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As 2026 approaches, global health stands at a crossroads, confronting declining vaccine trust, strained multilateralism, and the uneven rise of pharmaceutical solutions to complex public health challenges
Image Source: Getty Images
Global health underwent a tumultuous journey in 2025 with the anticipated United States (US) withdrawal from the World Health Organization (WHO), the disassembly of the United States Agency for International Development (USAID), and the adoption of key multilateral global health agreements at the World Health Assembly. Against this backdrop, discernible challenges to global health have emerged, which will likely gain prominence in 2026. This commentary will delineate three impending challenges to global health in 2026:
surges in vaccine-preventable diseases spurred by policy changes on vaccines, the evolving role of the US in global health activities and its impact on multilateral efforts, and the growing prominence of pharmaceutical interventions in addressing the global obesity crisis.
First, a spike in the number of measles cases has been reported in South Carolina, USA, bearing a striking resemblance to initial accounts of the COVID-19 pandemic. Remote learning, quarantining, and over-strained hospitals reveal a region experiencing an accelerating measles outbreak. Currently, 126 people are infected, of whom 119 were unvaccinated. This is the US’s second major outbreak, the first one being in Texas earlier this year, which later spread to the northern regions of Mexico. Reflecting the impact of the anti-vax movement and widespread misinformation and disinformation campaigns, vaccine hesitancy is on the rise. The US will likely lose its measles-free status by next year.
Subsequently, the US Centers for Disease Control and Prevention (CDC) updated its website to state that the premise that vaccines and autism are not linked is not based on evidence and went on to claim that health authorities have ignored research exploring such links. While such statements have cast doubt on vaccine safety, a WHO Expert Committee reaffirmed that there is no evidence linking vaccines to autism.
Globally, the burden of vaccine-preventable diseases is on the rise; Japan, the United Kingdom, and Australia reported large outbreaks of whooping cough and measles in 2025. Disruptions to regular immunisation schedules owing to COVID-19 affected health systems in low- and middle-income countries (LMICs). Vaccine hesitancy in high-income countries stemmed from mistrust, political polarisation, and an aversion towards evidence-based research. More recently, political statements from Robert F. Kennedy, Jr., US Secretary of Health and Human Services, suggesting that vaccines and the development of autism were strongly linked, have further affected vaccine uptake. Subsequently, the US Centers for Disease Control and Prevention (CDC) updated its website to state that the premise that vaccines and autism are not linked is not based on evidence and went on to claim that health authorities have ignored research exploring such links. While such statements have cast doubt on vaccine safety, a WHO Expert Committee reaffirmed that there is no evidence linking vaccines to autism.
An advisory panel of the US CDC recommended changes to the routine paediatric vaccine schedule by restricting access to the MMRV (mumps, measles, rubella, and varicella) combination vaccine and instead recommending that children be immunised with multiple vaccines against mumps, measles, rubella, and chickenpox. Citing concerns that the MMRV combination vaccine can cause febrile seizures in 1 in 3000 vaccinations, the new recommendation will likely result in reduced compliance. In addition, the committee removed a recommendation for newborns to be vaccinated against Hepatitis B if the mother tests negative.
Collectively, with widespread misinformation on vaccine safety catalysed by social media, vaccine uptake is in decline, and this trend is likely to persist well into 2026, adversely impacting global health security. It will be the responsibility of the scientific and medical community to ensure that the public is well-informed about the benefits of vaccines, particularly for children, quell any misinformation or disinformation campaigns, and sustain evidence-based scientific research to instill public trust.
It will be the responsibility of the scientific and medical community to ensure that the public is well-informed about the benefits of vaccines, particularly for children, quell any misinformation or disinformation campaigns, and sustain evidence-based scientific research to instill public trust.
This comes at a time when the US scaled back its funding towards Gavi, the Vaccine Alliance, despite being one of its most significant contributors. Gavi’s efforts to support immunisation activities in LMICs and to ensure equitable access to vaccine services are essential to global health security. In its pledging summit in June 2025, Gavi fell short of its initial US$11 billion target, likely affecting global stockpiling of vaccines, responsiveness to outbreaks, and efforts to strengthen regional vaccine manufacturing. Combined with vaccine hesitancy, these events will have ripple effects across the world, weakening the global health response to vaccine-preventable diseases.
Intricate Global Health Negotiations
As these challenges highlight the difficulties in sustaining immunisation programmes, the global health paradigm has been reinvigorated through amendments to the International Health Regulations and the adoption of the pandemic agreement. A key aspect of the agreement — the PABS (pathogen-associated benefit-sharing) mechanism — has been placed in an annex and is currently under negotiation. While much of the negotiations have focused on equitable and fair access to genetic sequence information and data on pathogens with pandemic potential, as well as the development of medical countermeasures, the agreement will likely need to address other obstacles.
The US released the America First Global Health Strategy in September 2025 and, while it did not adopt the pandemic agreement, it has begun negotiating global health activities with individual countries.
Developing countries are pushing for contractual obligations on recipients of pathogen information as a means of ensuring the PABS works. The intergovernmental working group (IGWG) on PABS will resume negotiations in January 2026. Meanwhile, the US released the America First Global Health Strategy in September 2025 and, while it did not adopt the pandemic agreement, it has begun negotiating global health activities with individual countries. Bilateral agreements, which include pathogen-sharing agreements, have been initiated with Kenya and Rwanda. These bilateral arrangements may shape the trajectory of the PABS negotiations.
Finally, 2026 will likely witness the widespread adoption of pharmaceuticals to address non-communicable conditions, especially the global obesity crisis. Semaglutide [glucagon-like peptide-1 (GLP-1) receptor agonist] patents are nearing expiry, and the demand for Ozempic and Wegovy (brand names of semaglutide) is soaring. Weight-loss markets, including India’s, are poised for rapid expansion. Yet, caution is warranted: supplemental drug approvals often lack full clarity on long-term impacts and molecular mechanisms of action, and sustained dependence may be required to maintain benefits. The high financial burden of these therapies and the complex nature of obesity further complicate their role. Clinicians and public health experts are divided over whether drugs should be the frontline solution to address the global obesity crisis. Their widespread adoption may deepen health disparities, with the wealthy better positioned to access these cutting-edge drugs, while lower-income populations struggle with access.
With the approaching patent cliff, 2026 will likely see policy debates over whether ‘quick-fix’ pharmaceutical solutions to obesity are the way forward, and whether their use should be balanced with greater scrutiny to ensure that efforts to address obesity extend beyond pharmaceutical interventions to tackle its underlying causes.
Further, ethical concerns around access will need to be addressed, distinguishing between patients who clinically require weight-loss drugs and those seeking them for cosmetic reasons, as this will affect drug supply. This is already a cause for concern, with counterfeit drugs being produced to match demand. With the approaching patent cliff, 2026 will likely see policy debates over whether ‘quick-fix’ pharmaceutical solutions to obesity are the way forward, and whether their use should be balanced with greater scrutiny to ensure that efforts to address obesity extend beyond pharmaceutical interventions to tackle its underlying causes.
As global health enters 2026, cognisance must be taken of the frailties of the emerging multilateral order, marked by an increasingly politicised and market-driven environment. The resurgence of vaccine-preventable diseases highlights the erosion of trust in science and medicine, while collective action will be required to address recalibrated US engagement in global health. The rapid adoption of pharmaceutical interventions in addressing the obesity crisis points to the risk of deepening disparities in access and an aversion towards lifestyle-modifying approaches to healthcare. Collectively, 2026 presents an opportunity to restore trust in science and to balance innovation with equitable health outcomes.
Lakshmy Ramakrishnan is an Associate Fellow with the Centre for New Economic Diplomacy at the Observer Research Foundation.
The views expressed above belong to the author(s). ORF research and analyses now available on Telegram! Click here to access our curated content — blogs, longforms and interviews.
Lakshmy is an Associate Fellow with ORF’s Centre for New Economic Diplomacy. Her work focuses on the intersection of biotechnology, health, and international relations, with a ...
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