The 79th World Health Assembly (WHA79), held 18–23 May 2026, took place amid a confluence of crises. Negotiations were overshadowed not only by geopolitical tensions but also by fresh Ebola outbreaks in Uganda and the Democratic Republic of Congo, and a hantavirus outbreak aboard a cruise ship.

Looming over everything, however, was a more fundamental crisis: The increasing fragmentation and funding breakdown of the global health system. A growing number of international organisations, health funds, and multi-stakeholder initiatives (MSIs) are operating in parallel, competing for resources and influence.

Health emergencies throw these structural weaknesses into sharp relief. The COVID-19 pandemic already laid bare how poorly coordinated the international response was. National and regional unilateralism dominated pandemic policy, while WHO recommendations on the equitable distribution of vaccines and medical products were largely ignored.

Rather than strengthening the WHO as the central coordinating body, the crisis instead spawned a new global MSI: the Access to COVID-19 Tools Accelerator (ACT-A), backed by governments, philanthropic foundations, the WHO, the pharmaceutical industry, and various partner organisations. ACT-A was meant to coordinate the global pandemic response — but fell short of both its distribution targets and its own coordination ambitions.

This raises the question: Who sets global health priorities and what role should the WHO play going forward?

More and more actors are competing for power and resources

While health crises demand rapid decisions, coordinated funding, and clear lines of accountability, today's global health system is characterised by a proliferation of parallel initiatives and actors.

These include UN agencies, global health funds, and MSIs such as the vaccine alliance Gavi, the Coalition for Epidemic Preparedness Innovations (CEPI), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Pandemic Fund under the World Bank umbrella. Many of these initiatives were created around the priorities of individual donor countries and have steadily expanded their mandates over the years.

The result is overlap, resource competition, and blurred lines of responsibility. National health authorities must manage acute crises while simultaneously navigating the demands of numerous donors, programmes, and initiatives. Rather than building long-term resilient health systems, countries become dependent on short-term funding logic and externally driven priorities.

The WHO is fighting for its place as the world's central health authority

Against this backdrop, reform of the so-called global health architecture has become unavoidable. Over the past year, numerous forums and initiatives have explored potential approaches — among them the Accra Reset Initiative, HEARCSO, and efforts by the Wellcome Trust and the EU's Health Emergency Preparedness and Response Authority (HERA).

The reform debate has centred on several key questions: How should responsibilities be distributed between global, regional, and national institutions? How can funding be made more independent and sustainable? Who should have a greater say in global health policy?

Also at stake is how to improve access to medicines, health preparedness, and data collection worldwide — particularly in countries of the Global South.

Yet the central question running through all of these debates is: what role should the WHO play in this architecture?

This is where a core political tension lies. The WHO's mandate is to set global health standards and ensure international coordination. But it is far from certain that member states — particularly major donor countries with powerful pharmaceutical industries, such as Germany — actually want the WHO to take on a stronger norm-setting role.

Given the current wave of deregulation at EU level, there appears to be little political appetite in many EU member states for granting the WHO binding authority over economic actors. This is especially evident in the ongoing negotiations over the proposed Pathogen Access and Benefit Sharing (PABS) system for sharing pathogen data and medical countermeasures, where the EU is pushing for a voluntary mechanism. Industry associations also warned during WHA79 that the WHO could seek to intervene more directly in matters of intellectual property rights, licensing, or price regulation.

Donors set the agenda — the Global South demands a greater voice

Behind the question of the WHO's future role lies a more fundamental question of power: who sets the priorities in global health, and who controls the resources?

Countries of the Global South have long argued that decisions within global health policy continue to be shaped primarily by major donor states and international financing mechanisms. These power asymmetries are reflected in how the WHO itself is funded: the bulk of its budget comes from earmarked voluntary contributions. As a result, the organisation's work tends to reflect the priorities of individual donor governments and philanthropic foundations rather than actual global health needs.

Many reform proposals therefore focus on making WHO funding more independent. Options under discussion include further increases to member states' assessed contributions and more flexible, unearmarked funding. At the same time, many actors are calling for greater participation by Global South countries and affected populations, as well as stronger democratic oversight of global health initiatives.

WHA79 launches a new reform process

Based on a proposal from the Director-General — submitted at the Executive Board's request in early May — member states agreed at WHA79 to launch a joint reform process.

The process aims to better align responsibilities between global, regional, and national institutions; improve decision-making and collaboration; hold the various actors more accountable for their commitments; and align funding more closely with national and regional priorities. It also seeks to strengthen national ownership and place the long-term financing of global health on a more reliable footing.

A new joint task force is to develop reform options by WHA80 in May 2027. The task force will have 25 members, drawn from WHO member states across all regions, global health initiatives including Gavi, the Global Fund, CEPI, and Unitaid, as well as UN agencies, the World Bank, and a regional health organisation. Civil society organisations and the pharmaceutical lobby have criticised their exclusion from the task force itself — they will only be consulted.

This process must not repeat the mistakes of the SDG3 GAP

The current reform effort is not the first attempt to bring greater coherence to the fragmented global health system. In 2019, the WHO led the launch of the Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP) — an initiative to improve coordination among the major global health organisations, backed at the time by the heads of government of Germany, Ghana, and Norway: Angela Merkel, Nana Akufo-Addo, and Erna Solberg.

Then as now, the goal was to improve collaboration among international health and development organisations. While the action plan created new coordination structures, the promised improvements were only partially implemented by the participating actors and at country level. What was missing was a shared understanding of the objectives, meaningful civil society participation, and accountability mechanisms through which states could hold global health initiatives and actors to their commitments.

This reform process will not fundamentally change the system

Expectations for the new reform process are high — but fundamental transformation is unlikely. The Director-General's proposal, as adopted by member states, explicitly rules out deep institutional change. There will be no revision of existing organisations' mandates, and no mergers or consolidations are on the table.

This leaves the reform process with inherently limited scope. Yet the real challenge goes beyond improving coordination or creating more efficient structures. What will ultimately matter is whether the process can address the structural dependencies and global inequalities that define the current system.

For as long as donor-driven interests, geopolitical power imbalances, and commercial profit logic continue to dominate, no reform process will resolve the global health crisis.