The global health ecosystem has faced a tumultuous year. The future of global health systems and the organisations that mobilise expertise, financing and oversight of public health initiatives worldwide are firmly in question.
As we approach 2026, health professionals are asking: what comes next?
“We have hit a critical moment… The current global health system cannot deliver the next generation of health gains without substantial structural change.”
John-Arne Røttingen, CEO at Wellcome
Political shocks and reduced financial support from Global North countries — such as the disbanding of USAID and cuts to World Health Organisation funding — along with internal restructures and re-prioritisation within health agencies have raised urgent questions about the future of global health security. This includes, critically, calls for countries to take ownership of their health agendas and strengthen national and regional health institutions.
As highlighted by our recent webinar, ‘Global Health After the Breakpoint: Evidence for What Comes Next’, it’s clear that a new global health architecture must be deeply rooted in an understanding of what works — and what doesn’t.
A sustainable approach to global health must be built on evidence
As global health institutions (GHIs) navigate seismic shifts in the global context, harnessing existing evidence will be critical to build a sustainable, inclusive health system.
For years, Itad has been helping numerous GHIs to understand and improve their impact through monitoring, evaluation and learning, including:
- Strategy and organisation-wide evaluation of the Global Fund Strategic Reviews in 2015 and 2017, and Unitaid’s ART Optimisation Portfolio
- Disease and intervention-specific work, including an evaluation of Gavi and Partners’ COVAX initiative and UNAIDS’ Unified Budget, Results and Accountability Framework
- Thematically-focused evaluation of Gavi’s engagement of civil society actors and as part of the Health Systems Strengthening Evaluation Collaborative.
These evaluations have generated vital learnings on effective approaches to help shape the conversation for where GHIs go next:
“[Itad] has a deep understanding of what the evidence says about what works — and what doesn’t. We want to make sure that this evidence is fed into the debates about the future of GHIs to ensure that best possible global health outcomes are achieved even in an increasingly challenging environment”
Sam McPherson, Partner, Itad
Lessons for shaping the future architecture of global health
Preserve what works
Any transition to new models must not undermine the profound impact achieved by GHIs for public health. The Global Fund has saved an estimated 70 million lives since its inception. Gavi, the Vaccine Alliance, has delivered life-saving immunisations to one billion children in the world’s poorest countries. Transformation, though necessary, risks disrupting momentum in the fight against diseases such as TB, AIDS and malaria – as well as planning for future pandemics. Successful strategies and ‘what works’ in global health must be preserved – critically, with marginalised and vulnerable populations kept at the centre.
Anchor strategies in reality
GHIs play a critical role in shaping global health markets. They have the influence and capacity to counterbalance market forces and address structural gaps that limit access to essential health products and services. Their interventions have transformed affordability and availability, driving major health gains. For example, one Unitaid market-shaping initiative reduced the cost of optimal antiretroviral treatment in low- and middle -income countries generating an estimated $1.6bn in savings. In a global landscape where pharmaceutical companies hold significant pricing power, this role remains indispensable.
However, failing to account for the realities of global health dynamics can undermine progress. Itad’s evaluation of the COVAX Facility and AMC found that assumptions about vaccine market shaping, development and distribution were overly optimistic – particularly regarding the behaviour of wealthier countries during the pandemic. In practice, vaccine nationalism proved far more aggressive than anticipated, sidelining collective procurement and weakening the mechanism’s equitable intentions.
Harness evidence to challenge the status quo
The robust case for a radical overhaul of the global health architecture, which relocates power and puts countries in the driving seat, will inevitably cause friction – particularly in today’s reactive political climate.
As such, it is critical to frame and anchor conversations about the future of the global health system in evidence about what works, what doesn’t, and for whom. In so doing, we must also reflect critically on what evidence is prioritised:
“We count the usual things: How many lives were saved? … How many people were immunized? Those are the right metrices.
But where is the measurement of how many systems were strengthened? Where is the measurement of how governments were empowered and built and how power was transitioned?
We need to start to include that if we’re genuinely going to measure how effective the GHIs were”
Ebere Okereke FFPHM, MSc, MBB
MEL has a key role to play in the transformation of global health systems. By underpinning these conversations with nuance on what has and hasn’t worked and in what contexts, we can support stakeholders to take steps which bring preserve the global goods of GHIs’ legacies to date and use lessons learned to build better.
Want to know more? Rewatch our global health webinar
Our recent webinar brought together leading voices in global health for an evidence-based discussion of how to rebuild global health for a more resilient, equitable and sustainable future.
This discussion further explored which parts of the current systems are worth preserving — and which parts need abandoning or overhauling.
Watch now: Global Health After the Breakpoint: Evidence for What Comes Next
Jointly sponsored by Duke Center for Policy Impact in Global Health, Itad and PLOS Medicine, this event featured a keynote address from John-Arne Røttingen (CEO of Wellcome) and insights from Itad, the Centre for Policy Impact in Global Health, Global Health at Chatham House and Spark Street Advisors.
