## Global health governance in crisis: A system on the brink
Funding shocks, political U-turns and weakened institutions have laid bare the flaws in a global health architecture long overdue for reform – and the need for brave leadership to stop it from unravelling.
Global health governance hit a rough patch in 2025 – to put it mildly. It is tempting to lay all the blame at the door of the White House. But that would belie the complexity of a transition that has been long coming.
Those who work in global health – and the communities they serve – have had to crash-land the plane while simultaneously building a raft mid-air. it has been far from easy, as the rules of the game are changing so fast. Global health has been forced to reckon with structural financing and governance challenges. Whether lasting changes will come from the ground up, or from hollowed-out institutions in western capitals, remains to be seen.
###The scale of the damage
The double whammy of the US’s proposed withdrawal from the World Health Organization (WHO), announced in january 2025 – the US is still a WHO member state, pending the settlement of it’s arrears -, followed by the swift cuts in overseas development assistance by a slew of donor countries, hit communities on the ground and institutions in Geneva and elsewhere hard. Hard enough to cost lives and upend health systems and livelihoods, exposing the vulnerabilities of the way global health is governed and administered.
The damage has been staggering in both scale and depth, with consequences that will be felt for many years to come.
According to the WHO and the OECD‘s projections, external health aid dropped by 30 per cent to 40 per cent in 2025 compared with 2023. The impact on health services in low- and middle-income countries was severe.
HIV infections rose,the response to tuberculosis was disrupted, and the immunisation agenda, including for polio and measles, suffered serious setbacks, compounded by disinformation campaigns. Add to that an onslaught on science itself, these have had debilitating impacts on not only how global health is funded, but also how research is conducted, how data is gathered and how institutions are run.UNAids
Global Health Funding Faces Turbulence
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Global health security is facing a turbulent period marked by funding cuts, geopolitical shifts, and a recalibration of priorities, threatening to undermine decades of progress. The World Health Organization (WHO), a central pillar of global health governance, is especially vulnerable, navigating a landscape of reduced sovereign funding and increased reliance on private sources.
A year of Uncertainty
2025 proved to be a challenging year for global health funding. Several major donor countries announced significant cuts to their contributions to the WHO and othre multilateral health organizations. These cuts,often framed as necessary austerity measures or a reassessment of priorities,have left agencies scrambling to maintain essential programs and respond to emerging health threats.
The US,historically the largest single donor to the WHO,announced a substantial reduction in its assessed contribution,citing concerns about the organization’s efficiency and effectiveness. Other major donors, including the UK and Germany, followed suit, albeit with varying degrees of severity. These cuts were not simply about the amount of money; they also signaled a broader questioning of the WHO’s role and authority.
Beyond direct budget cuts, institutions have had to deliver their services through health systems thrown out of gear, given that many developing countries depend acutely on foreign aid.
As the year coursed along, the first six months were spent second-guessing and playing catch-up to White House announcements, including a flip-flop on tariff measures affecting the cost of products, services and procurement.
Even for the biggest health agencies, better funded than the WHO, the year was humbling. Gavi raised $9bn against a target of $11.9bn for its 2026-2030 cycle.
The Global Fund to fight Aids, Tuberculosis and Malaria fared better, securing $11.34bn for its activities between 2027-2929, including $4.6bn from the US. The Fund had sought $18bn in investment, arguing that it would prevent 400 million new infections and save 23 million lives by 2029.
Both these organisations also contribute to the WHO, though it is not yet clear how those contributions will be affected by tighter envelopes.
Normative role at stake
Funding cuts by sovereign donors have coincided with a rise in private financing for the UN agency, including from the Novo Nordisk Foundation.
Senior officials at the WHO and from donors have vowed to protect the organisation’s normative role. The unique selling proposition and the integrity of the institution rest on whether that promise translates into action, though it remains unclear how they will do so.
Although there is a lot of concern about the overall direction for global health governance, ultimately, the decisions will be taken by those who quickly step in to mould the transition.
Not all is bleak, or is it?
Despite swift geopolitics and trade considerations, WHO member states reached consensus and adopted the pandemic agreement in May 2025 after more than three years – a desperate and deft pushback against shrinking globalism.an annexe on a new pathogen access benefit-sharing system is still under negotiation, and countries must reach consensus by May 2026 ahead of the next World Health assembly. A consensus on the annexe holds the key to