Opinion: Enlightened self-interest demands global health investments

Not even five years ago, a gathering such as the one taking place next week in Sevilla, Spain — the Fourth International Conference on Financing for Development, or FfD4 — would have been impossible to hold in person. The COVID-19 pandemic revealed just how interconnected our fates are. It also underscored a previously overlooked lesson: Global health is not a peripheral issue. It is foundational to resilient economies, national security, and global stability.

In these highly uncertain times marked by rising geopolitical tensions, economic volatility, climate stress, deepening debt crises, and the ever-present threat of pandemics, investing in health sector development is not just a moral imperative — it is enlightened self-interest.

Health is smart policy

The case for sustained — and smarter — investment in health has never been clearer.

First, the economic returns are substantial. Healthy populations are more productive, better able to participate in the labor force, and more likely to drive inclusive economic growth. Every dollar invested in health yields up to $20 in full-income returns. At the same time, the health sector itself is an economic engine, creating jobs and generating wealth not only in countries receiving support, but also in donor nations. From frontline health workers to logistics and manufacturing professionals, millions of people are employed across the global health value chain, making health a powerful economic multiplier across borders.

Beyond the economic implications, policymakers should recognize that an investment in health is an investment in their own security. A virus outbreak in one corner of the world can cascade into a global crisis in months. Funding surveillance, primary care, and rapid response infrastructure is not charity — it is insurance. Initiatives such as CEPI and the Access to COVID-19 Tools Accelerator, or ACT-A, have shown that global platforms can accelerate countermeasures, but they need to be rooted in stronger national systems to be effective.

Third, we must acknowledge the effectiveness of global health initiatives, or GHIs, over the past two decades. Gavi, the Vaccine Alliance has helped vaccinate over a billion children. The Global Fund to Fight AIDS, Tuberculosis and Malaria has saved over 65 million lives. The Global Financing Facility, or GFF, has mobilized billions to support women’s and children’s health. These are not abstract numbers — they represent real progress, often in challenging, hard-to-reach settings.

Finally, health remains one of the few frontiers of global diplomacy where consensus and collaboration remain possible. At a time when global cooperation is fraying, health has served as a platform for common purpose and mutual benefit. Cross-border health efforts offer not just a path to recovery, but a basis for reconnection.

Global health at a crossroads

Despite remarkable progress over the past two decades, the global health system is at risk of falling behind. Half the world still lacks access to essential health services. Immunization gaps persist, with tens of millions of “zero-dose” children left behind. The fight against HIV, TB, and malaria has stalled in many regions. And health systems remain dangerously underdeveloped — fragile, fragmented, and heavily dependent on external expertise and financing.

Much of this stems from the way global health is organized and financed. Countries continue to experience inefficiencies, siloed programming, and limited ownership, while at the same time enabling a culture of dependency on imported products sourced from globally organized and procured pools. Even with these challenges, 19 countries have so far graduated from Gavi support and are financing their vaccine programs.

Now, we need to reimagine the global health ecosystem so it is fit for the future. That means moving away from fragmented, donor-driven models toward a more integrated approach that puts people first, strengthens national systems, and enables true country ownership to transition out of dependency over time. It also requires reconnecting the global to the local — ensuring that priorities are shaped by those closest to the challenges — and regaining the trust of the populations these systems are meant to serve. With the right reforms, global health can move beyond temporary fixes to deliver lasting resilience and shared prosperity.

A new model in practice: Nigeria’s pivot

Nigeria offers a promising example of what this transformation could look like. Under President Bola Tinubu, the country has begun aligning all three levels of its federal system (national, state, and local governments) around a coherent health investment agenda, the Health Sector Renewal Investment Initiative. Promisingly, this includes renewed strategic collaboration with key GHIs such as the Global Fund, Gavi, and GFF, and is rooted firmly in country ownership, increasing use of national systems, and greater domestic financing.

With a targeted focus on primary health care, routine immunization, and the continued fight against HIV, TB, and malaria, what sets Nigeria’s approach apart is its dual strategy: strengthening service delivery while unlocking health value chains to enable local manufacturing, improve supply chains, and generate economic value and jobs.

Working with global and local partners, Nigeria has identified 77 high-potential private sector investment cases in areas ranging from supply chains to local pharmaceutical manufacturing — amounting to over $5 billion in opportunities. Innovations such as Zipline’s drone-based delivery of health commodities show how health investment can simultaneously address service gaps and drive job creation.

This is smart development that mobilizes global and local private sector capital, blending financial and social returns — and demonstrating how GHIs can be catalysts for broader system transformation when embedded in a country-led strategy.

In this context, public leadership and regulation are key to ensuring that private investment does not displace equity, access, or public health priorities. Guardrails are needed to align commercial incentives with national health goals, especially in fragile or underserved areas where market forces alone may fall short.

What FfD4 must deliver

As leaders convene in Sevilla to shape the future of development financing, it is crucial that investments in health are recognized not as optional add-ons, but as essential drivers of sustainable development, economic resilience, and security. Three priorities must guide further global action to ensure health remains central to development agendas.

1. Put people first. Rebuild trust by respecting the dignity, priorities, and agency of the populations served. This means shifting away from top-down, externally imposed programs and toward country-owned, context-specific approaches that reconcile global issues with local needs.

2. Link continued investment to meaningful reforms. Support for GHIs must be sustained, but it must include a clear commitment to smart reform, including a time-bound transition ultimately toward sustainable self-financing by countries and regions. Core global public functions can remain anchored in a lean global institution, while regional and national entities are enabled to drive their local priorities — a federated multilateralism of sorts. It means investing in country and regional systems that can stand on their own over time. It also means enabling decentralization of manufacturing capacity and sourcing essential goods and local expertise. The era of GHIs stationed in distant geographies away from the problems they are trying to solve must end soon, as it is neither efficient nor effective. In the transition phase, GHIs must accelerate alignment with national health strategies, systems, invest in local institutions, and work toward building local capacity that lasts. But this evolution, and the progress it will catalyze in countries, will not be possible if GHIs do not receive the funding they need now.

3. Public funds must be used to attract private capital and spark innovation. Here, multilateral development banks and other development finance institutions have a key role to play: They must lean back into health, using their financial firepower, multi-sectoral expertise, and risk-sharing tools to unlock blended finance for health infrastructure, digital systems, and innovations.

The vision ahead is one of co-investment, shared responsibility, and mutual benefit. One where health systems are not merely surviving on external aid, but thriving as engines of development, resilience, and dignity for all. One that is in our collective self-interest to achieve. We must all step up.

This is the future the world must commit to in Sevilla.