Five years after COVID-19, the contradiction at the heart of global health has never been clearer.
Governments routinely describe global health as an investment in security, prosperity and resilience. Pandemic preparedness is now embedded in national security strategies. Political leaders speak of "learning the lessons" from COVID-19, while international organisations continue to warn that another pandemic is not a question of if, but when. Yet when difficult political choices arise, global health is often among the first areas to face cuts.
Recent decisions by the United States to withdraw from the World Health Organization (WHO) and freeze USAID funding, followed by the United Kingdom's decision to reduce its overseas development assistance budget from 0.5% to 0.3% of Gross National Income, may appear unrelated. They emerged from different political contexts and were justified on different grounds.
But they share a common assumption: that global health is discretionary spending rather than essential infrastructure. I believe that assumption is fundamentally wrong.
Health security begins long before an emergency
One of the most enduring lessons from COVID-19 is that preparedness cannot be built during a crisis. Laboratories, surveillance systems, disease intelligence, health workers, supply chains and international coordination mechanisms require years of sustained investment. They cannot simply be switched on once an outbreak begins.
The same applies to international institutions. Having spent several years researching the governance and financing of the World Health Organization, one lesson became impossible to ignore: WHO's effectiveness depends as much on political commitment and predictable financing as it does on technical expertise.
Public debate tends to focus on WHO's performance during emergencies, while paying far less attention to the financial and political architecture that determines what the organisation is actually capable of doing. Institutions cannot deliver beyond the resources and authority they are given.
Why financing matters
For decades, WHO's financing has gradually shifted away from flexible assessed contributions provided by Member States towards voluntary contributions that are frequently earmarked for donor priorities. This transformation has had profound consequences.
While voluntary funding has allowed important programmes to grow, it has also reduced WHO's ability to independently allocate resources according to global health needs. Instead, priorities increasingly reflect the interests of those able to finance them. This is more than an accounting issue; it is a governance issue. Financial dependence inevitably shapes institutional autonomy.
Underinvestment before a crisis becomes vulnerability during one.
The consequences became painfully visible during the 2014-16 Ebola outbreak in West Africa. Years of constrained budgets had weakened WHO's emergency capacity, contributing to delays that were widely criticised in subsequent independent reviews. COVID-19 reinforced exactly the same point.
A strong, financially independent WHO is not a luxury of multilateralism, it is a prerequisite for effective global health governance, including managing future health threats, ensuring equitable health responses, and maintaining the global leadership needed to tackle emerging diseases. Its ability to coordinate international responses, however, depends on both technical authority and financial autonomy.
The false economy of aid cuts
The UK's recent reduction in development spending illustrates a broader contradiction. Less than two years ago, the UK Government's White Paper International Development in a Contested World described international development as both a moral responsibility and an essential component of the UK's own security and prosperity.
That argument remains valid. Infectious diseases do not recognise borders. Neither do antimicrobial resistance, climate-related health threats or fragile health systems. Reducing investment in global health does not eliminate these risks. It merely shifts them into the future, where they often become more expensive, more complex and more difficult to contain.
Cutting aid undermines global health security, weakens critical infrastructure, and erodes the UK's leadership in international development. Development assistance should therefore be understood not as charity, but as long-term investment in global public goods. Strong surveillance systems in one country help protect every country. Robust primary healthcare reduces vulnerability during outbreaks. A well-funded WHO strengthens international coordination precisely when no single government can respond alone.
Beyond WHO
The same principle extends far beyond one institution. Global health security is not built through emergency declarations or political speeches. It is built through resilient health systems, a protected and supported health workforce, sustainable financing, trusted institutions and long-term international cooperation.
These investments rarely attract headlines. They rarely produce immediate political rewards. But they determine whether countries are prepared when the next emergency arrives. Preparedness is not an event. It is a continuous political choice.
A different way of thinking about global health
Global health funding is often framed as a trade-off between domestic priorities and international solidarity. That framing misses the point. In an interconnected world, these priorities are inseparable. Investing in stronger health systems abroad contributes to resilience at home. Supporting international institutions strengthens collective capacity to respond to shared threats.
Protecting development budgets is not simply about generosity. It is about recognising that security today depends on cooperation long before a crisis begins. Five years after COVID-19, perhaps the most important question is no longer whether we learned the lessons of the pandemic, but whether we are willing to invest in them.