Resetting global health: sovereignty must strengthen rights, not replace them

Global health is being re-imagined. As The BMJ’s series on the geopolitics of global health observes, “if 2025 marked a dismantling of the global health architecture, 2026 has brought debate about its reform.”1 The important reduction in development assistance has accelerated a reckoning that was already overdue.2 The Accra Reset, a global development framework developed in 2025, calls for an architecture built around sovereign national capability, strong regional functions, and genuine global public goods.3 A Member State-led reform process hosted by the World Health Organization, that will report to the World Health Assembly in May 2027,4 places principles of country leadership and ownership, subsidiarity, equity, solidarity, and accountability among its core principles.This is a welcome direction as the existing architecture has too often fragmented national systems and privileged donor priorities. This architecture has also reproduced existing deep inequalities in whose expertise is valued. However, as we attempt to answer one...