Global health governance, US withdrawal from WHO

THE recent political developments surrounding the United States and the World Health Organisation (WHO) have raised significant questions about global health governance. While the US has signaled disengagement from WHO, the broader implications for Africa, including Ghana, are profound.

The United States has historically been one of the largest contributors to WHO’s budget, funding critical programmes in disease surveillance, emergency preparedness, vaccine procurement and technical guidance. Reduced contributions or a complete withdrawal risks undermining global coordination, especially during pandemics or cross-border outbreaks. For countries with weaker health systems, the loss of such support can delay disease detection, reduce access to vaccines and hinder effective response strategies.

Africa’s vulnerability and vaccine capacity

Africa is particularly vulnerable due to limited local resources and reliance on external funding for essential health programmes. Many African nations, including Ghana, have faced challenges in pandemic preparedness and vaccination coverage. During the COVID-19 pandemic, the continent struggled to secure equitable access to vaccines, highlighting the urgent need for regional manufacturing and research capacity.

Currently, less than two per cent of vaccines consumed in Africa are produced locally. Initiatives such as the African Union’s Partnerships for African Vaccine Manufacturing aim to increase production capacity through training hubs, technology transfer programmes and regional centres of excellence. With strategic investment, Ghana can benefit by building local vaccine manufacturing and research capacity, ensuring quicker access during public health emergencies.

Domestic health financing: The Abuja Declaration

One critical avenue to strengthen health systems is revisiting the Abuja Declaration, a 2001 agreement in which African Union member states pledged to allocate at least 15 per cent of their national budgets to health. In practice, most countries have failed to meet this target, and even those approaching it often fall short.

Increased domestic financing would reduce dependence on external donors, improve health system resilience and enable sustained investment in disease prevention, healthcare infrastructure and workforce development. By committing to the Abuja target, Ghana could generate resources to expand vaccination coverage, strengthen primary healthcare and support emergency preparedness programmes.

Expanding vaccination capacity

Expanding vaccination capacity in Ghana is another area of strategic importance. Beyond routine immunisations, the COVID-19 pandemic exposed the risks of relying heavily on imported vaccines and external donors.

By developing national vaccine production hubs, Ghana could improve access, reduce vulnerability to global supply shocks and support research and training opportunities for local scientists. Partnerships with Africa CDC, WHO and regional manufacturing initiatives offer avenues for investment, training and technology transfer. Over time, such centres could serve as regional resources, contributing to broader African health security.

Using fiscal policies to support health systems

Health financing can also be strengthened through targeted taxation policies. Excise taxes on tobacco and alcohol, commonly referred to as “sin taxes,” provide dual benefits: generating revenue for health systems and discouraging harmful consumption patterns.

In Ghana, legislation such as the Public Health Act, Tobacco Control Regulations and excise duty laws already provide frameworks for taxation and regulation. Enforcement, however, remains inconsistent. Experiences from countries such as South Africa, Botswana and Rwanda show that strong governance, effective monitoring and complementary public health campaigns can significantly improve outcomes.

Globally, countries like the United Kingdom, Australia and Thailand have successfully implemented high excise taxes, advertising restrictions and health warnings, leading to measurable reductions in smoking and excessive alcohol consumption.

While these measures do not guarantee complete cessation of harmful behaviour, they generate essential funding to offset healthcare costs associated with alcohol- and tobacco-related diseases. Excessive consumption contributes to non-communicable diseases such as cardiovascular disease, hypertension, liver disease, mental health disorders, cancers and metabolic syndromes. By coupling taxation with awareness campaigns, health promotion and enforcement, Ghana can mitigate lifestyle-related risks while strengthening health financing.

A roadmap for resilient health systems

Taken together, these strategies form a cohesive roadmap for building resilient health systems. Increased domestic financing through the Abuja Declaration, strategic investment in vaccine production hubs and targeted taxation policies provide complementary approaches that reduce reliance on external actors, build local capacity and support sustainable public health interventions.

Strengthening health diplomacy and governance is essential for coordinating these policies, negotiating partnerships and ensuring effective use of investments.

As a medical doctor and health policy practitioner with experience in medical journalism, I observe that public awareness, policy advocacy and stakeholder engagement are critical to successful implementation. Media platforms play an important role in informing citizens, mobilising public support and creating accountability mechanisms that drive policy compliance. Engagement with policymakers, civil society and international partners ensures that health policies remain evidence-based, contextually relevant and responsive to population needs.

Conclusion: Opportunities amid challenges

The potential withdrawal of the United States from WHO underscores the urgency for Africa to strengthen its health systems. Ghana has the opportunity to lead by increasing health financing, developing vaccine manufacturing hubs and leveraging taxation policies on alcohol and tobacco.

Combined with strong governance, public engagement and health diplomacy, these measures can enhance resilience, improve population health and reduce dependence on external support. By taking these steps, Ghana and Africa can build a future in which health security is sustainable and self-reliant.

The writer is a Global Health and Governance enthusiast.

BY DR MICHAEL BAAH BINEY

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