The only way is forward together
Our world and global health are experiencing a debilitating polycrisis, with interconnected issues amplifying each other’s impact. The US decisions to withdraw from the World Health Organization and drastically reduce funding for USAID and the Centers for Disease Control and Prevention have escalated risks for much of global health, and domestic health security. Even before the Covid-19 pandemic, progress on the Sustainable Development Goals had slowed and now we risk not achieving any of the 17 SDGs by 2030. The polycrisis unfolding in the lives of hundreds of millions of the marginalised and people not previously considered high risk across the world will be exacerbated by the multifarious impacts of climate emergencies and conflicts.
Derailing life-saving services in neonatal care, HIV, tuberculosis and other diseases is unconscionable. Deteriorating core promotive and preventive public health issues including vaccination, nutrition, sexual and reproductive health and rights, comprehensive primary health care, and early interventions in non-communicable diseases may undo the gains made in improving lives and strengthening health systems.
Far more nefarious will be the loss of trust that millions of community workers, health professionals and the polity have painstakingly built through medicine, perseverance, sacrifice and grassroots wisdom. This loss is intertwined with decreasing faith in science and skyrocketing misinformation. Decreased reliance on evidence-based medicine, response to programmatic mobilisation and impetus in social discourse for public financing may soon amplify the polycrisis of our seemingly fractured world.
The promise
Fortunately, many interventions are ripe for strategically scaling up impacts in health outcomes. They are currently in various stages of implementation and already improving the lives of people.
Collaborative research platforms enable scientists from diverse regions to rapidly share data, methodologies and best practices, from tracking emerging pathogens to modelling climate-health linkages. Such platforms can democratise access to knowledge, empower those in low-resource settings, and foster equity in research priorities and participation. Working in solidarity, countries can overcome siloed research systems so advances benefit all populations equitably. This inter-
connectedness, however, must be complemented by robust governance frameworks that safeguard data privacy, equity and ethical research norms. The WHO’s mRNA Technology Transfer Programme is one such initiative that enables equitable regional pandemic preparedness through hub-based research and manufacturing collaborations for vaccines and monoclonal antibodies.
Artificial intelligence and digital health are advancing at unprecedented rates, in discovering drugs, predicting protein structures for disease, engaging in risk surveillance and improving access to diagnostics. Deploying these technologies responsibly, countries must institute robust AI governance frameworks that prioritise ethics, accountability and social inclusivity. Global public goods depend on transparency in AI operations, rigorous external oversight and conscientious management of sensitive data. AI through humans-
in-the-loop and communties-in-the-loop must support – not supplant – human judgement. Digital health platforms – from telemedicine apps to wearable monitors – can revolutionise access, especially in remote or underserved regions. Digital health solutions should be tested in varied populations, ensuring they address unique environmental, genetic and social determinants of health. Solutions with offline functionality must cater to low-resource realities in many communities.
At the heart of health interventions lies human behaviour. The science of health is incomplete without an understanding of social and behavioural factors: how individuals and communities perceive risk, adopt innovation and respond to public messaging. Understanding gender roles, misinformation dynamics, local norms and socio-economic factors often means the difference between success and failure. This became paramount for the effectiveness of masking and social distancing during the Covid-19 pandemic. Integrating behavioural insights into every stage – from design and implementation to communication – is non-negotiable for building sustainable and equitable health outcomes.
Philanthropy can catalyse research focused on priorities, such as climate adaptation and disease elimination. Philanthropic investment aligned with local needs and partnerships enables scalable impacts and creates public goods tailored to community realities. Global health leaders may now have to take on the responsibility of expanding their peer group by galvanising potential donors – family, corporate, independent and start-up founder foundations – who align on specific objectives.
The pathway
These promising interventions will have to work with each other in prioritised ways on areas of need for on-the-ground change. Choices must now be made for the short term and perhaps the long term. The financing that the global health architecture will now access will have to be applied to prioritised areas. Pandemic preparedness will rank high in the set of priorities. Global health should also maintain the funding and the technical prowess to finish the job on diseases that have recently been eliminated or are on the cusp of being eliminated, such as polio, visceral leishmaniasis, yaws and guinea worm disease. Funding for research and development should continue for high-impact projects where medical breakthroughs are imminent. Frittering away billions, years of research and investment of cutting-edge talent because of funding shortages may risk future generations. Urgent action is needed on the industrial determinants of health for dampening the impacts of air pollution and ultra-processed food systems – both areas fundamentally driven by international cooperation and hence well suited for coordinated global action.
Global health must inculcate higher order strategic financing lessons from the ongoing polycrisis. More efficient and responsive structures must be considered for regional cooperation in supply security and equitable access to commodities. The Partnership for African Vaccine Manufacturing under the Africa Centres for Disease Control and Prevention aims to enable indigenous production of up to 60% of the continent’s vaccine demand by 2040. Regional consortia for capacity building, talent pooling, and clinical and implementation research should ensure that countries in the Global South are jointly learning and addressing challenges that do not respect political boundaries.
The journey of securing global health must ultimately be anchored in science and clear and objective communication. Training the next generation in critical thinking and instilling a deep appreciation for evidence drive progress. Building a scientifically literate society that values evidence requires resolute political leadership at every level. Governments must boldly invest public finances into basic and translational research, incentivise cross-sector partnerships, and champion scalable innovations.
