The Global Health Architecture: Governance and International Institutions to Advance Population Health Worldwide

The United Nations (UN) created the World Health Organization (WHO) as its first specialized agency out of the ruins and atrocities of World War II. For decades after its creation, the WHO had an unrivaled place leading world health at the very center of the global health architecture. In those early years, the WHO was one of very few institutions in the health space, later joined by the World Bank. By 1980, the WHO achieved the unimaginable—the eradication of the ancient scourge of smallpox. But the WHO’s power and influence has steadily waned, with a plethora of global institutions and actors entering the space that the WHO alone had once occupied.

Following the West African Ebola epidemic (2014-2016), the WHO enacted several key reforms, notably the creation of its Health Emergencies Programme and a Contingency Fund for Emergencies. However, the COVID-19 pandemic was a turning point for the WHO. The agency found itself embroiled in a bitter political dispute between two superpowers, China and the United States, culminating in former President Trump’s announcement that the United States would withdraw from the WHO. During COVID-19, the WHO’s leadership was called into question, and governments largely failed to comply with the International Health Regulations (2005) (IHR) while disregarding WHO recommendations under the IHR. This precipitated a series of audacious reform proposals. The World Health Assembly (WHA) charged an Intergovernmental Negotiating Body with negotiating and codifying a new international instrument for pandemic prevention, preparedness, response, and recovery, often referred to as a pandemic treaty.