Global Health Governance in South and Southeast Asia in a Time of Geopolitical Flux

Global health is experiencing a rupture.

Competing interests and duplicated mandates among emerging actors, such as the World Health Organization (WHO), development banks, and public–private partnerships, have led to fragmentation in global health governance (GHG). This complexity, amidst geopolitical shifts, brings us to a critical point in international health cooperation. Due to diminished trust in the post-WWII global governance architecture (especially following the COVID-19 pandemic), a global rise in nationalism—illustrated by the US’s withdrawal from the WHO—and the growing influence of private actors, calls for reforming the system abound.

The Asian region plays a crucial role in shaping the future of the global health architecture, given its size, political and economic heft and vulnerability to climate and health shocks. Managing transnational health threats by integrating health into regional institutions is therefore urgent.

This rupture may also be re-imagined as an opportunity to reshape GHG to be more inclusive of the Global South, equitable, and fit-for-purpose. With imminent challenges such as climate, epidemiological, and demographic transitions that require cross-border attention, regionalisation is emerging as a pathway to amplify the previously underrepresented voices of the Global South. While Europe, Africa, and Latin America have made integrated efforts towards health cooperation, there is immense potential in Asia, particularly South and Southeast Asia.

The Asian region plays a crucial role in shaping the future of the global health architecture, given its size, political and economic heft and vulnerability to climate and health shocks. Managing transnational health threats by integrating health into regional institutions is therefore urgent.

Against this backdrop, the Centre for Social and Economic Progress (CSEP), in partnership with the United Nations University–International Institute of Global Health (UNU-IIGH), convened a two-day regional consultation in New Delhi in November 2025. Participants from South and Southeast Asia, including government officials, regulators, scholars, technical experts, and practitioners, reflected on what this moment in time means for the region and how emerging governance arrangements might better reflect regional priorities.

What emerged was neither a call for wholesale institutional replacement nor a rejection of the global governance architecture, but rather a growing recognition that South and Southeast Asian countries need to be more deliberate in articulating shared priorities, identifying strategic entry points for cooperation in a fragmented, politicised, and financially constrained global health landscape.

Responding to Rupture: Governance Amidst Fragmentation

Discussions during the consultation focused on the increased distribution of authority and function in global health institutions. While there was agreement that the WHO enjoys a level of universal legitimacy in norm-setting and emergency coordination, donor-driven earmarking has blurred the WHO’s autonomy and accountability. Moreover, financing roles played by private sector entities, philanthropies, and development banks have diluted functional clarity within the system. The global health agenda is also increasingly shaped by these actors, as well as by alternative geopolitical groupings like the Association of Southeast Asian Nations (ASEAN), the G20, and BRICS.

What emerged was neither a call for wholesale institutional replacement nor a rejection of the global governance architecture, but rather a growing recognition that South and Southeast Asian countries need to be more deliberate in articulating shared priorities, identifying strategic entry points for cooperation in a fragmented, politicised, and financially constrained global health landscape.

As health becomes embedded in trade policy, industrial strategy, technology transfer, and supply-chain security, mandates overlap, and decision-making spaces grow. This places the burden on smaller and lower-income countries, which often lack the capacity to engage effectively across multiple forums.

The consultation did not frame this fragmentation as a problem solvable through a single, unified global or regional health institution. Rather, the future of GHG may lie in layered arrangements, with greater interoperability across national, regional, and global levels, and flexible, issue-specific coalitions forming where incentives align and action is urgent.

Shifts in the direction of global governance reform are already underway. Participants pointed to the emergence of institutional actors, such as the Africa Centres for Disease Control and Prevention, and the growing prominence of shared voice—most visibly during negotiations on the Pandemic Agreement. Broader efforts, including UN80 reforms, were also seen as part of this wider reconfiguration of roles and functions.

This shift raised a central concern: How can layered governance arrangements remain cohesive? The need for greater role clarity in an increasingly complex governance environment was emphasised: who convenes, who negotiates, who sets standards, who implements, who regulates, and who is ultimately accountable.

Fragmentation itself is not an anomaly but a defining feature of the multilateral order; the challenge lies in how it is navigated. Governance effectiveness may depend less on uniformity and more on the ability to coordinate across complexity and address critical gaps in responsibility concerning public financing and long-term stewardship of global health.

Crucially, neither regional nor global governance arrangements can substitute for strong national health systems. Any reorientation of GHG must ultimately reinforce national capacities to deliver public health domestically.

What Does “the Region” Mean and Why Does it Matter?

With the established importance of regional health governance, a fundamental question surfaced: What constitutes “the region”, and why should regional cooperation be privileged over other forms of collective action?

Participants emphasised that South and Southeast Asia do not constitute a single, cohesive political region. Asia itself comprises multiple geopolitical imaginaries, including South Asia, Southeast Asia, East Asia, and the Asia-Pacific, each shaped by distinct historical trajectories. The institutional landscape reflects this fragmentation: ASEAN, South Asian Association for Regional Cooperation (SAARC), and the Bay of Bengal Initiative for Multi-Sectoral Technical and Economic Cooperation (BIMSTEC) have overlapping membership and varying mandates. While they provide forums for cooperation, health remains peripheral to their core mandates of security, trade, and economic integration.

Rather, the future of GHG may lie in layered arrangements, with greater interoperability across national, regional, and global levels, and flexible, issue-specific coalitions forming where incentives align and action is urgent.

Compounding this complexity are the WHO regional offices (South-East Asia Region [SEARO], the Western Pacific Region [WPRO], and, in some cases, the Regional Office for the Eastern Mediterranean [EMRO]), whose post-Cold War configurations reflect political rather than epidemiological or operational logics and have limited congruency with the aforementioned regional blocs. Questions were raised about how these overlaps might be navigated, including proposals for more interregional forums across regions; however, the feasibility and institutional capacity to sustain such mechanisms remain uncertain.

Geography alone, it was argued, is rarely sufficient to catalyse cooperation. Proximity creates shared risks—pandemics, climate-related health threats, and workforce migration—but collaboration tends to materialise only when reinforced by strategic or material incentives, such as pooled procurement, preparedness financing, or negotiating leverage. Where benefits are uneven or issues are sensitive, cooperation often stalls.

Importantly, participants cautioned against overly rigid geographic thinking. Effective health cooperation may emerge through configurations that cut across regions, particularly around shared challenges or interests. In this sense, regional health governance should be understood as flexible and issue-driven rather than territorially fixed. “Coalitions of the willing” may be better suited to pragmatically advance common priorities through opt-in mechanisms, bilateral agreements, and multi-layered platforms.

Participants also noted the potential challenges of regionalisation, including risks of isolation or siloed approaches that might undermine responses to truly global issues. Questions of political sensitivity, uneven capacity, donor influence, and historically low levels of trust further complicate collaboration.

Naming Shared Priorities: Where Regional Cooperation Adds Value

Discussions converged around three broad areas where regional cooperation was seen as particularly valuable.

The region may not yet act collectively, but it is beginning to think collectively and articulate its own expectations, priorities, and pathways. This raised several questions: How can Asia play a more active role in global governance? What forms of participation give countries a voice in decision-making? How can regional pathways reinforce, rather than fragment, global norms?

The first centred on strengthening cross-border learning and knowledge exchange. Participants noted both similarities and disparities across regional health systems in areas such as community health worker networks, manufacturing capacities, and digital infrastructure. While learning already occurs, it is often ad hoc or externally driven. There was strong support for more systematic regional learning platforms connecting policymakers, practitioners, and researchers to build on the region’s substantial technical capabilities. A regional network of experts would enhance self-reliance and reduce dependence on external expertise. Participants noted that cross-border knowledge sharing is essential but not sufficient in a globalised world and can extend across regions and countries.

The second addressed the governance of cross-border health threats. Pandemic preparedness and climate-related health risks emerged as areas where mere national action is insufficient, yet regional coordination mechanisms remain aspirational. Commitments to shared surveillance or collective regulation often lack enforceable pathways. Climate-linked health threats, such as extreme heat and air pollution, cross borders rapidly yet continue to be managed through national frameworks that are only loosely connected to regional systems. Participants acknowledged the potential of interoperable surveillance systems and shared reporting mechanisms, but emphasised that data are neither neutral nor purely technical, as they are shaped by sovereignty concerns and geopolitical determinants.

The third concerned pooled resources. These were discussed in two distinct but related contexts. First, as a means of strengthening external leverage and collective negotiation with global actors, such as under the Framework Convention on Tobacco Control. Health workforce migration was another area where combined bargaining power could enhance negotiations with workforce-recipient countries. Second, as a way of addressing internal system constraints, including shared financing instruments and pooled procurement.

The rupture in GHG has created uncertainty, but also a vacuum and an opportunity. How that space is navigated—through regional cooperation, cross-regional alliances, or issue-based coalitions—is key in determining the future of global health.

Across these domains, financing emerged as a critical driver of both reform and fragmentation. Cuts to Development Assistance for Health and the rise of bilateral financing arrangements risk exacerbating inequalities. Participants stressed that any reorientation of governance must grapple directly with the political economy of health financing, rather than being an abstract exercise.

Conclusion

As the meeting concluded, participants identified unresolved questions about sovereignty, identity, trust, financing, and the balance of authority across global, regional, and national levels. Instead of institutional overhaul, they recognised ongoing transformation: The region may not yet act collectively, but it is beginning to think collectively and articulate its own expectations, priorities, and pathways. This raised several questions: How can Asia play a more active role in global governance? What forms of participation give countries a voice in decision-making? How can regional pathways reinforce, rather than fragment, global norms?

Rather than proposing a prescriptive way forward, the consultation employed a SWOT-style reflection to assess strengths, weaknesses, opportunities, and threats within the current system. This approach underscored that transformation is already underway, driven as much by shifts in financing and geopolitics as by institutional design.

The rupture in GHG has created uncertainty, but also a vacuum and an opportunity. How that space is navigated—through regional cooperation, cross-regional alliances, or issue-based coalitions—is key in determining the future of global health.