As the US retreats from global health leadership, Lakshmy Ramakrishnan examines how BRICS is stepping up as a key player. With the Pandemic Agreement still under negotiation, BRICS countries have an opportunity to promote a more equitable, inclusive approach to global health diplomacy in a shifting geopolitical landscape
Global health has experienced a series of sudden jolts in 2025. The US retreated from the World Health Organisation (WHO). The Trump administration abruptly disbursed a major development partner, USAID. We also saw cuts to various global health funding organisations, including GAVI, the Vaccine Alliance. The US attributes most of these changes to the WHO’s alleged lack of transparency and accountability over the origins of Covid-19.
Concerningly, the US’ overall stance on health has taken a defiant turn. The Trump administration's actions put global health security at risk. The US Centers for Disease Control and Prevention have ceased data exchange with the WHO. The US government has also taken an anti-vaccine stance, and made severe funding cuts to biomedical science research. Amid declining vaccination rates, the US is experiencing its worst measles outbreak in over three decades. The message could not be any clearer: health is not a major foreign policy goal for the US.
Infectious diseases like dengue, malaria, Nipah, and tuberculosis (TB) continue to place huge strain on health systems. Non-communicable diseases such as obesity, diabetes, cardiovascular disease, cancer, and mental health illnesses, meanwhile, contribute significantly to the burden. These are not challenges borne by the Global South alone. As the Covid pandemic demonstrated, diseases know no territorial borders. Just last year, climate change and global travel patterns saw the Paris Olympics marred by dengue fever and chikungunya – both mosquito-borne diseases.
The BRICS bloc – which initially comprised the countries Brazil, Russia, India, China, and South Africa of the acronym but has grown to include Egypt, Ethiopia, Indonesia, Iran and the United Arab Emirates – has tended to be seen as an anti-Western bloc which aims to assuage the grievances of the Global South. Now, it reflects a multipolar world. BRICS is a geopolitical hedge in a climate which does not deem global health a priority.
The middle-sized powers of the BRICS nations can use their healthcare knowhow and experience in south-south cooperation to engage in meaningful global health diplomacy
BRICS countries contain more than half the world’s population and generate 44% of GDP. They hold significant clout. BRICS fora are thus ideal platforms for middle-sized powers to engage in meaningful global health diplomacy by using their healthcare knowhow and experience in south-south cooperation. This year’s summit and XV BRICS Health Ministers’ Meet made global health governance a priority. The BRICS grouping has indicated that it is ready to take decisive action on its future.
BRICS countries need to address mutually beneficial areas of cooperation in healthcare. They could direct political will towards managing lifestyle diseases, funding research and development on TB, and leading negotiations over contentious issues in the Pandemic Agreement.
Diseases such as Ebola and Zika, which high-income countries treat as security threats, should take priority. But BRICS must also tackle non-communicable diseases, which have not received the same political or financial attention, and which BRICS could mitigate through behavioural interventions. Clearly, there is a need to mobilise actors outside the health sphere, in the food, alcohol and tobacco industries.
While BRICS countries must prioritise virulent threats such as Ebola and Zika, they must also tackle non-communicable diseases, through behavioural interventions
BRICS countries bear half the global tuberculosis burden and have already set in place national strategies to tackle it. Well-defined partnerships facilitated by scientific collaboration, technology and data exchange, capacity-building measures, and strategic investments can aid in the research and development of useful healthcare technologies. India, for example, recently developed an AI-assisted chest X-ray to screen for TB cases.
Global health financing is in dire straits – and not just because the US has stepped back from its commitments. It is also because other nations have had to divert funds towards the Russia-Ukraine war, and conflicts in West Asia. Increased security threats have prompted the US, China, Russia, Germany, and India to increase military spending over the past year. Through philanthropies and corporate social responsibility, BRICS countries must therefore urgently harness alternative funding sources.
As Covid fatigue sets in, we should remember that the Global South has long championed reform to the WHO and other multilateral health programmes. South Africa and India jointly filed for an Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) waiver during the pandemic, to enable flexibility in procuring medical countermeasures. The late arrival of the waiver, however, rendered it only minimally useful.
COVAX is a multilateral initiative that enabled the development and supply of Covid diagnostics and vaccines. But governments rolled it out at a time when national interests trumped global health equity. Indeed, Canada alone ordered vaccines five times in excess of the country's demand. Using what became known as vaccine diplomacy, China exported its stocks across the world, bolstering its geopolitical influence in the process.
The Pandemic Agreement has been heralded as a success in multilateralism, yet a major portion of it has yet to be negotiated
The WHO adopted its historic Pandemic Agreement in May 2025, heralding it as a success in multilateralism. Yet a major portion of the Agreement – the pathogen access and benefit-sharing (PABS) mechanism – has yet to be negotiated. PABS provides a legal avenue for the sharing of pathogen samples and the supply of vaccines and diagnostics during pandemics. Discussions on it will be held through an Intergovernmental Working Group that presents its findings at next year’s World Health Assembly.
The text contains several contentious issues on which developing and developed countries are at odds. Points that need addressing include the lack of a comprehensive One Health approach (a collaborative, multisectoral, and interdisciplinary approach that recognises the interconnectedness of human, animal, and environmental health), ambiguity over contractual obligations between the WHO and pharmaceutical manufacturers, and overlap with the newly launched Cali fund (a similar benefit-sharing mechanism introduced last year under the Convention on Biological Diversity, and named after the town in Colombia in which it was agreed).
BRICS is a coalition of capable middle powers. There is reason and opportunity for it to influence the future of global health diplomacy. By committing to more inclusive negotiation processes and addressing financing and access, BRICS can help ensure that the health of all earth's citizens remains a global priority, not a geopolitical afterthought.
