Overall cooperation remained steady, as health outcomes held, but flows of global aid eroded sharply, signalling potential challenges ahead.

 

The barometer shows that topline cooperation in the health and wellness pillar held steady, supported by resilient health outcomes, which may reflect a gradual “normalization” after having dropped during the pandemic. This stability, however, masks a growing fragility. Pressures on multilateral organizations have eroded aid support, and development assistance forhealth (DAH) has contracted sharply. The result is that costs are shifting to lower-income countries, potentially endangering health outcomes in the future.

The heaviest pressure on this pillar was the drop in DAH, which fell 6% to $50 billion in 2024, continuing its erosion since 2021. Key donors, including Germany, the United Kingdom and the US, cut funding. Donations through multilateral channels pulled back more than those in bilateral channels; their funding fell by about 20%, while country-tocountry funding contracted by 3%. This may suggest that the aid landscape is increasingly tilting towards bilateral arrangements, which can prioritize medicines, diagnostics and frontline delivery. While helpful at the point of care, these arrangements could impose more pressure on recipient governments, as they typically leave system costs uncovered, shifting those on to domestic budgets. For example, the new US guidance for its HIV programme aims for services to be managed by domestic actors (PEPFAR COP25 Strategic Guidance), and similarly, the United States Agency for International Development (USAID) tightened cost-sharing rules for recipient governments. Estimates for 2025 indicate further worsening, with global DAH declining by an additional $11 billion, largely because US funding agencies are expected to cut about $9 billion.As a result, it is not surprising that many council members and executives expect cooperation in this pillar to deteriorate further (Figure 10). 

Health outcomes have not yet started to reflect the potential impacts of the shift taking place. In 2024, all health outcomes – including disability-adjusted lifeyears (DALYs), life expectancy, child mortality and maternal mortality – showed progress. However, health outcomes often lag their drivers significantly, and these improvements might be capturing a postpandemic rebound, and perhaps also the results of longer-term cooperation. Although these indicators reflect positive outcomes, other evidence points to a widening gap between “healthspan” and lifespan, as health-adjusted life expectancy lags gains in life expectancy. Put simply, this means people are living more years with illness. Despite a slowdown in overall goods trade (as discussed in the trade and capital pillar), trade in health goods increased in 2024. This increase was propelled by innovation-led demandin pharmaceuticals – most visibly a rise in GLP-1 therapies, and exports from hubs such as Ireland, Denmark and Switzerland feeding US/EU demand. The WTO’s “zero-for-zero” deal also kept pharmaceuticals tariffs near zero.

 Recent global multilateral efforts – such as WHO’sPandemic Agreement (though not yet ratified and without US participation) and the United Nations GeneralAssembly’s declaration on non-communicable diseases and mental health – signal continued commitment to coordination in global health governance. Meanwhile, regional cooperation is gaining definition, exemplified by the Organisationof Eastern Caribbean States scaling a model to reduce the price of insulin throughout the region, the launch of the African Medicine Agency (AMA), as well as the Accra consensus, with African governments aligning on shared priorities and execution. Looking ahead, the critical question is the extent to which fading global multilateral efforts could translate into worse health outcomes. As global financial flows weaken and the remaining support flows limit their coverage to treatment and delivery, pressures on domestic health budgets will rise. Many domestic economies will be unable to make up for the shortfall, and the test ahead will be whether progress on health outcomes can be sustained.