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Virginia Rodríguez Bartolomé
Advocacy Coordinator at ISGlobal
March 2026
The World Health Organization (WHO) occupies a unique position within the architecture of global health. As a specialised agency of the United Nations system, with a constitutional mandate to act as the directing and coordinating authority on international health matters, WHO has for decades been the normative, technical and political hub around which global health governance has been structured. However, the current context of a reconfiguring world order, marked by growing geopolitical tensions, institutional fragmentation, a shift towards a multipolar world and pressure on multilateralism, raises substantial questions about its role, adaptability and future legitimacy.
Since its creation in 1948, WHO has developed three core functions within the global health ecosystem:
- Normative and regulatory function: development of technical standards, clinical guidelines and international regulatory frameworks. A paradigmatic example is the International Health Regulations (IHR), a legally binding instrument that structures the notification and management of public health emergencies of international concern.
- Coordination function in health emergencies: technical and operational leadership in response to cross-border health crises, such as the declaration of the COVID-19 pandemic or outbreaks of Ebola and mpox.
- Technical support and health system strengthening: assistance to Member States in the design of public policies, universal health coverage, epidemiological surveillance and capacity building.
However, the global health ecosystem has undergone profound transformation since the 1990s. The emergence of multilateral actors mobilising unprecedented levels of resources for specific mandates has led to a more polycentric and financially fragmented architecture.
The COVID-19 pandemic exposed important weaknesses in global emergency response capacities. Furthermore, the current geopolitical context, in which global health has become a key element of national and global security, and the withdrawal of the United States from WHO, place the organisation at an existential crossroads from which it must address reform.
What reflections should guide this reform? Below are some of the key questions.
1. How does WHO define and prioritise its own role?
The Fourteenth General Programme of Work (GPW 14) for the period 2025–2028 sets out the strategic roadmap to restore progress towards the Sustainable Development Goals (SDGs) in a context shaped by climate crises and conflict. This strategy is based on a triple mission: promote, provide and protect health and wellbeing for all, leaving no one behind.
WHO’s central objective for the next four years is to save 40 million lives through the implementation of six strategic objectives addressing contemporary crises.
- First, the organisation aims to promote health by addressing the root causes of disease, with particular emphasis on climate change, identified as the greatest health threat of the 21st century.
- Second, it prioritises providing health through a radical reorientation of systems towards Primary Health Care (PHC), a model capable of covering up to 90% of essential interventions.
- Finally, WHO seeks to protect health by strengthening preparedness and response to emergencies, integrating lessons from the COVID-19 pandemic to safeguard 7 billion people from health risks.
2. What resources does WHO have to fulfil this role?
Reforming the health architecture is inseparable from financial reform. Currently, reliance on voluntary earmarked contributions (80% of the budget) limits WHO’s strategic agility. The Investment Case 2025–2028 highlights that WHO requires a base budget of 11.1 billion US dollars, of which 7.1 billion must be raised through an innovative investment round.
Investing in WHO is not only an ethical imperative but also an economically efficient decision: every dollar invested generates a return of 35 dollars in economic and social benefits. The goal is to move towards a model in which assessed contributions (mandatory fees) cover 50% of the base budget by 2030, ensuring a more independent and resilient organisation.
3. What challenges must WHO respond to?
The 21st-century health architecture requires new governance tools and technologies. WHO is currently leading the rollout of the pandemic agreement and the implementation of the amendments to the International Health Regulations (IHR), aiming to establish a legal framework that balances national sovereignty with the need for robust and equitable international cooperation.
Beyond responding to international public health emergencies, WHO must lead on other key aspects of the global health agenda, such as the climate crisis and the lack of equity in access to the right to health, particularly for women, in a context of regression in the protection of their sexual and reproductive rights.
Finally, the organisation positions itself as an ethical steward in the expansion of digital health and artificial intelligence, promoting standards for interoperability and data sovereignty that prevent new inequality gaps.
4. What alternatives are being proposed in this debate?
There is an ongoing critical debate about the organisation’s future role within the global ecosystem. Some analysts at the Center for Global Development propose a “lean WHO”, arguing that the organisation should withdraw from direct technical assistance in countries and focus exclusively on its comparative advantage: global leadership, health security and the provision of global public goods for health. Under this reform vision, country offices would be reduced to liaison functions, shifting operational implementation to local or regional actors.
However, the official WHO position and that of various experts maintains that a strong in-country presence is essential for normative legitimacy, as it allows global standards to be informed by local contexts and translated into real impact. The reform of the global architecture proposed by WHO does not aim for withdrawal, but rather for systemic leadership that aligns actors such as Gavi, the Global Fund and multilateral development banks under national priorities, which should guide the coordinated agenda led by the organisation.
5. Future perspectives
In summary, WHO stands at a historic turning point. The transition towards a more fragmented and competitive international order challenges the foundations of the traditional multilateralism on which its authority was built. At the same time, global health interdependence is more evident than ever.
Its future role will depend on several factors: sustainable reform of its financing, strengthening of the international legal framework, improved operational capacities in emergencies, effective coordination with new actors, and the ability to uphold principles of equity and solidarity in a politically polarised environment.
Far from losing relevance, WHO can consolidate its position as an essential platform for the provision of global public goods for health. However, this will require political will from Member States to provide it with sufficient resources, mandate and support. In a rapidly evolving ecosystem, the key question is under what institutional and geopolitical conditions WHO will be able to exercise effective and legitimate leadership in 21st-century global health governance.
