The Geopolitics of Global Health: Power, Pathogens, and the New Rules of International Risk

In today’s complex international risk landscape, the idea that global health exists outside the sphere of politics no longer holds. What was once perceived as a humanitarian and scientific endeavour has become a site of contestation shaped by geopolitical rivalries, strategic dependencies, and unequal access to resources. From vaccine diplomacy to digital surveillance, and from data extraction to biosecurity regulation, health is now deeply enmeshed in global power dynamics. On this episode of The International Risk Podcast, Dominic Bowen is joined by Dr. Abha Saxena, a leading global bioethics expert, renowned anaesthesiologist, and former head of the World Health Organization’s global health ethics programme, whose decades of experience advising governments, research institutions, and multilateral bodies offer invaluable insight into the shifting terrain of global health governance and its implications for international risk.

Health as a Tool of Strategy

Dr. Saxena opens the conversation by challenging the myth that global health was ever truly apolitical. While organisations like the World Health Organization (WHO) have historically served as neutral conveners, geopolitical interests have always shaped negotiations, funding priorities, and institutional behaviour. The difference now is the visibility of those political forces. According to Dr. Saxena, the neutrality once provided by institutions like WHO is increasingly undermined by funding imbalances and donor-driven influence. With more than 80 percent of WHO’s budget dependent on voluntary contributions, major players such as the US government and the Gates Foundation often shape its agenda.

When political actors pull funding, they do not just create a vacuum, they invite competition. As Western governments reduce their contributions, other actors step in. China, for instance, significantly increased its voluntary support to WHO in the wake of US funding cuts. Simultaneously, it expanded its global footprint through initiatives like the Health Silk Road, delivering more than 2.2 billion vaccine doses to over 120 countries. Yet, despite these numbers, many Asian and African respondents viewed China’s influence with scepticism, suggesting that material support alone does not guarantee geopolitical goodwill.

Vaccine Diplomacy and Sovereignty Dilemmas

During the COVID-19 pandemic, many low- and middle-income countries found themselves relying on foreign powers for health infrastructure, vaccines, and disease surveillance tools. Dr. Saxena notes that this dependency brings ethical complications. While dual-track aid from the US and China may appear as a strategic hedge for countries like Ethiopia, it also discourages domestic investment in health systems. More critically, it can create subtle imbalances in sovereignty. When public health infrastructure is externally funded, the ability of national governments to negotiate access to biological data, enforce equitable benefit-sharing, or even control their own diagnostics pipeline is severely diminished.

One particularly contentious issue is when outbreaks emerge in low-resource settings, researchers from wealthier nations often seek access to local samples and data in order to develop diagnostics and treatments. Yet the benefits of these discoveries are not always returned to the source country. This raises questions about fairness, reciprocity, and global preparedness. As Dr. Saxena recalls, such inequities were stark during the Ebola crisis and persisted during COVID-19.

The Pandemic Treaty and the Fragile Path to Equity

In response to these challenges, the international community has been negotiating a pandemic treaty that would establish legally binding rules on data sharing, equitable access to treatments, and collective preparedness. Encouragingly, all WHO member states have supported the development of this agreement. However, negotiations remain deadlocked over the most critical component: access and benefit-sharing. This clause concerns whether countries that provide pathogen samples will be guaranteed access to resulting diagnostics, vaccines, and therapeutics.

Without consensus on this issue, the treaty cannot yet be ratified. But the existence of a draft framework marks a significant shift. Even if not yet legally binding, it could serve as a normative tool in future crises. Dr. Saxena remains cautiously optimistic, believing that countries may still feel morally compelled to follow the framework even in the absence of full ratification.

The Data Dilemma: Private Tech and Public Health

Beyond state actors, private technology firms now play a central role in the health ecosystem. These companies manage nearly 40 percent of global health data and have accelerated the digital transformation of healthcare through cloud infrastructure, artificial intelligence, and analytics. While these innovations offer substantial benefits, they also raise serious concerns about equity, access, and data security.

According to Dr. Saxena, this is not necessarily an institutional failure. Governments lack the resources to manage such systems alone. The real issue is the absence of strong regulatory frameworks, especially in lower-income countries. Without clear rules to ensure privacy, consent, and accountability, private firms risk deepening global inequalities. Moreover, access to these advanced tools remains largely restricted to wealthier nations, further marginalising those most in need.

WHO and other neutral actors, she argues, have an essential role in mediating this imbalance. By helping broker fair data-sharing agreements and demanding subsidised access to technologies for developing countries, they can help ensure that innovation does not come at the expense of justice.

Cyber Risk and Systemic Vulnerabilities

The convergence of health, data, and geopolitics has also introduced new risks. Cyberattacks on health systems are on the rise, with a significant share originating from state-linked actors in Russia and China. The increasing militarisation of data infrastructures has exposed healthcare systems to espionage, disruption, and exploitation. Dr. Saxena acknowledges that WHO lacks the technical capacity to lead on cybersecurity but stresses the need for partnerships with IT regulators and intelligence communities. Data protection in healthcare, she warns, can no longer be treated as a secondary concern.

Interconnected Risk in a Fragmented World

Dr. Saxena closes the conversation with a reflection on today’s broader landscape of risk. From climate-related disasters to geopolitical tensions, the ripple effects of global crises are increasingly unpredictable and far-reaching. Even countries like Switzerland, long viewed as stable and self-sufficient, have experienced medicine shortages due to global supply chain disruptions linked to the war in Ukraine.

In her view, these cascading vulnerabilities signal the end of an era in which health systems could be treated as independent or isolated domains. The future of global health security depends not only on scientific progress, but also on ethical cooperation, legal frameworks, and the political will to act collectively. Although she remains optimistic, Dr. Saxena is clear: the stakes are higher, the threats more complex, and the need for a fair and functional global health architecture more urgent than ever.