Challenges Beyond Borders

Intensified cross-border movement of people, goods and information has created global risks beyond the capacity of any one nation-state to manage. The state-based system for international governance constructed after World War II lacks the political authority or enforcement powers to protect and promote global health. And yet globalization has positioned health as central to state interests and foreign policy on issues such as pandemics and vector-borne disease, the health impacts of trade and intellectual property regulations, and workforce migration. The challenge is how to effectively strengthen both global health governance and global governance for health, in order to collectively address shared risks such as the economic burden of chronic disease, health consequences of conflict, food and water insecurity, and environment and climate change. How can we improve the governance of actors in both the health and non-health sectors, foster communication and cooperation, and collaboratively construct new kinds of cross-sectoral alliances and policy instruments?

Subthemes

Globalization & Health

Infectious Diseases

Governance for Health

The effects of globalization on health call for clear and well-coordinated governance and stewardship by global actors. Global health governance refers mainly to those institutions and processes of governance which have a primary and explicit health mandate, such as the World Health Organization. But it also includes regional alliances, public-private partnerships and multilateral international consortia that focus on global health. The architecture of global health governance should be capable of functions at the global level (e.g., international collective action), but also support the strengthening of national health systems. The recent Ebola crisis has shown that weak health systems make countries more vulnerable and makes both the domestic and global response far more challenging. Of equal importance is to improve the coordination and collaboration of global health actors and funders to avoid duplication, redundancy and inefficiency, and better empower and support country priority-setting and decision making.

Below are examples of resources relevant to the overarching themes. Previously highlighted resources and additional resources can be found in our digital Repository.

Resources:

WHO Shapes Priorities for Medicines?
This article from The Lancet discusses the history of the World Health Organization (WHO) Model List of Essential Medicines (EML), a list of medicines intended to help countries prioritize which to keep available and affordable at all times. The article examines who proposed new medicines for the EML, including which countries and organizations they represented and what medications they submitted. The article uses this information to reflect on for whom the EML is intended and how the WHO might approach reforming the EML selection process.

Donor Government Funding for HIV in Low- and Middle-Income Countries in 2024
This report, prepared by the Kaiser Family Foundation and the Joint United Nations Programme on HIV/AIDS (UNAIDS), provides an annual update on the state of government donations to address HIV in low- and middle-income countries worldwide. The report summarizes key findings and discusses the future of government commitments to HIV amid continued global challenges such as conflict, mass displacement, and economic stress. This year’s report finds that donor government funding for HIV increased in 2024 compared to 2023, with disbursements rising from 7.91 billion USD in 2023 to 8.37 billion USD in 2024. However, the report also warns that looking forward, donor government funding for HIV is expected to decrease.

Financing Global Health 2025: Cuts in Aid and Future Outlook
This report from the Institute for Health Metrics and Evaluation (IHME) estimates current and future global health spending and health financing, specifically focusing on health investment in low- and middle-income countries (LMICs). The report includes estimates for domestic spending on health, development assistance for health (DAH), and future health spending for countries worldwide. This year’s report focuses on recent cuts to development assistance funding. The report finds that the U.S. government made the largest cuts, decreasing DAH by more than $9 billion in 2025. The report also analyzes which countries, regions, and organizations are most affected by funding cuts. Report authors predict that countries, especially those with the fewest resources and those affected by conflict, will likely be unable to make up for financing gaps.

Insufficient financing and weak incentives currently exist for investment in research and development to tackle neglected and poverty-related diseases that make up the ‘unfinished agenda’ in less developed countries, as well as new infectious diseases that are emerging or re-emerging in the context of globalization. Consider malaria. If there’s any one disease that can be described as “global”—in its reach and in the impact of its consequences—it is malaria. Almost half of the world’s population is at risk for this illness, which can lead to anemia, incapacitation, and death; in Africa alone, malaria kills more children than any other disease. Malaria presents a medical challenge calling for advances in science and policy that counteract resistance to treatments and fulfill the need for vaccines. Yet malaria’s reach and impact reflect deeper challenges, a complex web of interrelated biomedical and socioeconomic problems, and the need for better communications among diverse stakeholders. Programs such as the Harvard University initiative, Defeating Malaria: From the Genes to the Globe, help leverage expertise in law, politics, business, education, engineering, and design to address every dimension of the malaria challenge.

Below are examples of resources relevant to the overarching themes. Previously highlighted resources and additional resources can be found in our digital Repository.

Resources:

World Malaria Report 2025
This report is the flagship malaria publication from the World Health Organization (WHO), updated annually to summarize the information received from malaria-endemic countries and national malaria control programs. The 2025 edition of the report finds that in 2024, the global number of malaria cases reached 282 million—representing 9 million more cases compared to the previous year. The report tracks investments in malaria programs and research and documents the progress of malaria interventions across key areas: prevention, diagnosis, treatment, elimination, and surveillance. This year’s report includes a special focus on antimalarial drug resistance, a growing threat that has now been confirmed or suspected in eight African countries.

Global Tuberculosis Report 2025
This report, published by the World Health Organization (WHO), provides a comprehensive, up-to-date assessment of the tuberculosis (TB) epidemic worldwide. The 2025 edition of the report examines progress in the prevention, diagnosis, and treatment of TB at global, regional, and country levels. The report analyzes TB disease trends and updates progress toward meeting global TB targets. The report emphasizes the continued importance of improving health coverage of TB prevention and services, addressing the driving determinants of TB such as poverty and HIV, and accelerating TB research and technological breakthroughs, such as a new TB vaccine. However, the report also warns that these all require adequate funding at a time when international donor funding for TB has been cut.

Zika Virus: Research Priorities for Preparedness and Response
This Lancet series focuses on identifying priorities for Zika virus research. In the ten years since the 2015-2016 Zika virus epidemic that became a public health emergency of international concern, there have been no licensed Zika virus vaccines, therapeutics, or diagnostic tests appropriate for screening during pregnancy. This series aims to provide a roadmap for Zika virus research, preparedness, and response, including vaccine research, non-human primate research, and buillding capacity for specimen and data sharing.

Global governance for health refers mainly to those institutions and processes of global governance that do not have primary health mandates, but that can directly or indirectly influence health, such as trade and finance, security and foreign policy, migration and labor, or agriculture and environment. The institutional actions within these domains influence health determinants within countries and are often the drivers of the global flows of health-relevant risks between countries. The health sector will need to acquire an understanding of these domains, develop relationships with its representatives, and engage in new kinds of alliances if health is to be considered in their strategies and policies. Even then, there will be formidable challenges given the competing interests of powerful global actors, and the relative paucity of mechanisms and instruments for cross-sectoral global policy. Global health leaders and leaders who value global health—both have a role to play in meeting these challenges.

Below are examples of resources relevant to the overarching themes. Previously highlighted resources and additional resources can be found in our digital Repository.

Resources:

World Development Report 2025
The 2025 edition of the World Development Report (WDR), published annually by the World Bank, discusses the global landscape of international standards and how standards can be used to accelerate global development. The report highlights how standardization shapes the global economy, oftentimes benefiting the wealthy countries and multinationals companies that set the standards and leaving behind the developing countries forced to play catch up. The report aims to provide a roadmap for countries of all stages of development to adapt, align, and author international standards that drive economic growth.

World Trade Report 2025: Making Trade and AI Work Together for the Benefit of All
This report from the World Trade Organization (WTO) examines the relationship between artificial intelligence (AI) and international trade. This year’s report builds on work from the previous year’s report, which discussed how to make trade more inclusive for low- and middle-income economies. The 2025 report examines the potential of AI to catalyze inclusive trade through reducing costs and expanding participation in global markets. The authors emphasize that the extent to which AI can enable inclusive growth depends on how well the world addresses the global digital divide. The report also outlines how domestic policy and international cooperation can create more favorable environments for AI development, capacity, and uptake in low- and middle-income countries.

Sendai Framework for Disaster Risk Reduction (2015-2030)
This portal, managed by the United Nations Office for Disaster Risk Reduction (UNDRR) offers access to all information related to the Sendai Framework. The Sendai Framework for Disaster Risk Reduction 2015-2030 adopted in Sendai, Japan, in 2015, is a global framework aimed at reducing disaster risks and losses over a 15-year period. It emphasizes understanding disaster risk, strengthening governance, investing in resilience, and enhancing disaster preparedness. The framework outlines four priorities for action to improve risk understanding, governance, investment, and preparedness, thereby enhancing overall resilience.

The Next Pandemic Flu

Regional Profile

Outbreaks of both the H5N1 and H1N1 influenza strains have illustrated that the global institutions charged with preventing and responding to these pandemics are not up to the task. With both, there were significant problems with the development, production, and distribution of flu vaccines. Indeed, stemming a modern-day pandemic depends on the rapid development, sufficient production, and equitable, timely access to influenza vaccines, all within a complex global context. Compounding these challenges are the disease-specific “unknowns” related to the emergence of a new virus, including severity levels, transmission ease, human immunity, and drug vulnerability. Explore a teaching case that highlights the challenges of managing externalities and sovereignty through the example of pandemic flu. Learn more through a perspective on the future of the Pandemic Influenza Preparedness (PIP) Framework, initially established to promote the fair sharing of public health–related pandemic influenza samples between countries.

Vaccine Partnerships for Population Health

Population Snapshot

This case follows the vaccine development for Meningitis A, a disease that routinely caused deadly epidemics in Sub-Saharan Africa. The case explores why this vaccine had not been developed previously and how the creation of the Meningitis Vaccine Project (MVP)—a partnership between the World Health Organization (WHO) and PATH, a non-governmental organization—enabled the vaccine to be successfully developed over 10 years by creating a novel product development partnership. Students examine why the public/private partnership was successful and how such a model could be applied to the development of other vaccines and health technologies. Additionally, the case explores the strategies applied by Marc LaForce, the MVP’s director and veteran public health advocate, to make the MVP a success.

Global Governance for Health

Sector Perspective

Many of the factors that influence health are outside the direct control of national governments and often also outside the control of the health sector. How can global governance processes outside the health system better protect and promote the health of the world’s population? This was the driving question explored by The Lancet-University of Oslo Commission on Global Governance for Health. The Commission’s work was published in an extensive report in The Lancet on February 11, 2014. The report examines power disparities and dynamics across a range of policy areas that require improved global governance: economic crises and austerity measures, intellectual property, foreign investment treaties, food security, transnational corporate activity, irregular migration, and violent conflict

Global Security

Featured

This commission report The Neglected Dimension of Global Security: A Framework to Counter Infectious Disease Crises considers the evidence supplied by four workshops convened by the Institute of Medicine to analyze the international management and response to infectious disease outbreaks. Since the 2014 Ebola outbreak many public—and private—sector leaders have seen a need for improved management of global public health emergencies. The effects of the Ebola epidemic go well beyond the three hardest-hit countries and beyond the health sector. Education, child protection, commerce, transportation, and human rights have all suffered. The consequences and lethality of Ebola have increased interest in coordinated global response to infectious threats, many of which could disrupt global health and commerce far more than the recent outbreak. The report offers recommendations to guide policy makers, international funders, civil society organizations, and the private sector.

Challenges Beyond Borders

Subthemes

Globalization & Health

Infectious Diseases

Governance for Health

GLOBAL HEALTH GOVERNANCE expand_more

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EMERGING INFECTIOUS DISEASES expand_more

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GLOBAL GOVERNANCE expand_more

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The Next Pandemic Flu

Vaccine Partnerships for Population Health

Global Governance for Health

Global Security

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