Benjamin Mason Meier

China has become a key actor in global health diplomacy, particularly in Africa, but little attention has been given to the evolution of Chinese health assistance to African states. This paper conceptualizes Chinese health diplomacy in Africa over the past fifty years through three analytic frameworks: realist vs. constructivist motivations in international relations, vertical vs. horizontal initiatives for health assistance, and bilateral vs. multilateral approaches to global health. Drawing lessons from the evolution of American health assistance, we argue that a better understanding of these frameworks-recognizing why countries pursue health diplomacy, what vertical and horizontal strategies they use, and how they engage in this work bilaterally or multilaterally-could improve global health diplomacy.

If the public health community is to advance global health amid rising political divisions, we must actively teach political advocacy to the next generation of global health practitioners. Political advocacy is an essential tool of health communication, influencing policymakers to shape policies that prevent disease and promote health across countries. Rapid and ongoing political abandonment of global health initiatives is threatening global health equity and solidarity, failing to consider the interconnected health threats of a globalized world. Supporting training in political communication to advance health, advocacy education for global health students-at the intersection of health science and public policy-can build the political skills necessary to ensure the future of evidence-based policy to uphold global health. However, gaps remain in integrating policy and advocacy training competencies in the global health curriculum. To equip students with the health communication skills necessary to engage in global health policymaking, we must expand coursework on political advocacy through expansive curricular reforms, new course offerings, and faculty support structures-as well as teaching by example through our own advocacy practices. This commentary examines the rising imperative for political advocacy training in global health education, considering competency-based policy coursework across global health programs and offering recommendations for mainstreaming advocacy in the global health curriculum.

Antimicrobial resistance (AMR) is an intensifying global crisis arising from the unsustainable use and misuse of antimicrobials in human health, animal health, agrifood systems, and the environment that threatens the effective prevention and treatment of a range of diseases. With AMR already a leading cause of death globally, this mortality is projected to increase rapidly if urgent action is not taken to contain it. The AMR crisis has demanded multisectoral governance frameworks, spearheaded by the United Nations (UN) and the Quadripartite (comprised of WHO, FAO, WOAH, and UNEP) and implemented at all levels of government. Yet these mitigation efforts have been plagued by insufficient investment and vast coordination challenges across human, animal, and environmental health sectors within and between countries. Adopting a One Health approach, which recognises the interconnectedness of human, animal, and environmental health, guided by systems thinking and underpinned by global health law, is essential to transform global governance for responding to AMR as a complex systems challenge. This article examines the growing threat of AMR and the multisectoral drivers accelerating it, discusses the One Health approach and its application to AMR, and traces the evolution of global AMR governance leading to the establishment of Quadripartite cooperation and the initial, targeted codification of AMR-related obligations under the WHO Pandemic Agreement. To strengthen global AMR governance, this article offers recommendations for developing and implementing binding international law, applying a One Health approach underpinned by systems thinking in updates to WHO's AMR Global Action Plan, and mobilising sustainable financing and new partnerships for antimicrobial innovation and AMR policy implementation.

The United States stands apart from other nations in opposing the right to health under international law, with longstanding conservative opposition to a human right to health holding back policy efforts to realize health care and underlying determinants of health-at home and throughout the world. Over the past 80 years, American conservative ideology has presented persistent political obstacles to the advancement of health as a human right, challenging who is entitled to rights and what those rights entail. This ideological opposition has reframed health as a narrow privilege for some rather than an expansive right for all. Examining the historical evolution of the right to health since the end of World War II, this paper analyzes how shifting conservative opposition over the years has undermined human rights in health policy and culminated in existential challenges for health systems. The paper concludes that the guarantee of health as a human right must be codified as a defining principle of American democracy, enshrining constitutive commitments to health as a foundation for a healthier future under law.

The second Trump administration has shaken the foundations of US leadership in global health, with this column assessing rapid shifts in global health governance. By analyzing how the administration’s anti-science ethos, foreign assistance cuts, and multilateral disengagement have undermined global solidarity, the column considers the destabilizing impacts on global health and examines how other states, regional bodies, and international organizations are responding to this US decline. This examination reveals both strains for global health promotion and resilience within a changed governance landscape.

The Global Health Security Agenda (GHSA) provides a foundation in global health law to support legal preparedness across nations. This column examines the legal authorities necessary to meet the objectives of the GHSA Legal Preparedness Action Package and advance national law reforms to prevent, detect, and respond to public health emergencies.

The field of global health law encompasses both “hard” law treaties and “soft” law policies that shape global health norms. Transitioning from “international health law” to “global health law and policy,” global health policymakers have increasingly looked to soft law instruments to address public health needs in a rapidly globalizing world – within the World Health Organization and across global health governance. Yet, as policymakers have expanded the landscape of soft law policy instruments to advance global health across state and non-state actors, the COVID-19 response revealed the limitations of this soft law approach to global health threats, with states now seeking hard law reforms to strengthen global health governance. As hard and soft law can provide complementary approaches to preventing disease and promoting health, future research must conceptualize how these normative frameworks interact in advancing global health.

The field of global health law has evolved over the past decade to describe new legal and policy instruments that apply to a changing set of public health threats, non-state actors, and regulatory norms that structure the global response to public health challenges. This special issue—bringing together the O’Neill Institute for National & Global Health Law and the Global Health Law Consortium—examines the expansive evolution of the field of global health law and its continuing development to face new health threats.

On 20 January, President Trump announced the withdrawal of the United States from the World Health Organization (WHO). President Trump shares many of the same concerns about WHO as previous administrations, including improved transparency, financial oversight, and accountability. He also believes that China has exerted undue influence on WHO—a charge that WHO adamantly denies. But the US cannot influence WHO if it is not at the table. WHO will remain at the center of global health governance, but this withdrawal will limit US leadership to protect public health and challenge WHO coordination in facing global challenges.