Fostering a fine future for global health in a fractured world
Throughout the world, people face exceptionally severe, persisting and rising threats to their health and well-being. Climate change, biodiversity loss and pollution breed chronic heat, drought and extreme weather events such as wildfires, floods, hurricanes and tsunamis that bring more death, disease and damage. Pandemics remain a persistent problem, as outbreaks of new Covid-19 variants, measles, avian influenza, mpox and Ebola can rapidly go global at any time. Misinformation and disinformation proliferate, making people stop protecting themselves through vaccines or long-proven basic health measures and generating fear and actions that do more harm. And increasing deadly conflicts within and between countries kill and wound innocent civilians and the healthcare workers who seek to save them.
But the needed global response now comes from a world whose supply of global governance is shrinking and increasingly fractured, even among those actors with the greatest capacity and responsibility to respond.
The United States, the world’s most powerful country, is withdrawing from the central multilateral organisations that counter climate change, pandemics, mis- and disinformation, and conflicts and that promote human rights, including the right to health for all. This badly erodes the capacity and effectiveness of the World Health Organization, UN Climate, the United Nations Security Council and the United Nations Human Rights Council.
At the leaders’ level, this year’s UN high-level meetings on health and other major threats cover only a few of the critical health problems and their determinants. The HLMs address them in separated and sequential ways, rather than in a synergistic, simultaneous fashion, and struggle to get the heads of the world’s most important governments to attend.
Nor has the gap been filled by the most powerful leaders of the world’s most powerful countries when they come together at their summits to define and deliver the solutions that they alone can produce.
Falling short on health as crises converge
The annual G7 summits of the world’s major democratic powers have long led in addressing conflict since their start in 1975, soon adding climate change in 1979, health in 1981 and information integrity later on. But at their most recent summit, in Kananaskis, Canada, in June 2025, G7 leaders addressed only some of these central threats. Their 149 commitments included 21 on climate-related wildfires, for second place among subjects. Those contained the summit’s only commitment related to health, as leaders promised to build on their “shared capacity to mitigate and respond to the impacts of wildfire exposure on human health and well-being”. Regional security secured eight commitments for sixth place; there were very few on mis- and disinformation, and none focused on health or pandemics.
The bigger, broader, newer G20 at its most recent summit at Rio de Janeiro in November 2024, did somewhat better. Its leaders made 11 health commitments, to rank fifth among all subjects. They followed 28 on climate change in first place, 25 on development in second, 18 on international institutional reform in third and 17 on the natural environment in fourth; the five on regional security placed it eleventh. The health commitments broadly covered the WHO investment round, health systems, universal health coverage, the healthcare workforce, the health-related Sustainable Development Goals, the infectious diseases of AIDS, tuberculosis, malaria and polio, and the negotiations of the new Pandemic Agreement and Fund. But only the commitment on water, sanitation and hygiene linked health to climate change and biodiversity. And the many on climate change and conflicts made no explicit links to health, while mis- and disinformation were absent everywhere.
The BRICS, based on Brazil, Russia, India, China and South Africa and now expanded to include five smaller members, has also addressed health. Overall its leaders seek to reform the existing global system to build one that puts their priorities and influence at the centre – which could bring further fragmentation. At their most recent summit in Rio in July, leaders made only four commitments on health, for 17th place among subjects. These health commitments all related to strengthening the existing global health architecture, including securing the Pandemic Agreement. To be sure, their first focus was on climate change, where they made 44 commitments, but none explicitly were linked to health. Nor did any of the eight commitments on regional security, in sixth place.
Finding hope in innovation, cooperation and local action
Yet amidst this growing gloom are several signs of hope, as individuals and institutions are inspired to respond more, in proven and innovative ways. Progress is being made on producing and implementing a pandemic accord and, painfully although now paused, on plastics. On financing, China, other donor countries, recipient countries and philanthropists are stepping up as the US steps back. The Green Climate Fund emphasises the health benefits of its project financing, as its new replenishment round is scheduled to start soon. And many actors are pioneering ways to address the major threats in ways that improve people’s health and well-being.
This edition of Health: A Political Choice explores the impacts of these larger political, ecological, societal, technological and security trends on global health and its governance. It examines how key global health actors are searching for and finding the solutions that work – many of which are local, national or regional in scope. It reflects on the results of major initiatives from the UN, the WHO, and the summits of UN Climate, the G7, G20 and the BRICS.
It focuses on four major threats – climate change, pandemics, mis- and disinformation, and conflict – and the search for solutions from scientific, technological and global governance innovation. Distinguished contributors share approaches that have been most successful, describe the uphill battles to implement them and propose how to move forward. As always, this edition includes voices from government, international organisations, philanthropy, business, civil society, think tanks and academia. A special section, curated by Jeremy Farrar of the WHO, focuses on science, research, innovation and technology, all of which have moved to centre stage in global health, while wavering between cooperation and competition.
This edition also features several spotlights on issues that deserve particular attention: on planetary health, pandemics, mis- and disinformation, and human security.
After introductions by leading authorities from the global health and global governance worlds, it presents sections on:
- Planetary health and climate change
- Pandemics
- Scientific innovation, research and technology
- Health information integrity
- Security from war, conflict and crime
- Improving global health institutions
and instruments.