The recent Ebola and hantavirus outbreaks, respectively in the Democratic Republic of Congo and Uganda, and on a cruise ship in the Atlantic Ocean, remind us that the next health crisis is never far away. They also illustrate the World Health Organization’s key role in global coordination and the importance of international cooperation for more effective responses.
The WHO declared the Ebola outbreak a “public health emergency of international concern”, raising a global alert that the outbreak may require “a coordinated international response”. In the hantavirus case, it supported medical care, evacuations, and risk assessment, which, together with cooperation among numerous countries, have been crucial for implementing an effective response. Yet the very conditions that would allow for a timely and effective alert and response are eroding.
According to our research, this threatens worse crises in the future.
In January, the US, which was the WHO’s biggest funder, formally completed its exit from the global health agency. A few weeks later, in March, Argentina’s exit was finalised.
Other countries, including Hungary and Israel, have publicly signalled they may leave.
These withdrawals are occurring in a broader retreat from aid.
Major Western donors such as the US, the UK, and the EU have enacted significant cuts: the US shut down USAID, until recently the world’s largest aid agency, creating a global funding gap of $54 billion more than six times Somalia’s GDP; the UK is reducing aid from 0.5% of GNI in 2021 to 0.3% in 2027; and the EU is reallocating €2 billion from aid funds to ‘other priorities’.
WHO had to reduce its 2026-27 budget by $1.1 billion (a 21% cut), on top of a previous 30-40% drop in global health aid from 2023 to 2025. To make things even worse, funding cuts have been particularly substantial for aid allocated to institutions and civil society.
Dismantling USAID, for example, has generated estimated reductions of 100% in civil society aid and 97% in good governance aid in its portfolio. Hence, besides direct aid cuts in health, core sectors for public health provision have also been hit hard.
One recent study predicts that the USAID shutdown could result, overall, in over 14 million extra deaths by 2030.
But some experts argue that weaker cooperation and aid cuts will ultimately help the world become more prepared to tackle health crises.
According to one expert, African countries have quickly demonstrated resilience, finding various ways to adapt to funding cuts. This view of aid cuts as an opportunity is also reflected in discussions among some practitioners. “We have decided that we have to think bigger”, stated one NGO leader.
We fear this optimism is misplaced: evidence from Covid-19 suggests the opposite.
International cooperation and institutional quality – understood as a combination of state capacity, legitimacy, and authority – were key factors in how Global South countries responded to the pandemic.
Low capacity created challenges for effective responses, but mere high capacity (i.e., greater state ability to get things done) was no guarantee of success: this typically also required state legitimacy and authority – crucial ingredients for transforming capacity into positive outcomes.
International cooperation further provided latent capacity through cross-border collaboration and coordination.
Weaker cooperation and aid cuts risk reducing institutional quality and international cooperation – the two key factors for better pandemic responses in the Global South.
Instead of increasing resilience, these trends are thus more likely to undermine preparedness for future health emergencies. Case studies from our book How States Respond to Crisis (Oxford University Press, 2025) show this more in detail.
UNU-WIDER
Covid-19 responses across the Global South reveal uneven preparedness
The Philippines, Nicaragua, and Tanzania illustrate the consequences of weak legitimacy and authority.
In these countries, political leaders used the pandemic to consolidate authoritarian power by further repressing political opposition, manipulating mortality data, or denying the crisis outright, with deleterious public health outcomes.
Vietnam, by contrast, shows how legitimacy and authority can compensate for limited capacity. State authority allowed the country to promptly adopt strong public health measures, while legitimacy, especially at the local level, fostered citizens’ compliance with these measures.
The state’s central government’s clear vision of ‘people’s safety first’, which was accepted as the national consensus, as well as its rules on quarantine, social distancing, and movement between provinces, free testing and treatment, and support for people in quarantine centres and affected by the pandemic were widely understood and followed by local governments and people. This helped Vietnam contain the first waves of Covid-19 at relatively low levels of infection and made a robust economic recovery possible, building public trust in government. This high level of trust, in turn, made the government’s responses more effective.
Ghana underscores the importance of international cooperation. While not considered as a high-capacity country, during the pandemic, Ghana managed to act more effectively than expected, thanks to residual capacity acquired through cross-border collaboration and experiences with past health crises. For example the Africa Centres for Disease Control and Prevention (Africa CDC) quickly activated its emergency coordination mechanisms, developed a joint strategy – drawing on technical expertise and experience with past epidemics – to improve domestic detection and containment, and helped in increasing the continent’s testing labs from 2 to 43 just in a few weeks.
What were the key takeaways?
Lessons from how Global South countries responded to Covid-19 tell us that a combination of institutional quality and international cooperation are crucial for successful crisis response.
State capacity made effective responses easier, while legitimacy and authority increased citizens’ compliance and political trust. International cooperation, in turn, facilitated cross-border coordination and allowed countries to share resources and expertise, improving domestic ability to respond to the pandemic beyond what states could do on their own.
Dismantling global health cooperation and reducing aid will not advance any of these factors. Rather, they are likely to erode preparedness for health crises.
While it is still possible to revert the dismantling of global health cooperation and shrinking aid, we must prioritise a long-term strategy over short-term political considerations.
Resources allocated to aid have never been colossal – e.g. Official Development Assistance (ODA) has rarely been greater than 1% of GDP for any country. It is short-sighted and counterproductive, for countries both in the Global South and Global North, to run down structures that have proven their ability to facilitate better public health responses.
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