By Ramesh Thakur at Brownstone dot org. Before asking how power in global health should be rebalanced, reformers must confront a prior question: have existing policies and practices created a growing dependency on donor countries and international organisations? In many low-resourced countries, earmarked finance, externally selected priorities, imported program designs, a growing non-state and donor-dependent workforce, and donor reporting requirements have weakened the link between national choices and national accountability. If that dependency has hollowed out or undermined sovereign responsibility, the answer cannot be another layer of international coordination. The architecture must instead return responsibility for health outcomes to those directly invested in population health, particularly national governments. The World Health Organization's (WHO's) mandates, functions, resources, and authority should progressively contract where functions can be performed effectively closer to affected populations, as countries recover the capacity and express accountability to make their own choices (IHRP, 2026a, 2026b). The Right to Health Sovereignty Policy Report International Health Reform Project · Brownstone Institute Buy on Amazon Sovereignty here does not mean isolation; it means that international cooperation should support governments that remain politically and financially accountable for decisions made in their name. Recent proposals for reforming pandemic governance begin from a familiar diagnosis. The global health system is fragmented, public trust has deteriorated, poorer countries exercise too little influence, and inequality magnifies the damage caused by outbreaks (Lal et al., 2026; Cullinan, 2026). Much of this is true. Yet the remedies advanced in a new Nature Health commentary and in the draft United Nations Political Declaration on Pandemic Prevention, Preparedness and Response (PPPR) do not follow from that diagnosis. They largely reaffirm the institutions, financing models, and biomedical priorities that drove the loss of trust in the first place (Brown, Bate, and Bell, 2026). The contradiction is stark. Global health leaders condemn inequality while supporting a preparedness architecture that can transfer scarce public resources from low- and middle-income countries towards international organisations, development-finance intermediaries, consultants, surveillance contractors, universities, and pharmaceutical manufacturers concentrated in wealthier states. They call for power to be 'rebalanced,' but offer few realistic and enforceable means by which powerful institutions would surrender authority rather than serve their own interests (Lal et al., 2026). They conflate access to centrally selected commodities with health equity—the equivalent opportunity to live a healthy and fulfilling life (Brown, Bate, and Bell, 2026). Above all, they avoid the transparency regarding evidence and error that restoring trust requires. Trust was lost for a reason. Repeating the policies underlying that loss will not restore it. The WHO does not ordinarily possess formal power to order national lockdowns, vaccination mandates, or other domestic measures. Its practical influence is nonetheless considerable. Emergency declarations, technical standards, model laws, procurement arrangements, donor conditions, and reputational pressure can narrow the choices available to governments, particularly those dependent on external finance and expertise. The relevant sovereignty question is therefore not whether the WHO can legally command a state, but whether the surrounding institutional system makes departure from its preferred policies politically or financially bearable. Lal and colleagues' Nature Health commentary, 'Reforming global health for an age of mistrust, fragmentation and overlapping crises,' identifies three desired transformations: rebalancing power, reinforcing systems, and restoring trust. It recognises that the Lusa...
