Commentary by Council Chair Ilona Kickbusch

2025 was a year of contradictory developments in global health. On the one hand, countries moved towards closure of the pandemic years by adopting a pandemic treaty at the World Health Organization and confirmed the significant increase in assessed contributions, on the other hand the global health ecosystem was shaken by drastic funding cuts and a strong contestation of multilateralism.  

Three key trends have emerged:  

First: Equitable, interoperable global responses will increasingly get harder (data sharing, standards, Pathogen Access and Benefit Sharing (PABS)) as the competition between multilateralism and bilateral/mini-lateral deals gets stronger. But: multilateral meetings in 2025 have clearly positioned the Global South as a forward-looking defining force in global health. Their actions will prove to be critical. 

Second: There will be significantly less resources and where money flows, the conditionalities weaken national health sovereignty. After the COVID-19 surge, development assistance for health (DAH) has been falling sharply and in 2025 nearly all major donor countries have cut back on DAH and on their financial support to the WHO as well as other global health agencies. The executive order by President Trump on January 20, 2025, paused all foreign aid, including most USAID programs, severely disrupting health initiatives worldwide. But increased assessed contributions will make WHO stronger and more independent.  

Third: Geopolitical interests combined with industry pressures make it more difficult to address complex threats to health such as NCDs and climate change. This risks shifting attention and resources away from long-term solutions, making sustained progress on prevention and equity even more challenging. But: health is now present in other key negotiations such as climate and high level meetings at the United Nations.  

A treaty and its challenges  

“On razor’s edge” the member states adopted the WHO Pandemic Agreement in May 2025, but negotiations on the PABS annex continue. The plan is to reach agreement for adoption at the 2026 World Health Assembly, opening the way for the ratification by at least 60 countries to enter into force.  

Step by step (and much too slow for some) the world is moving from ad-hoc crisis response to formalized global structures for preparedness, surveillance, PABS and financing. As always, coordination and financing will remain a challenge but compared to early 2020, when the COVID-19 pandemic hit the world, multilateral tools now exist to coordinate response. What is still missing is an independent monitoring system. How the United States will finally fit into this system – which includes the International Health Regulations - remains unclear. 

Strategic leverage is key  

In 2025, health diplomacy has increasingly evolved into strategic leverage. Global health is a tool of foreign policy, economic advantage and influence. Access to manufacturing, intellectual property, and supply-chain partnerships are strategic assets; money comes with strings attached. Throughout 2025 technological acceleration has entered the global health sphere as a key factor. Surveillance networks, genomic sequencing consortia, and epidemic-intelligence hubs (WHO Hub, International Pathogen Surveillance Network (IPSN), Epidemic Intelligence from Open Sources (EIOS) etc.) have expanded rapidly, improving early detection and analytics. These tools raise capability but also raise questions about data governance, cross-border access, and biosecurity. Control over genomics data and pathogen samples (PABS) is politically charged and will also shape the bargaining over the Pandemic Agreement’s operational rules. 

Regional action increases  

In 2025, both the European Union (EU) and the African Union (AU) expanded their regional global health engagement. In her State of the Union speech, European Commission President Ursula von der Leyen announced that the EU will head a new Global Health Resilience Initiative, stressing that Europe must take the lead on global health and make health a central pillar of its external policy.  

The Africa Centers for Disease Control and Prevention’s (Africa CDC) long-term Africa Health Security and Sovereignty Agenda, endorsed by the AU in November 2025, has also redefined its role in global health.  It centers on sovereignty, domestic financing, digital transformation and local manufacturing.  One of the biggest challenges for the continent are the bilateral deals by the U.S. that offer funds in exchange for access to pathogen information. Countries that build manufacturing, genomic surveillance and logistic capacity gain diplomatic leverage; others risk becoming bargaining chips. The contracts proposed as part of the implementation of the new “America First”-Strategy Global Health include non-negotiable clauses to share data and pathogens with the USA for 25 years  Kenya’s high court has suspended the USD 2.5 bn aid deal over data privacy concerns.  

Geopolitics and the rise of the rest 

Make no mistake – the United States have not withdrawn from global health but sees it as an entry point for a range of other political goals.  U.S. officials are increasingly seen on global health boards such as Gavi, the Global Fund, and the Stop TB Partnership. While many other donors reduce their activities and funding  other geo-political players, especially in the Global South, have increased their global health activities in 2025.  The 2025 G20 presidency of South Africa – boycotted by the U.S. – put equity at the center of the health agenda. Brazil positioned itself as a leader in climate-health integration. During its COP30 presidency in November 2025, Brazil launched the Belem Health Action Plan, the first climate adaptation plan focused specifically on health, reframing climate change as a public health crisis.   

In 2025, China announced a significant increase in voluntary contributions to WHO and is now – after the U.S. departure –   the largest payer of assessed contributions to WHO. It is positioning itself as a reliable pillar in global governance and it has been a strong supporter of the move of the expanded BRICS group to increase South-South cooperation in health. China renewed and strengthened the China-Africa Cooperation with a new Beijing action plan for 2025–2027. It is aligning its global health activities not only with trade and security goals but also with data partnerships and manufacturing diplomacy, partly linked to the Belt and Road Initiative. Other Asian countries are also expanding their global health activities. India, for example, is investing in pharmaceuticals and digital health leadership – as already illustrated during their G20 presidency.  

Complex issues that lose out 

Despite the adoption of the 2025 UN High-Level Meeting Political Declaration on preventing and controlling NCDs and promoting mental health, the appetite to address the commercial determinants of NCD’s is weakening as countries face financial pressures and need many for security concerns.  

But NCDs and aging populations will increase baseline health system pressure; requiring multisectoral action. However, such approaches are harder to implement as geopolitical pressures and conflicts grow. Many countries are reducing global and national health spending to strengthen military security.  Wars, civil conflicts, terrorist insurgencies, migration, and the increase in refugee numbers has also pushed the humanitarian system to its limits.  This includes increasing erosion of international humanitarian law. 

A roller-coaster year for global health 

2025 has been a roller-coaster year. It has redefined global health and pushed it into a more transactional space. It will probably take several years until the global health ecosystem moves out of crisis mode and finds equilibrium and a new architecture that drives global health equity. Until then, the drivers will be geopolitics, profit, technology, climate change, and demography.