Global Health in Crisis: Why the World Needs a Fair and Robust Health Architecture

Global Health Is at a Critical Turning Point.

Two developments are shaping the situation: a regulatory crisis and a financing crisis. While pandemics, climate change, and geopolitical tensions strain health systems worldwide, international institutions and partnerships risk becoming unable to take action. Countries in the Global South feel the consequences most acutely—despite being the ones most urgently dependent on global solidarity.

Fragmented Architecture and Unequal Power Structures

The global health system is highly fragmented. Governments in the Global South must comply with countless parallel requirements and reporting obligations. International organizations such as the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the vaccine alliance Gavi, or the Global Fund hardly harmonize their procedures and rarely adapt them to national systems. The result: valuable resources flow into bureaucracy instead of healthcare.

A structural power imbalance worsens the situation: wealthy states (particularly the G7 and G20) and large foundations dominate decision-making structures. This means that actors with the greatest financial resources set the priorities. These inequalities deepen dependencies and prevent equitable participation.

A Dangerous Financing Gap

Alongside structural overload, financial resources are dwindling. The withdrawal of the United States from parts of development cooperation has hit the health sector particularly hard. With around 41 percent of global public development assistance (ODA) for health, the U.S. was a central actor in women’s and children’s healthcare and the fight against HIV/AIDS. In countries such as the Democratic Republic of the Congo, this support was in some cases the only external source of funding.

European countries—including Germany—have also cut their ODA contributions, thereby violating the international commitment to allocate 0.7 percent of gross national income (GNI) to development cooperation. At least 0.1 percent of that should go to health—a promise increasingly being undermined. The consequences: programs are being thinned out, systems weakened, and lives put at risk.

UN agencies, the WHO, UNAIDS, as well as multilateral partners like Gavi and the Global Fund are therefore facing an existential situation. At the same time, climate change and pandemic risks exacerbate global health challenges—yet a coordinated global response is often lacking. The sluggish negotiations on the new WHO Pandemic Treaty are a stark warning.

Global Reforms as an Opportunity—or a Risk

Against this backdrop, the world is debating reforms to the international health architecture within the UN80 process. The aim is to make the United Nations and the global health system more coherent, inclusive, and accountable, and to reduce power imbalances.

But reforms must not dismantle existing protective mechanisms. Weakening or even dissolving UNAIDS, for example, would undermine participation and the rights of affected groups—an unacceptable step backwards. Instead, reform must strengthen solidarity, transparency, and the perspectives of civil society.

What Elements Are Necessary for a Just Health Architecture?

A future-ready global health order requires clear guiding principles:

• Legitimacy & inclusiveness: Decision-making processes must be transparent and broadly legitimized—with active involvement of affected populations and civil society organizations.
• Human rights & gender equality: Marginalized groups must be at the center. Gender equality and sexual and reproductive rights must be non-negotiable.
• Strengthening local leadership: Health programs must be country-led. This includes building local capacities—from administration to regional production of medicines and vaccines.
• Solid, sustainable financing: In addition to meeting international financing commitments, new and complementary financing models are needed.
• Strong monitoring mechanisms: Progress must be measurable, independently reviewed, and disaggregated by gender and population group.
• Regional research and production: Local systems need resources to develop medical innovations and manufacture products themselves.

Positive examples show that inclusive structures work—such as the Global Fund’s Country Coordinating Mechanisms, where affected communities and civil society participate equally in decision-making.

Germany Must Assume Responsibility

As a strong economy and reliable multilateral partner, Germany carries special responsibility. Especially in times of growing global competition, Germany must stand firmly for a just international order—and demonstrate through its own funding and diplomatic leadership that global solidarity is not an empty slogan. Cuts to the development budget not only send the wrong political signal but also endanger lives and global stability.

What We Advocate for at VENRO

The global health landscape stands at a decisive crossroads. Health is a human right and a global public good. Courageous political decisions and genuine partnership are needed to ensure that no one is left behind.

We therefore call for:

• Germany must work to ensure that affected communities and civil society are systematically included in global health decision-making.
• The German government must meet the 0.7 percent target and allocate at least 0.1 percent of GNI to health.
• Intergovernmental partnerships must systematically support the development of local health capacities, production, and civil society structures in the Global South.