Between Hope and Hesitation: The 78th World Health Assembly and the Future of Global Health

Reflections from WHA78 on global health, WHO reform, and the real impact of funding cuts on lives—beyond rhetoric, frameworks, and diplomacy.

The 78th World Health Assembly (WHA78) was held in Geneva last month, gathering more than 3000 delegates from around the world. While attending one of the side events, I had the opportunity to experience the city as it hosted one of the most prominent platforms for multilateral cooperation and dialogue in global health.

It was my first time in Geneva, a city I’d long associated with diplomacy and development. Having spent much of my academic life reading about the post-war world and institutions like the UN and WHO in history and politics textbooks, actually being there felt surreal. Delegates bustled through a dense itinerary of sessions scattered across buildings, often pausing for photos in front of the rows of national flags at the Palais des Nations - a quiet nod to the significance of being part of this moment, and of course, perfect material for a LinkedIn post. Much like many of us, as we step from academia into our careers on ground, we quickly realise how complex, and - as we’re witnessing now more than ever - fragile these institutions are.

WHO Director-General Dr. Tedros Adhanom Ghebreyesus takes a photo with an attendee at the 78th World Health Assembly in Geneva, Switzerland. Photo: WHO/Pierre Albouy.

While the official theme of this year’s Assembly was “One World for Health,” the true unspoken theme across each formal and informal conversation was another: the seismic funding cuts initiated by the President of the United States, and mirrored by several European governments. It was both revealing and immensely sobering to witness that the direction of one of the most influential gatherings in global health could be so deeply shaped by the decisions and ideology of a single man.

I found myself oscillating between cautious optimism and quiet disillusionment. I left Geneva carrying a mix of reflections and questions

The WHA78 surely delivered some powerful outcomes: a historic Pandemic Agreement was adopted; a 20% increase in assessed contributions was approved; more than $210 million was pledged during the WHO Investment Round; and the Spanish Health Minister was appointed to the WHO Executive Board - a notable step in the country’s growing engagement with global health diplomacy, and more. These decisions were no small feat; and yet, the question that lingered was: are they enough to meet the scale and urgency of the challenges unfolding on the ground?

In the midst of these conversations, I found myself oscillating between cautious optimism and quiet disillusionment. I left Geneva carrying a mix of reflections and questions (and a tad bit of an existential crisis), which I now leave with you to ponder alongside me.

Reform is under construction — But what about today?

While discussions focused upon reform roadmaps, and mid- to long-term opportunities to restructure aid systems, I wondered: how are we addressing what’s happening to real people as a result of aid cuts right now?

The sudden shortfall in funding isn’t just a budget issue — These are real-time disruptions in the lives of people who are more than statistics. Our own teams at ISGlobal estimate that up to 14 million lives could be lost due to these cuts

The sudden shortfall in funding isn’t just a budget issue — These are real-time disruptions in the lives of people who are more than statistics. Our own teams at ISGlobal estimate that up to 14 million lives could be lost due to these cuts. Health facilities that serve hundreds of people each day have shut down. Health and development workers have lost their jobs overnight. Grassroots organisations are shutting down. Access to life saving diagnostics and medicines has been disrupted. Yet, few sessions engaged with this crisis in the present tense.

Sustainable systemic change undoubtedly takes time — but those most affected by the consequences don’t have that time. How did we reach this point with no contingency plan? How are we responding now? These realities demand more than frameworks — they demand urgency, empathy, and a willingness to act.

Global health financing still rests on deeply colonial foundations, why aren’t we talking about it?

While conversations about fundamentally restructuring the global health financing landscape were central to this year’s Assembly, there was no meaningful recognition of the colonial underpinnings of the infrastructure. There was growing emphasis on domestic resource mobilization and a shift away from traditional donor-recipient dynamics towards co-creation. Yet, little was said about the structural conditions — past and present — that have limited LMICs’ (most of which are post-colonial nations) capacity to mobilize domestic resources in the first place. Debt burdens, extractive trade relationships, and political instability and conflict - that inherently cripple local health systems and a colonial legacy - continue to shape what is possible for many countries today. If we are serious about country ownership and equitable partnerships then we must confront these deeply embedded power hierarchies. Without doing so, co-creation risks becoming little more than a rebranded form of dependency — a new label for an old imbalance.

The World Health Assembly at the Palais des Nations in Geneva, Switzerland. Photo: WHO/Pierre Albouy.

Is all engagement meaningful engagement?

Over a 100 side events alongside the core Assembly sessions ran in parallel — an impressive display of global attention. However, sheer volume doesn’t always translate to meaningful engagement. Hour long and overlapping discussions often stayed at the surface, inundated with buzzwords like “innovative financing” while avoiding the difficult questions on how these propositions translate on ground, across diverse health systems and socio-political contexts, and on what timelines? As the global health sector grows in scale and complexity, perhaps it’s time to rethink the formats of how we gather — not just to manage crowds, but to foster deeper, more inclusive dialogue. Because if engagement remains a box to tick rather than a practice to improve, we risk reproducing the very exclusions we claim to change.

As the global health sector grows in scale and complexity, perhaps it’s time to rethink the formats of how we gather — not just to manage crowds, but to foster deeper, more inclusive dialogue

Conversations about financial sustainability, diversification, and resilience are not new. They’ve existed for over a decade. What’s different now is that we’re at a juncture where these ideas must move from rhetoric to practice. These problems are not linear and thus neither are their solutions. Platforms like WHA78 remain vital, however, to ensure their value, we must hold them to high standards of accountability and inclusion, while also using them as moments to reflect on our own roles within the system. We must put in the mental labour to ponder over complexity, disillusionment, and contradiction with the system, and still push for change. Change that is meaningful in the long term and also responsive to the urgency of the present, because people can’t wait for systems to evolve and neither should we.