Global Health as the Canary in the Globalisation Coal Mine

Globalisation offers a mixed bag of risks and benefits for global health. Many promised benefits of globalisation—increased access to expertise, technologies and products offering solutions to global health challenges—have not equitably improved health outcomes. Institutions associated with globalisation and health have delivered uneven results, partly because of incoherence in functions and objectives. The COVID-19 pandemic demonstrated deep structural weaknesses affecting healthcare within the existing model of globalisation. Issues included breakdown of information-sharing between states, hampering surveillance and identification efforts; politicisation of governance and funding arrangements underpinning the World Health Organisation; inadequacies within the IP protection system; and re-emergence of sovereignty-based restrictions on global flows of critical resources including vaccines, pharmaceuticals, and medical equipment. COVID-19 highlighted vulnerabilities to rapid global dissemination of disease outbreaks mediated by human migration, supply chain disruption of critical resources and commodities, and under-development of domestic research, development and manufacturing capabilities. This chapter reviews COVID-19 through a public health globalisation lens. It focuses on the conflicting roles and priorities of key institutions responsible for the global response to the pandemic, considering failures and frequently disregarded successes. It identifies the impact of key post-pandemic responses including the US withdrawal from the WHO and the recent Pandemic Agreement. It concludes by considering potential futures for existing models of globalised health in an erratically de-globalising world.