- Gavi CEO Dr Sania Nishtar, writing in The Lancet, sets out a framework for radical reform of global health institutions
- Global health institutions should merge operations in countries in order to focus on generating global public goods, scaling impact and supporting the most fragile contexts, Dr Nishtar writes
- Dr Sania Nishtar: “We must move away from piecemeal reform and imagine a new system that places the needs of countries, not the institutions themselves, at its heart.”
Geneva, 21 January 2026 – Dr Sania Nishtar, CEO of Gavi, the Vaccine Alliance today issues an urgent call to reform global health institutions. Writing in a Viewpoint article in The Lancet, Dr Nishtar argues that global health institutions (GHIs), collectively known as “the global health architecture”, must be radically reformed to support the needs of countries.
A far-reaching reform process, or global health leap, Dr Nishtar writes, would not only protect the spectacular gains made across global health in past decades but also unlock further impact for years to come. Such a leap, Dr Nishtar continues, could be achieved if GHIs were to focus solely on activities that cannot be achieved by individual countries, for example generating global public goods, scaling impact and supporting people in fragile and conflict-affected contexts, with operations in countries merged and handed over to national governments to run.
“Our global health architecture, which has achieved so much in the past, is in crisis. We must move away from piecemeal reform and imagine a new system that places the needs of countries, not the institutions themselves, at its heart. Our urgent need now is for all stakeholders to come together and agree on principles, objectives and scope of reform,” said Dr Sania Nishtar, CEO of Gavi, the Vaccine Alliance.
Gavi’s own reform programme, the Gavi Leap, could serve as a blueprint for broader global health reform. By facilitating a historic shift in decision making power to countries, Gavi has been able to maintain its ambitious immunisation targets for its new five-year strategy period, despite a major reduction in funding and staff.
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