The Peoples of the Global South Don't Need Health Security: They Need Health Sovereignty

At a recent conference hosted by the Economic Commission for Africa (ECA), African ministers and corporate leaders highlighted that Africa's 'health security cannot be mortgaged to foreign funding'. United Nations (UN) Assistant Secretary-General Ahunna Eziakonwa-Onochie added in agreement that until African decision makers start using local public health services, there will be no progress on health security on the continent. We applaud the sentiment on sovereign self-reliance, but worry about framing health as security.

Securitisation of the health agenda has practical consequences. It enables a dramatic expansion of state power over populations by collapsing health safety into national security. It risks a corresponding curtailment of individual freedoms and business autonomy.

It means higher visibility and relevance and increased authority and budgets for health bureaucrats and the World Health Organisation (WHO). It produces greater opportunities for grants and career advancement for researchers and more media attention. And for the pharmaceutical industry, it means higher profits with accelerated approvals, fewer constraints and lower regulatory burdens.

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Surveillance Erodes Patient Confidentiality

One strategy deployed in public health with wider consequences is surveillance. In sharp contrast to medical care, which traditionally upholds patient confidentiality, public health relies heavily on surveillance that has been augmented by sophisticated digital technologies and algorithmic search engines. This erodes the sanctity of the doctor-patient relationship through legislation and policies that prioritise the common good over individual patient welfare.

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Health Rights Before Security

Previously, it was widely accepted that health is first and foremost about human rights – those entitlements that belong to all human beings by virtue of their humanity. Human rights are in turn based on human dignity, which is why the 1948 Universal Declaration of Human Rights puts 'inherent dignity' before 'equal and inalienable rights' in its opening sentence.

Human dignity presumes human agency, that is, the individual's capacity to act from his/her uniquely human viewpoint. The recent trend towards the centralisation and globalisation of medical care and public health perpetuates the dehumanising practice of colonial governance that had stripped the peoples of the Global South of their dignity, rights and agency.

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Proportionality Matters in Outbreaks

Health is not merely about trying to eliminate pathogens. Indeed, pandemics account for a relatively small share of long-term global mortality compared with endemic infectious diseases and non-communicable diseases. Some of the events declared as 'public health emergencies' have actually resulted in far fewer fatalities, calling into serious question the draconian measures put in place to contain them.

Twice, for example, the WHO has declared monkeypox, now renamed Mpox, a public health emergency of international concern (PHEIC). But numbers remained low with laboratory-confirmed Mpox deaths rising to just 410 from January 2022 to September 2025. The Democratic Republic of the Congo (DRC) had seen sixty-eight of those confirmed deaths, compared to up to 70,000 malaria deaths per year in the same country.

Regardless, Mpox received prominent attention from the WHO, with a vaccination programme once again being promoted and implemented. Analysis for the DRC suggests that procurement costs alone would range between $682.5 million (roughly twice the country's yearly public health expenditure) and $1.7 billion in order to save fewer than 400 lives. It is therefore time we reaffirmed that proportionality must guide future investment and intervention decisions on outbreaks of highly infectious diseases.

Historically, life expectancy gains have primarily come from sanitation, nutrition, antibiotics and primary care – not emergency architectures.

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Health Sovereignty Equals National Sovereignty

Clever Gatete, Executive Secretary of the ECA observed at the conference, that health sovereignty is national sovereignty. The G20 leaders' summit in South Africa in November called for new financing models and a move beyond traditional aid structures to build resilient, sovereign health systems across the Global South.

In a 'same old, same old' story, the latter have too often been treated as passive participants and not sovereign actors. On 3 April, the Accra Reset Chancery announced that an eighteen-member high-level panel had been formed to make recommendations on reforms in global health architecture and governance in order to strengthen equity and sovereignty for Global South countries.

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International Health Reform Project Reports

Over the past 18 months a ten-member panel of the International Health Reform Project (IHRP) has published two reports titled The Right to Health Sovereignty. The technical report provides an analytical foundation and examines ethics, institutional history, disease burden, financing, governance structures and legal frameworks. The policy report distils these findings into principles and reform pathways for policymakers.

The IHRP was formed in response to the growing crisis of confidence in international public health governance whose roots predate Covid-19 and reflect deeper structural and ethical problems within the WHO and the broader global health architecture.

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Mission Creep Undermines WHO Legitimacy

International cooperation in health is necessary and valuable. Cross-border surveillance, data sharing and technical assistance have contributed to dramatic gains in life expectancy, particularly in low- and middle-income countries. But multilateral cooperation derives legitimacy from voluntary state participation. When authority drifts towards centralised technocratic bodies detached from domestic accountability their legitimacy weakens.

Early WHO programmes demonstrated what focused, technically grounded cooperation can achieve. Over time, however, global health governance has drifted from those foundations, expanding beyond core public health functions ('mission creep'), with an accompanying centralisation of authority justified by emergency framing and growing dependence on earmarked and nonstate donor funding.

These developments have reduced efficiency and eroded trust and legitimacy. To restore faith and confidence, there is urgent need to affirm the notion of health sovereignty rather than health security, upholding in particular the principles of beneficence, non-maleficence, patient confidentiality and informed consent.

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Principles for Reforming Global Health

The policy report advances a conception of health sovereignty of individuals and countries that is grounded in responsibility, not isolationism. People bear primary responsibility for ensuring their individual health and states for protecting their populations' health. International organisations exist to support states – not to replace or override them.

The report proposes principles for reforming the WHO – or, failing that, establishing a successor International Health Organisation (IHO):

• The IHO must be given limited and clearly defined mandates, with success measured by redundancy, not expansion
• Emergency powers must be proportionate to demonstrated, evidence-based risk and the highly-differentiated disease burdens in the Global South and North
• Policy interventions should be evaluated transparently against trade-offs and long-term, as well as short-term, harms
• Financial independence should be protected through assessed contributions and avoidance of specified voluntary contributions from governments and private foundations
• Outside assistance must prioritise national capacity-building in recipient countries

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Critical Moment for Institutional Reform

The United States exit from the WHO and the forthcoming election of a new WHO Director-General in July 2027 present a critical moment. Leadership transitions create space for institutional reassessment of mandate, structure, financing and scope. The IHRP reports are intended to inform that debate.

They promote cooperation, coordinated response, science-based decision-making and a return to foundational determinants of health over pharmaceutical and technological interventions. Effective cooperation requires legitimacy – and legitimacy requires ethics, evidence, proportionality and respect for the sovereign responsibility of individuals and states.

The goal is not institutional destruction, but restoration of legitimacy through clarity of purpose and accountability.