Written by: Molly Moss, United Nations Foundation
2025 was a year of profound reckoning in global health. The United States’ dismantling of the U.S. Agency for International Development (USAID) at the start of the year, alongside missed replenishment targets, and shrinking aid budgets from other major donors, made it clear that the political landscape for global cooperation on health has been permanently altered.
A new vocabulary is emerging to make sense of the transition away from legacy systems. Developing countries have rallied around the concept of health sovereignty while donor countries and other partners have opted to use self-reliance to convey similar aspirations of lower-middle-income countries that are able to finance, produce, and govern their own health systems and countermeasures. As 2025 draws to a close, countries and partners are charting a path toward a ‘new normal’ that will be characterized by a deeper focus on national ownership and regional alignment. Bilateral arrangements – driven by the U.S.’s America First Global Health Strategy – are set to define a new approach to global health partnership that paves the way for private business interests to thrive.
With the current emphasis on country-centricity and more exclusive, transactional partnerships, how can global health institutions like the World Health Organization (WHO), Gavi, and the Global Fund best contribute to delivering essential global public goods and closing major health gaps? This question is being asked by many global health partners as they seek to shepherd a rapid evolution of the global health architecture. If past is precedent (and it may not be, considering how 2025 has gone), the strength and durability of reform decisions taken in 2026 will be determined by the quality of the process taken to reach those decisions, and the political buy-in to see them through.
The Lusaka Agenda – first launched in December 2023 – has proved to be critical for sensitizing global health stakeholders to big changes that were later imposed upon them more urgently by the present funding cliff. Many of the good proposals captured in the Lusaka Agenda’s five shifts have taken root in some of the more prominent reform agendas that were introduced this year, such as the Gavi Leap.
But reform will require changes that go far beyond global health institutions to include donor and implementing governments, philanthropic partners, and a broad set of civil society actors. The Accra Reset and Africa CDC’s Africa’s Health Security and Sovereignty paradigm emphasize that implementing governments must prioritize domestic resource mobilization and regional manufacturing. The European Commission and like-minded donors’ reflection process focuses on understanding the changing attitudes and strategies of donor governments. The World Bank’s Health Works program takes a strong orientation toward universal health coverage and enhancing access to health services.
Initiatives are also emanating from the civil society space, including Wellcome Trust’s discussion papers and multisectoral regional dialogues, as well as the newly-formed Health Architecture Reimagined (HEAR CSO) platform helping catalyze ambitious and innovative ideas for global health reform. Many of these processes will deliver key findings in the first half of 2026.
Given the scope of the discourse, it is helpful to at least bifurcate the discussion to treat reform of multilateral financing for health separately from broader governance reform processes, as others have argued. While some dimensions of the financing equation may be solved through more targeted partnerships, broader governance reform will demand a legitimacy that can only be achieved through uniquely inclusive, multilateral policymaking in formal arenas like the World Health Assembly (WHA) and the United Nations General Assembly. The locus of programmatic decision-making is rightly moving toward regional and country levels, but the interconnected nature of today’s global health challenges continues to warrant robust engagement in global diplomacy.
WHO’s Executive Board meeting in February 2026 is the first port of call for countries to be on the record sharing their vision of a new global health order. Thanks to a suggestion from France and following approval from the other 33 Executive Board members, Reform of the Global Health Architecture is on the agenda for February. Geneva diplomats are already convening in small informal groups on the issue, and a board paper drafted by the WHO Secretariat is expected to be published in December.
Although various smaller groupings of UN Member States, civil society, philanthropic, and private sector entities are suitable and even preferable for decision-making on certain issues, a durable and coherent global health reform agenda can only emerge from a set of shared values and principles that broadly reflect global political will. The growing recognition of the Africa Centers for Disease Control (Africa CDC) as a regional public health institution, for example, demonstrates the necessity and timeliness of regionalization, a trend that should be nurtured within and beyond Africa. But even as Africa CDC and others like it work to promote a common vision and shared position among their constituency, there is still need for a broader multilateral forum that is conducive to reconciling perspectives of the global north and global south and establishing norms in global health.
Countries have already adopted a resolution on Strengthening Health Financing Globally at the WHA in May 2025. Heading into 2026, WHO governance meetings provide further opportunities for Member States to demonstrate one of the organization’s truly unique capabilities – global convening – to start a common discussion on shared principles for a reform agenda. The WHO Executive Board meeting in February and the upcoming WHA in May are crucial opportunities to take inventory of emerging ideas and share national and regional reflections on new fiscal realities within health systems.
Even as governments pursue new models of partnership in global health through bilateral compacts and tighter regional cooperation, the imperative for alignment and coherence at the global level is not diminished. Promoting health cooperation among states is WHO’s most basic function, and despite challenges like U.S. disengagement, WHO is still the most suitable forum for building broad coalitions of support around high-level reform principles.
Strong geopolitical forces are reshaping the enterprise of global health. Numerous papers, reports, discussions, and commissions are trying to make sense of the changes and articulate new or improved models of cooperation. These bold ideas are needed and welcomed, but without a mechanism to lay out options and align core tenets, the forthcoming solutions will suffer from a new form of fragmentation, information asymmetry, and lack of mutual understanding.
The decisions ahead in 2026 will be owned by a range of actors, and not all will be made under WHO’s auspices. However, WHO and its governance meetings – including at the regional level – can help rationalize reform proposals so that durable, future-proof models of cooperation can emerge. To succeed in this hosting function, WHO must create space for other actors to contribute meaningfully to deliberations.
The pendulum may be swinging away from traditional models of multilateral cooperation, but even country- and region-centric arrangements require global solidarity to be successful. Health sovereignty and self-reliance are rightfully in focus now, but the health challenges of today demand dialogue and diplomacy. The expansion of bilateral compacts by major powers will test whether WHO’s convening role can adapt fast enough to remain politically relevant. In 2026, WHO has the opportunity to play the standard-setting, normative role in global health governance that it was envisioned to do when it was established in 1948.
Last Updated: December 16, 2025
Molly Moss is a Director of Global Health at the United Nations Foundation, where her work focuses at the intersection of public health and international affairs. Based in New York City, Molly collaborates with UN Member States on a range of health policy issues, including antimicrobial resistance, Universal Health Coverage, pandemic preparedness, and health financing reform. She also writes extensively about governance issues emanating from World Health Organization in Geneva. In both New York and Geneva, she works closely with global health experts and advocacy partners to translate scientific knowledge and evidence into actionable and ambitious policy. Prior to the United Nations Foundation, Molly worked for the Center for Global Health at the University of Colorado, where she focused on immunization, neonatal survival, and research ethics. During her time there, Molly earned her Master of Public Health; she also holds a bachelor’s degree in medical anthropology from Hampshire College. Molly is currently an instructor in the Department of Global Health, Milken Institute School of Public Health at the George Washington University.
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