Global health in 2026

WHO Director-General election, US bilateral agreements, and intellectual honesty

I am never quite sure whether these New Year’s pieces are supposed to be predictions or wishes. Probably a bit of both. In that spirit, here is my look ahead on global health in 2026.

In 2025, the theme was disruption. That means 2026 should offer opportunities. We must seize them. The top three trends I am tracking: the WHO Director-General election, US bilateral agreements, and a few specific areas where I feel we could be more intellectually honest.

Although the WHO Director-General election will culminate in May 2027, a lot of the action will happen during 2026. We will see campaigning by the 2026 World Health Assembly, just a few months away.

No one has announced publicly yet. A Bloomberg article identified Hans Kluge and Hanan Bahlky, the Regional Directors of the European and Eastern Mediterranean WHO regions respectively, as “likely front-runners.” They are both very decent people — although I think it’s fair to ask whether any insider would bring the degree of change needed. I don’t see WHO as being in very good shape and I don’t know many people who do. If they do run, these friends could perhaps start by explaining how they would do things differently. I have heard rumours about other internal candidates, some of whom lack the character to be Director-General.

Outside candidates could bring fresh perspectives. At the same time, I have grown skeptical of the ‘great man’ (or woman) theory of history when it comes to UN agency leadership. Although UN agencies are steeply hierarchical and so change in leadership changes culture, it’s all too easy for the leader over time to become immured in the (often insincere) adulation and process-heavy views of staff.

At this point perhaps the most constructive approach is to speak in terms of criteria for Director-General selection. I have three: revive the results agenda, make WHO neutral on Israel, and bring back the US.

My top criterion is results. When I came to WHO in 2017, my goal was to help turn it into a relentlessly results-focussed organization. We were able to develop tools to measure the outcomes it supported in countries, manage the outputs it produced to do so, and even assess how the different multilateral agencies supported countries. However, where this broke down was in the lack of a sustained focus on results and the inability to transform governance. The election offers an opportunity to revive this results agenda, build on existing tools, and make WHO an organization truly focussed on results.

My second criterion is neutrality on Israel. When I was at WHO, I saw the double standard treatment of Israel — in having one resolution reporting on “health conditions in the occupied Palestinian territory” and one for every other health emergency in the world. At the time, I saw this as a nuisance, because I did not understand how it signalled a deeper inclination. After October 7, 2023, I feel differently. By focussing more on attacks against health facilities (by Israel) rather than the root cause of these attacks (militarization of those facilities by Hamas) WHO has likely contributed, even unintentionally, to anti-Israel and anti-Jewish sentiment. It’s also been better than many other UN organs. However, neutrality is a key UN value, and it’s time to take it more seriously.

My third criterion is to bring back the US. When President Trump announced he was leaving WHO on his first day in office, I hoped that a ‘deal’ could be reached. I was wrong. Now the situation is like when the Soviet Union left WHO in 1949 over philosophical differences in how global health should be pursued, only to return in 1955 following a thaw in relations and governance reforms that gave regions a greater voice. I don’t think that a candidate should advocate bringing back the US at any cost (e.g. adopting an anti-vax posture), but I do hope that a strong focus on results, neutrality on Israel, and some humility about the handling of COVID-19 might be enough.

Another trend I am following is the US bilateral global health agreements. There is a lot to like about these: their focus on country accountability and domestic finance, and their emphasis on data and innovation. There are also some things I don’t like: the transition in aid which is costing lives, the neglect of noncommunicable diseases which are a priority for many countries, the potential to exploit national data, and the single-minded emphasis on US innovation minimizing economic development of the country itself. Nonetheless, I strongly believe that accountability, data and innovation (in products, services, and finance) are the future of global health. And so, I see these agreements as a demonstration project where a lot of learning will occur over the coming year.

A final trend is intellectual honesty in global health. In Universal Health Coverage there is no progress beyond population growth and country level accountability is needed. In tobacco harm reduction there is ideological resistance to innovative products like vapes, heated tobacco, and nicotine pouches that could save millions of lives of current smokers. In GLP-1 drugs like Ozempic there is not enough priority on scaling up in low- and middle-income countries where, again, millions could be saved. And in future pandemic response, red teaming could prevent groupthink on issues like airborne transmission. I am also a fan of scaling up 7-1-7 (detect an outbreak within 7 days, notify within 1 day, and complete early response within 7 days) and the 100-day mission (diagnostics, therapeutics and vaccines made available in the first 100 days after a pandemic threat is identified).

By the end of 2026 I hope we see WHO Director-General candidates relentlessly focused on results, advocating neutrality on Israel, and finding smart ways to reunite with the US. I hope US bilateral agreements evolve into a model for accountability, data and home-grown innovation. I hope that Universal Health Coverage is increasing, smoking rates are falling faster from tobacco harm reduction, GLP-1s are scaling in low- and middle-income countries, and red teams, 7-1-7 and 100 day mission are all at the centre of pandemic preparedness and response.

Are these predictions or wishes? A wish is just a prediction we make happen.