Global Health: Towards a New Paradigm of Health Cooperation

By Oriana Ramírez Rubio

Twenty-five years ago, over 10 million children died each year worldwide. Today, fewer than five million die annually, despite a 30% increase in the global population. The deadliest infectious diseases have also been halved, particularly in Sub-Saharan Africa and South Asia.

From Historical Progress to Current Challenges

These achievements are the result of a combination of national leadership, international financing, and access to medical innovations: new vaccines, HIV treatments, malaria prevention methods, and more. However, these gains are now at risk of reversal. For example, child mortality (under five years old) is projected to rise in 2025 for the first time in 25 years, from 4.6 million in 2024 to 4.8 million in 2025.

In parallel, a key concept has emerged: global health public goods. These are resources and standards that benefit all countries, from eradicating diseases like polio to pandemic preparedness and combating climate change. Their provision requires global coordination and sustained funding, but their benefits are universal.

A Complex Global Ecosystem

The global health architecture is diverse: United Nations (UN) agencies, particularly the World Health Organization (WHO) as the central specialized multilateral agency, alongside the UN Population Fund (UNFPA) and the UN Children’s Fund (UNICEF); global health initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, or the Gavi Vaccine Alliance; product development partnerships like UNITAID, FIND, CEPI, or DNDi; technical platforms such as Stop TB, the Global Polio Eradication Initiative (GPEI), or UHC2030; and multilateral development banks.

Each actor plays distinct roles, from research and development to technical assistance and health system financing. This diversity has enabled unprecedented global achievements. Yet fragmentation, reliance on external funding, and multiple competing agendas present challenges that require active leadership and coordination.

Progress and Setbacks in Health Official Development Assistance (ODA)

Between 1990 and 2019, international cooperation invested over $880 billion in health, mainly targeting HIV, tuberculosis, malaria, and childhood vaccination. Countries such as Rwanda and Ethiopia have demonstrated that development aid, when aligned with national reforms and prioritizing primary and community healthcare programs, can yield sustainable results.

However, recent global trends are concerning. After reaching a historic peak of $80.3 billion in 2021 during the pandemic, health development assistance dropped to $49.6 billion in 2024 and is projected to decline further to $36.2 billion by 2030. These cuts, combined with vertical, disease-specific approaches, threaten to reverse decades of progress, potentially causing up to 22 million deaths by 2030 if current trends continue.

Spain as Facilitator, Promoter, and Connector

In this context, Spain has strengthened its leadership in a strategic and prominent way. On one hand, it has enhanced dialogue and cooperation among government actors through the Spanish Global Health Strategy 2025–2030, a whole-of-government effort including the Ministries of Foreign Affairs, EU and Cooperation (including AECID), Health, Science, and other key actors. The strategy positions Spain as a strategic global health actor distinguished by promoting a human rights- and equity-based approach, integrating feminist and intersectional perspectives, and adopting a planetary health approach, ensuring that global health reform is just and sustainable.

On the other hand, Spain organizes inclusive spaces among countries, multilateral organizations, and civil society, validating strategic orientations and commitments, demonstrating that strategic partnerships are key to achieving concrete global health results.

One example is AECID’s contribution to the global effort led by WHO and PAHO to eliminate cervical cancer, alongside other countries and partners such as the Gates Foundation, Gavi, UNITAID, UNICEF, and the World Bank.

Furthermore, in response to the projected rise in child mortality in 2025—the first in decades—Spain has renewed collaborations with philanthropic actors, including the Gates Foundation, focusing on maternal and child health, strengthening health systems, and reducing inequalities. Spain also promotes equitable access to technologies through its participation in Team Europe initiatives for local vaccine and medicine manufacturing in Africa and the VAC-MED initiative in Latin America, in collaboration with multiple actors such as FCSAI, AEMPS, ISCIII, PAHO, COMISCA, and Fiocruz. The November 2025 CELAC-EU Summit in Cartagena de Indias demonstrated how Spain translates innovation, regional production, and equitable access into a practical roadmap.

Finally, Spain serves as a facilitator of high-level dialogue and consensus, through initiatives such as the Seville Global Health Initiative, and as a connector between global initiatives and actors, reflecting on the necessary reform of the global health ecosystem—from the European Commission to the Wellcome Trust and Friends of Lusaka—ensuring complementarity and effectiveness in international action.

Looking Ahead

The success of these initiatives demonstrates a clear principle: what is technically possible only matters when supported politically.. Health was AECID’s priority sector in 2023, accounting for over 20% of its annual budget. This momentum is reflected in leadership at the highest levels, consolidating Spain as a reliable and visionary actor on the international stage.

This shows that health cooperation is not merely about financing: it is strategic policy, technical coordination, multi-stakeholder partnerships, and a focus on rights and equity—not only for people in lower-resource countries, but for the global population.

In a world of dwindling resources and rising challenges, Spain’s model illustrates how a country can turn commitments into tangible results, strengthen local and regional systems, and ensure that health remains a global public good.

Oriana Ramírez Rubio is a physician, specialist, and PhD in preventive medicine and public health, and Head of the Health Area at the Spanish Agency for International Development Cooperation (AECID).(13) Oriana Ramirez Rubio | LinkedIn Oriana Ramirez Rubio (@Ori_SaludGlobal) / X