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Global health coordination is increasingly challenged by geopolitical competition and fragmented governance. In this op-ed, Michael Ouma, a global health analyst, explains how competing blocs complicate outbreak response and how regional resilience and negotiated data-sharing can keep pandemic response functional in Africa.
"Blocs prioritise the health security of their own regions and develop parallel supply chains for pharmaceuticals. The result is a global health system weakened at its most critical junctures: early detection, transparent reporting and equitable distribution."
He argues that embracing solution-focused approaches like cooperation is essential to prevent future pandemics from becoming catastrophic.
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For decades, the aspirational blueprint for global health was built upon a foundation of universal consensus. The vision was one of a coordinated world, led by a benevolent hegemony of technical expertise through the World Health Organization (WHO), where data flowed freely, pathogens were met with collective resolve, and health was a neutral, apolitical good.
This paradigm is not merely strained; it is obsolete. We now operate in a world fractured into competing geopolitical and economic blocs—a landscape defined by the U.S. and its allies, a China-centric coalition, a resurgent Global South bloc, and various regional alliances.
In this new reality, the quest for universal consensus on health is a recipe for paralysis. The pressing question is no longer how to restore a singular system, but how to architect a functional, resilient, and equitable global health ecosystem in the absence of one.
The end of the universalist fiction
The cracks have been visible for years: the scramble for vaccines during COVID-19, marked by "vaccine nationalism" and the Covax facility's struggles; the geopolitical tension surrounding the origins-tracing of SARS-CoV-2; the use of medical aid as a tool of "mask diplomacy" and soft power.
These are not aberrations but features of the new order. Blocs prioritise the health security of their own constituencies, develop parallel supply chains for pharmaceuticals and PPE, fund competing health initiatives in third countries, and propagate distinct narratives about health governance.
The conventional model—waiting for all 194 WHO member states to agree—grinds to a halt when core strategic interests diverge. A bloc that views a pandemic through a lens of biosecurity rivalry will not seamlessly share early-outbreak genomic data with a bloc it perceives as a strategic competitor.
The result is a global health system weakened at its most critical junctures: early detection, transparent reporting, and equitable countermeasure distribution.
Paradigm shift: From universal consensus to "pluralistic coordination"
Accepting this fragmentation is not surrender; it is the prerequisite for pragmatic strategy. The goal must shift from enforcing a single set of rules to managing interdependence between blocs. We need a system of "pluralistic coordination," built not on naivete, but on hard-nosed recognition of aligned interests, even amidst competition.
This requires a new playbook, focused on three pillars:
1. Negotiated transparency and "firewalls": Instead of pretending trust exists where it doesn't, we need formal, negotiated agreements on data and sample sharing that include verifiable protocols and benefits. Imagine "WHO-facilitated, bloc-based early alert corridors." Competing blocs could pre-commit to sharing anonymized, real-time pathogen data with a trusted technical intermediary (like a reinforced WHO Hub for Pandemic Control) under strict, mutually-agreed "firewall" protocols that separate epidemiological intelligence from geopolitical intelligence. The incentive? All sides gain faster, more accurate threat assessment. It’s arms-control style verification, applied to public health.
2. Issue-specific coalitions of the willing (and the able): Universal agreements on pandemic preparedness may be impossible, but smaller, agile coalitions can drive progress. A coalition of scientific powers (across blocs) could forge a treaty on open-science pathogen research. A manufacturing bloc (e.g., India, Southeast Asia, Africa with support from various sponsors) could establish a distributed, end-to-end vaccine production network, with pre-negotiated licensing for emergencies. The recent pandemic accord negotiations should be seen not as a single, all-encompassing treaty, but as a framework enabling such variable-geometry coalitions.
3. Devolved governance and regional resilience as a global good: A world of blocs makes regional health sovereignty paramount. The strongest bulwark against global health collapse is not a fragile central authority, but a network of resilient, interoperable regional hubs. Investing in Africa CDC, ASEAN's health mechanisms, and the EU’s Health Union isn't fragmentation—it's intelligent redundancy. When each region has stronger surveillance, manufacturing, and response capacity, it reduces global dependency and pressure during a crisis. Blocs and donors should compete to build capacity in regions, not just to extract loyalty. A medically capable Global South is not a threat to any bloc's security; it is a prerequisite for global stability.
The critical role of middle powers and non-state actors
In this multi-polar health landscape, middle powers (e.g., Norway, Singapore, Rwanda, Costa Rica) and influential non-state actors (e.g., Médecins Sans Frontières, CEPI, major philanthropic foundations) gain outsized importance.
They can act as neutral conveners, trusted brokers, and operational implementers in spaces where major blocs are deadlocked. Their agility and perceived neutrality are assets to be leveraged, not sidelined.
Health as a circuit-breaker, not a casualty
Health will inevitably be entangled with geopolitics. The choice is whether it becomes a perpetual casualty of that competition or can be engineered as a "circuit-breaker"—a domain where even rivals have a tangible, immediate interest in limited cooperation.
Strengthening the global health system now means building connective tissue between blocs, not a single skeleton. It means designing mechanisms that allow for competition in health innovation and diplomacy, while mandating cooperation on core common threats. It is messy, complex, and profoundly challenging.
But it is the only pragmatic path forward. We must abandon the dream of a perfectly harmonious global health choir and start building a symphony from distinct, sometimes dissonant, sections—bound by a shared score of survival. The alternative is a cacophony that will cost millions of lives when the next pandemic, inevitably, arrives.