The Future of Multilateralism in Global
HealthBy Priti Patnaik
Geneva Health Files, May 2023
Global health governance is at the cusp of a transition.
The pandemic of COVID-19 had provided an opportunity for countries to put
to test the strength of multilateral decision-making. The pervading inequities
in the response and recovery from the pandemic has shown that theinternational community has spectacularly failed the multilateralism test. But
as a result, it has changed diplomacy and governance questions forever.
No where is this more evident than in the on-going negotiations at the World
Health Organization, where countries have come together to negotiate newrules in the governance of health emergencies and in the discussions on theamendments to the International Health Regulations (2005). And this in myview, is a renewed opportunity to push the boundaries, or indeed secure thefundamentals of multilateralism in global health.
But as before, the possibilities for strengthening multilateralism in global
health is being, and will be dictated by, current realities and forces outside ofglobal health.
WHY MULTILATERALISM IS FAILING?

There are multiple reasons why multilateralism in global health has been
under challenge. From prevailing economic structures to the rise oftransnational corporations, from the rising influence of philanthropists atnational and international levels to the systematic dismantling of publicfunded health systems – these underlying factors have affected decisionmaking at international levels.
Emergence of other forums of decision-making, made up of a smaller groupof countries have also skewed the way global health issues are discussed andgoverned. The nature of international cooperation has changed, not only
because of geopolitics, but also because of the rise bilateral and regional
interests among countries.

Image Credit: Photo by Bruno Thethe, Pexels
WHY MULTILATERALISM NEEDS TO SUCCEED?

COVID-19 has showed that complex challenges such as pandemics and theclimate crises that respect no borders, will need true international cooperation
and a functional multilateral system in decision-making.
The onus of making multilateralism work lies on all countries, and otherpowerful stakeholders that have impinged on this space.
Countries must make space for democratic engagement at not onlyinternational levels but also national levels. Policy space for countries must
be protected from commercial and private interests when governing healthmatters. A blatant and one-size-fits-all approach to “multistakeholderism”
that treats private interests at par with people’s interests represented by civilsociety groups, affects this policy space. In time, this begins to eat into thepossibilities in multilateral governance.
For multilateralism to work, and to solve multifaceted challenges, there needs
to be a new social contract between and within countries. This will not be
possible if governments everywhere ascribe to short-termism and protect
status quo without attempting radical changes in the way some of these issues
have been governed.
WHAT IS IN STORE?

The climate for multilateralism in global health does appear bleak. However,there are openings and possibilities that countries can explore and expand.
The onus is on all member states, but more so on those who have the luxuryof leading and shaping other exclusive forums such as the G7 and the G20.
To be sure, this is a challenge not only for WHO member states, but one thatwill continue to need support from democratic forces including robust civilsociety participation, expanded diverse decision-making rooted in decolonial
framings, and in the mutually supportive roles of other powerful global
health agencies. Many believe that for multilateralism in global health tosucceed in Geneva, the process must begin at the national and regional levels.
To an extent, Geneva is a reflection on impulses and impetus from capitals.
The answers to the concerns on multilateralism may lie beyond theimmediate confines in Geneva.
CURRENT NEGOTIATIONS IN GLOBAL HEALTH

Despite the diverse and complex motivations of various countries in the ongoing negotiations in global health, it appears that it may offer opportunities
for multilateralism to succeed. For one, the aspiration for better “globalhealth security” may be a powerful factor in catalysing a consensus forged bymultilateral decision-making. This is notwithstanding the top-down
imposition of the concept of global health security – that has now effectively
been embraced even by developing countries.
Ultimately, by way of these negotiations countries may begin to find sharedvisions to make the world a safer and a healthier place. And even if thismeans small steps to address the inequities in the access to medical products,
or in the investments in health systems, these efforts could collectively
contribute to an overall progress in the way countries come together to findsolutions to problems that affect everybody.
At stake are the lives, health, and futures of those left behind. Saving
multilateral decision-making in global health is a compulsion not anaspiration for international cooperation.
A number of successes have been cited as proof that the world can cometogether, whether it is signing up to achieve the sustainable development
goals, or numerous international treaties. Global health has the potential todemonstrate that multilateralism in decision-making is worth saving.
First published by newSpecial: May 2023 issue