The global health landscape will never be the same — and it shouldn’t be

Radical shifts in aid and development are forcing the entire global health sector to make long-overdue adjustments and to eliminate well-entrenched habits in addressing the challenging question: How do we design a new global health ecosystem that is effective, resilient, and fair? 2025 is unfolding as a year of unprecedented disruption and political turmoil for the global health and international development sector, challenging paradigms developed over decades. This change has largely been triggered by the decision of the Trump administration to withdraw the United States from the World Health Organization, even though the U.S. helped establish it 77 years ago and was its largest donor. The U.S. administration has also made major funding cuts to development and humanitarian aid, leading to enormous hardship and increased mortality in many of the world’s most vulnerable communities. Despite the current focus on these U.S. decisions among the humanitarian and development sectors, these events were foreshadowed in 2024, when France, Germany, the United Kingdom, and the U.S. cut their official development assistance significantly. To successfully redesign a global health ecosystem, no stone can be left unturned. We need to define what should be maintained, improved, and what must change fundamentally. It’s either this, reform and rebuild, or leave our multilateral system to become irrelevant. Here are four points that I believe are central to this discussion: 1. Safeguard a multilateral rule-based system The current global health architecture reflects the post-World War II power distribution and a strong north-south disparity. However, it also entails the agreement that a multilateral rule-based system built on joint values and aims is indispensable to make the world a safer and better place for everyone. The most pressing health challenges of our time, such as the climate crisis, drug resistance, and growing mental health challenges, cannot be handled by any individual country or stakeholder alone. Strong, coordinated, multisectoral responses across countries and regions during the last decades have resulted in historical improvements in “Good health and well-being” on a global scale — Sustainable Development Goal 3. We have learned that national interests in this domain are best served by multinational approaches, and we need to safeguard the multilateral rule-based system of the United Nations. Multilateral cooperation is often complicated and cumbersome — but there is no alternative to sitting together and defining common ground. If we don’t achieve this, everyone loses. In the face of rising nationalism, countries and stakeholders must step forward to protect and strengthen the multilateral system — and to fundamentally renew it to deliver effectively. 2. Make the global health system fit for purpose We are not talking about small cosmetic changes: We need a structural reform to make our multilateral system more efficient, robust, and fair. In this process, we need to make clear that the adherence to jointly defined principles — i.e., the right to health, fairness, rule-based partnership — does not contradict justified national interests, including competition. In fact, only the proper reflection of such interests will make a new deal for global health fair and stable. The new global health architecture must: • Strengthen the role of the global south. • Replace the donor-recipient paradigm with true partnerships. • Accommodate regional characteristics and approaches. • Redefine and simplify structures to increase effectiveness, transparency, and flexibility. 3. Spread the financial responsibility All countries have an interest in health, and the multilateral system needs to improve it. However, the conditions and economic means of countries and regions differ substantially, and not everyone can contribute to the same extent. A system that is overly dependent on any single donor, such as the U.S., has never been sustainable or fair since disproportionate contributions usually come with disproportionate influence. Therefore, we need to envisage contributions to the U.N. by all nations and stakeholders according to their actual economic power, which is developing very dynamically in many regions of the world. While the cuts from the U.S. government sound large — a decrease of development assistance for health by $9 billion in 2025 alone — the sum is still relatively modest when compared to the budgets of major economies, and particularly their defense budgets. Everyone needs to consider that “in order to have a say, you have to pay” — or contribute otherwise. This responsibility extends across all sectors. Too often, the focus is placed solely on the public sector, while major multinational corporations also play a decisive role in health. We need to ensure that all sectors meet and develop joint solutions. 4. Reframe communication for global health There is a striking discrepancy: Everyone wants health, but investments in global health are seen with a lot of skepticism. Population health is in all our economic interests, and engaging in health is not solely a charitable cause, but a strategic investment. Each dollar spent on prevention and curation has a catalytic effect, reducing future health care costs, making societies more resilient, and strengthening long-term growth. Health is the basis for the prosperity of nations and individuals. We just need to get that across. Transformation is never easy, but one thing is clear: We must use this challenging moment as an opportunity to reform the global health landscape. Editor’s note: Devex is a media partner for this year’s World Health Summit, bringing together leaders and changemakers from science, politics, the private sector, and civil society. While working in close partnership with the World Health Summit, we maintain editorial independence of our coverage. Register now for the Oct. 12-14 event in Berlin.