While the delegates at the 79th World Health Assembly (WHA79) navigate the halls of the ‘Palais des Nations’ this May, public health leaders at home are facing a starkly different landscape. Our global health architecture is currently undergoing a radical transformation, driven not only by new treaties but by a significant shift in geopolitics and financing. For all health leaders who aren’t attending, understanding these tectonic shifts, particularly the fallout from the United States’ withdrawal from the WHO, is essential to enable you as a senior health leader to plan organisational and national strategies into the future. Here are some things I think it would be helpful for you to be aware of this spring.
The New Realities of 2026 and Beyond for Global Health Leaders
The “Major Donor” Gap and Budget Revisions: Following the United States’ withdrawal from the WHO in early 2026, the World Health Organisation has had to implement “realistic budgeting” to reflect the loss of its largest contributor. The overall budget envelope for 2026–2027 was revised downward from an initial US 4.2 billion. This 14% decrease in the Base segment is forcing a sharper focus on core functions, accountability, and country-level capacities to ensure the most essential work remains safeguarded.
The National NIA Mandate: Regardless of Geneva attendance, every country must address the requirement to have established or designated a National IHR Authority (NIA) by September 2025. Unlike previous focal points, the NIA is designed to be an institutional anchor with the political authority to coordinate across sectors like finance and agriculture to reinforce national health security.
Finalising the Pathogen Access and Benefit Sharing (PABS) System: Negotiations for the PABS annex, the “heart” of the Pandemic Agreement, have been extended into late April 2026 to reach consensus before WHA79. The goal is to ensure the rapid sharing of pathogens with pandemic potential is matched by the fair and equitable distribution of vaccines and therapeutics.
A Decadal Pivot for AMR: The Assembly is set to adopt the Global Action Plan on Antimicrobial Resistance (GAP-AMR) 2026–2036. Public health leaders should track the new emphasis on voluntary and mutually agreed technology transfer, which aims to help low- and middle-income countries manufacture their own diagnostics and antimicrobials.
Generative AI as a Mental Health Concern: For the first time, experts are calling for generative AI use to be recognised as a public mental health issue. Recommendations for health leaders include integrating mental health into AI impact assessments and ensuring tools are co-designed with experts and youth to mitigate risks like emotional dependence.
An Opportunity For You To Lead as a Medical, Public Health, or Global Health Leader
The departure of the United States from the WHO marks a watershed moment for global health leadership. For those of you leading in a multi-lateral context, this is a “resilience test.” The reduction in the WHO’s global budget is a signal that the era of relying on a single superpower’s contribution is over. We are moving toward a more fragmented, yet diversified funding model, evidenced by the WHO Investment Round, which has already secured nearly US$ 2 billion from a broader base of donors. As a senior doctor or public health leader, your challenge is to identify how to sustain your domestic programmes while global technical support becomes more “disciplined” and “impact-oriented”.
This shift also makes the establishment of your National IHR Authority (NIA) more than just a compliance task. In a world with less centralised global oversight, your national health security architecture must be self-sustaining and empowered at the highest levels of government. I encourage you to use this mandate to break down the silos between your health ministry and the ministries of finance or trade for those in national roles, and the equivalent Directors at local level. If you aren’t in Geneva, your most important work is ensuring your NIA has the soft skills and legal authority to lead a “whole-of-government” response before the next public health crisis hits.
Finally, do not let the focus on budgets distract you from the ethical governance of emerging technology. As generative AI becomes a primary tool for emotional support among young people, you must step in as the “ethical guardian” of this new area of public health. Even without a ‘delegate badge’, you can take action around accountability and human well-being in your local health systems, ensuring that innovation does not outpace safety.
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