Rupture as Catalyst: The Case for Deep WHO Governance Reform; Comment on “The United States Withdrawal From the World Health Organization: Implications and Challenges”

Buse, Kent; Acharya, Shambhu

Rupture as Catalyst: The Case for Deep WHO Governance Reform; Comment on “The United States Withdrawal From the World Health Organization: Implications and Challenges”

Articles in Press

Document Type : Commentary

Authors

Kent Buse ¹

Shambhu Acharya ²

¹ Department of Global Population Health, School of Medicine and Health Sciences, Monash University Malaysia, Kuala Lumpur, Malaysia

² Independent Researcher, Kathmandu, Nepal

Abstract

US withdrawal from World Health Organization (WHO) in 2026 is widely framed as a crisis to be managed toward eventual membership restoration. We argue the opposite: geopolitical rupture has created the first genuine political opening for deep governance reform of an institution whose architecture has, for decades, enabled dominant funders to shape priorities. The burden-sharing critique of Global South non-engagement is reframed as a legitimacy deficit: countries have contributed pathogen samples, data, and biological materials to global systems while watching the resulting benefits captured by high-income states and their manufacturers, as illustrated by H5N1, COVID-19 vaccine inequity, and the unresolved Pathogen Access and Benefit Sharing (PABS) annex of the Pandemic Agreement. Seven interdependent reforms are identified spanning earmarking caps, assessed contributions, a single non-renewable Director-General term, a global common framing, civil society oversight, Executive Board (EB) reform, and regional director appointments. Our argument is that the rupture has disturbed the conditions that made structural change unlikely, and that durable legitimacy is more achievable now than at any prior moment.

Keywords

Global Health Governance

Health Geopolitics

WHO Reform

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