forums.

It has become clichéd to speak of crises as also being opportunities. But global health is truly at a crossroads, and one that provides an opportunity to construct a new vision that seeks not just the reduction of disease and illness but also the dismantling of ecologically destructive and unjust political and economic systems, as well as the reassertion of universal rights and freedoms. 

But for this to happen we must commit to principles of good global health governance and be willing to combine our professional duties with our civic responsibilities to uphold democratic and public-interest institutions, and to strengthen the voice and efforts of communities and civil society organizations on the ground.

David McCoy, Johanna Riha, Claudia Lopes, Remco van de Pas are all current Policy and Research Leads at the United Nations University – International Institute for Global Health (UNU-IIGH). Unni Karunakara was until recently the interim Director of UNU-IIGH.  Collectively they work across a range of policy issues including gendered inequalities in health, digital health governance and security, climate justice and health, and systems of power and accountability in global health.

Image Credits: WHO, US Mission in Geneva / Eric Bridiers via Flickr.