Global Health at a Crossroads: Why Now is the Time for Fundamental Reform

While the world showed resilience during COVID-19, the crisis exposed profound structural weaknesses in global health governance, including chronic underinvestment, fragmented architecture, and institutional silos.

Years later, health systems face the triple burden of disease—maternal/child health challenges, rising noncommunicable diseases, and reemerging communicable diseases—combined with malnutrition, mental health concerns, and aging populations. Post-pandemic fiscal tightening has constrained health budgets, with debt-to-gross domestic product ratios exceeding 70%–80% in some regions.

Climate change is redefining health risks. Over the next 25 years, it could result in 15 million excess deaths, with economic losses surpassing $20.8 trillion. Meanwhile, geopolitical conflicts have displaced over 122 million people and eroded health access. Health misinformation amassed over 4 billion views in 2023. Global development assistance for health has declined by more than $10 billion, driven by US cuts, with further decline expected (Figure 1).

Figure 1: Development Assistance for Health, US-sourced vs. Other, 1990–2025

Note: Development assistance for health is measured in 2023 real US dollars. Data for 2025 are preliminary estimates.
Source: Institute for Health Metrics and Evaluation. 2025. Financing Global Health.

These threats present opportunities for reform. Five critical directions can future-proof global health systems.

1. Sharpen WHO’s focus
The World Health Organization remains global health’s technical backbone, with mandates for standard-setting, setting research agendas, health monitoring, emergency response, and technical assistance. COVID-19 showed its indispensability—with initiatives like the Solidarity Trial and COVAX—and its limitations. However, WHO lacks enforcement authority, relies on donor funding, and at times goes beyond its core strengths into fund management and logistics. Limited by 7,000 staff and a modest budget, WHO faces mission creep that erodes its effectiveness. It needs to sharpen its focus on its convening power, technical expertise, emergency coordination under International Health Regulations, and equity advocacy. This focus will enable WHO to better lead during crises and maintain global health standards.

2. Operationalize One Health
Over 70% of emerging infectious diseases are zoonotic, with three-quarters of newly detected pathogens spilling over from animals to humans (WHO 2022; Jones, Patel, Levy, et al. 2008). Economic costs from zoonotic outbreaks have cost the global economy over $120 billion between 1997 and 2009. Drivers include deforestation, industrial livestock farming, wildlife trade, and climate change.

Even though the Quadripartite launched the One Health Joint Plan of Action (2022–2026), governance of animal health remains fragmented and underfunded. The world needs an independent intergovernmental alliance for animal health, strengthening One Health through joint surveillance, building veterinary capacity, and integrating environmental data into early warning systems. Annual One Health prevention investments of $10 billion–$11 billion could save multiple times that amount in avoided pandemic losses.

3. Make procurement systems agile, transparent, and equitable
COVID-19 revealed the vulnerability of procurement systems. When vaccines became available, strict procedures, fragmented supply chains, and export restrictions created inequitable access. Developed countries' advance agreements monopolized supplies while complex UN procurement rules and regulatory fragmentation delayed access for low- and middle-income countries.

Emergency playbooks should be pre-cleared to ensure that indemnity clauses and quality assurance requirements can be activated immediately when necessary. Regional pooled procurement mechanisms—the Pan American Health Organization’s Revolving Fund or the African Union’s pooled initiatives—should expand to diversify suppliers and anchor distributed manufacturing. End-to-end e-procurement platforms with real-time shipment tracking and open dashboards would strengthen accountability. Integrated financial management, including contingency funds, countercyclical reserves, and fast-disbursing credit lines, would ensure procurement systems function as lifelines, not bottlenecks, during crises.

4. Address the health–climate nexus
Climate change poses severe health risks through heatwaves, poor air quality, food and water insecurity, and infectious disease spread. In 2022, 308 climate-related disasters generated $270 billion in economic losses, with only $120 billion insured (ADRC 2022; Munich Re 2023). Asia and the Pacific account for nearly 40% of global disasters.

Health systems need dual adaptation and mitigation strategies. Adaptation calls for climate-resilient infrastructure, reliable clean energy, climate-informed surveillance, flexible supply chains, and trained frontline workers. Mitigation requires greening procurement, phasing out high-emission medical products, upgrading buildings/transport, and embedding sustainability into financing. The 2023 G20 Summit recognized this nexus as a priority. The next step is to translate commitments into operational change by integrating climate-health strategies into national plans, financing frameworks, and cross-sectoral policies.

5. Mobilize innovative financing
With global health funding declining, innovative mechanisms are essential. International financing institutions must deploy blended finance, public-private partnerships, guarantees, debt swaps, and outcome-based financing to mobilize private capital. Financing mandates must broaden beyond universal health coverage to include climate-health, mental health, nutrition, urbanization, and non-communicable diseases.

Innovative instruments with potential include the International Finance Facility for Immunisation, which has raised over $8 billion through vaccine bonds (Moody's 2024), and debt swaps like El Salvador's $11 million Debt2Health agreement and Seychelles' marine conservation financing. Contingent facilities like the Innovative Finance Facility for Climate in Asia and the Pacific and International Finance Facility for Education offer significant health potential.

The G20 Pandemic Fund exemplifies catalytic multilateralism—over $2 billion pooled from multiple sources has mobilized $7 for every $1 awarded. Fast-track mechanisms used during COVID-19 by Germany, the Netherlands, and Lithuania (Sagan, Webb, Azzopardi-Muscat, et al. 2021; Lee and Aboneaaj 2021) should be institutionalized to ensure rapid emergency disbursement.

The five reforms offer a roadmap for building resilient, equitable global health systems capable of confronting tomorrow's challenges. However, delivering on this reform agenda requires more than technical fixes—it demands political will, sustained financing, and cross-sectoral collaboration. Member states must empower WHO to lead within its comparative strengths, while reinforcing One Health through stronger mandates and funding.

Governments, international financial institutions, and the private sector should jointly design agile procurement and financing mechanisms that can be activated at speed during crises. Embedding health into climate policies and climate resilience into health strategies will ensure that future systems are both sustainable and resilient to shocks. Above all, reform efforts must be anchored in equity, so that the most vulnerable are protected first.

The opportunity before the global community is to reimagine health as the backbone of resilience and prosperity in the 21st century. A whole-of-systems approach is necessary to clarify mandates, integrate animal and environmental health, develop agile and fair procurement systems, embed climate action into health systems, and mobilize innovative financing. The steps taken in the next few years can lead to a more connected, cooperative, and future-ready global health architecture.

A. Sagan et al. 2021. Health Systems Resilience During COVID-19: Lessons for Building Back Better. World Health Organization and the European Observatory on Health Systems and Policies.

ADRC (Asian Disaster Reduction Center). Natural Disasters Data Book 2022.

K. E. Jones et al. 2008. “Global Trends in Emerging Infectious Diseases.” Nature 451: 990–93.

Moody’s. 2024. “International Finance Facility for Immunisation—Aa1 Stable.” Credit opinion. 29 October.

Munich Re. 2023. “Climate Change and La Niña Driving Losses: The Natural Disaster Figures for 2022.” 10 January.

N. Lee and R. Aboneaaj. 2021. “MDB COVID-19 Crisis Response: Where Did the Money Go?” CGD Note, Center for Global Development, November.

World Health Organization. 2022. Zoonoses and the Environment.