At a recent conference hosted by the Economic Commission for Africa (ECA), African ministers and corporate leaders highlighted that Africa’s ‘health security cannot be mortgaged to foreign funding’. United Nations (UN) Assistant Secretary-General Ahunna Eziakonwa-Onochie added in agreement that until African decision makers start using local public health services, there will be no progress on health security on the continent.
We applaud the sentiment on sovereign self-reliance, but worry about framing health as security. Securitisation of the health agenda has practical consequences. It enables a dramatic expansion of state power over populations by collapsing health safety into national security. It risks a corresponding curtailment of individual freedoms and business autonomy. It means higher visibility and relevance and increased authority and budgets for health bureaucrats and the World Health Organisation (WHO). It produces greater opportunities for grants and career advancement for researchers and more media attention. And for the pharmaceutical industry, it means higher profits with accelerated approvals, fewer constraints and lower regulatory burdens.
One strategy deployed in public health with wider consequences is surveillance. In sharp contrast to medical care, which traditionally upholds patient confidentiality, public health relies heavily on surveillance that has been augmented by sophisticated digital technologies and algorithmic search engines that frequently reflect the biases and idiosyncrasies of their creators. This erodes the sanctity of the doctor-patient relationship through legislation and policies that prioritise the common good over individual patient welfare. As John Francis and Leslie Francis observe, ‘When surveillance for security and surveillance for health intertwine in ways people find objectionable … loss of trust may be the unfortunate result.’
Previously, it was widely accepted that health is first and foremost about human rights – those entitlements that belong to all human beings by virtue of their humanity. Human rights are in turn based on human dignity, which is why the 1948 Universal Declaration of Human Rights puts ‘inherent dignity’ before ‘equal and inalienable rights’ in its opening sentence.
Human dignity presumes human agency, that is, the individual’s capacity to act from his/her uniquely human viewpoint. The recent trend towards the centralisation and globalisation of medical care and public health perpetuates the dehumanising practice of colonial governance that had stripped the peoples of the Global South of their dignity, rights and agency.
Health is not merely about trying to eliminate pathogens. Indeed, pandemics account for a relatively small share of long-term global mortality compared with endemic infectious diseases and non-communicable diseases. Some of the events declared as ‘public health emergencies’ with the potential to result in thousands or millions of deaths have actually resulted in far fewer fatalities, calling into serious question the draconian measures put in place to contain them.
Twice, for example, the WHO has declared monkeypox, now renamed Mpox, a public health emergency of international concern (PHEIC). But numbers remained low with laboratory-confirmed Mpox deaths rising to just 410 from January 2022 to September 2025. The Democratic Republic of the Congo (DRC) had seen sixty-eight of those confirmed deaths, compared to up to 70 000 malaria deaths per year in the same country. Regardless, Mpox received prominent attention from the WHO, with a vaccination programme once again being promoted and implemented. Analysis for the DRCsuggests that procurement costs alone would range between $682.5 million (that is, roughly twice the country’s yearly public health expenditure) and $1.7 billion in order to save fewer than 400 lives.
It is therefore time we reaffirmed that proportionality must guide future investment and intervention decisions on outbreaks of highly infectious diseases. Historically, life expectancy gains have primarily come from sanitation, nutrition, antibiotics and primary care – not emergency architectures.
The right to health sovereignty
Clever Gatete, Executive Secretary of the ECA observed at the conference, that health sovereignty is national sovereignty. The G20 leaders’ summit in South Africa in November called for new financing models and a move beyond traditional aid structures to build resilient, sovereign health systems across the Global South. In a ‘same old, same old’ story, the latter have too often been treated as passive participants and not sovereign actors. On 3 April, the Accra Reset Chancery announced that an eighteen-member high-level panel had been formed to make recommendations on reforms in global health architecture and governance in order to strengthen equity and sovereignty for Global South countries.
As it happens, over the past 18 months a ten-member panel of the International Health Reform Project (IHRP) has published two reports titled The Right to Health Sovereignty. The technical report provides an analytical foundation and examines ethics, institutional history, disease burden, financing, governance structures and legal frameworks. The policy report distils these findings into principles and reform pathways for policymakers.
The IHRP was formed in response to the growing crisis of confidence in international public health governance whose roots predate Covid-19 and reflect deeper structural and ethical problems within the WHO and the broader global health architecture. International cooperation in health is necessary and valuable. Cross-border surveillance, data sharing and technical assistance have contributed to dramatic gains in life expectancy, particularly in low- and middle-income countries. But multilateral cooperation derives legitimacy from voluntary state participation. When authority drifts towards centralised technocratic bodies detached from domestic accountability their legitimacy weakens.
International cooperation in health is necessary and valuable. Cross-border surveillance, data sharing and technical assistance have contributed to dramatic gains in life expectancy, particularly in low- and middle-income countries
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Early WHO programmes demonstrated what focused, technically grounded cooperation can achieve. Over time, however, global health governance has drifted from those foundations, expanding beyond core public health functions (‘mission creep’), with an accompanying centralisation of authority justified by emergency framing and growing dependence on earmarked and nonstate donor funding.
Early WHO programmes demonstrated what focused, technically grounded cooperation can achieve. Over time, however, global health governance has drifted from those foundations, expanding beyond core public health functions.
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These developments have reduced efficiency and eroded trust and legitimacy. To restore faith and confidence, there is urgent need to affirm the notion of health sovereignty rather than health security, upholding in particular the principles of beneficence, non-maleficence, patient confidentiality and informed consent. Only in this way can we safeguard the holistic oft-quoted definition of health in the WHO Constitution: ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’.
The policy report advances a conception of health sovereignty of individuals and countries that is grounded in responsibility, not isolationism. People bear primary responsibility for ensuring their individual health and states for protecting their populations’ health. International organisations exist to support states – not to replace or override them.
The report proposes principles for reforming the WHO – or, failing that, establishing a successor International Health Organisation (IHO). The IHO must be given limited and clearly defined mandates, with success measured by redundancy, not expansion. Emergency powers must be proportionate to demonstrated, evidence-based risk and the highly-differentiated disease burdens in the Global South and North. Policy interventions should be evaluated transparently against trade-offs and long-term, as well as short-term, harms. Financial independence should be protected through assessed contributions and avoidance of specified voluntary contributions from governments and private foundations that reflect their health priorities. Outside assistance must prioritise national capacity-building in recipient countries.
The United States exit from the WHO and the forthcoming election of a new WHO Director-General in July 2027 present a critical moment. Leadership transitions create space for institutional reassessment of mandate, structure, financing and scope.
The IHRP reports are intended to inform that debate. They promote cooperation, coordinated response, science-based decision-making and a return to foundational determinants of health over pharmaceutical and technological interventions. Effective cooperation requires legitimacy – and legitimacy requires ethics, evidence, proportionality and respect for the sovereign responsibility of individuals and states.
The goal is not institutional destruction, but restoration of legitimacy through clarity of purpose and accountability.
Ramesh Thakur is emeritus professor in the Crawford School of Public Policy, Australian National University; former United Nations Assistant Secretary-General; and co-chair of the International Health Reform Project (IHRP).
Reginald M.J. Oduor is Associate Professor of Philosophy, University of Nairobi, Member of the International Health Reform Project (IHRP) Panel, and Co-Chair of the Pan-African Epidemic and Pandemic Working Group (PEPWG).
