Hardly anything is more difficult than setting global health priorities and deciding which are the most important issues to focus on. In global health we often end up thinking in terms of disease or population groups that need attention but that leads to a neglect of the systemic and structural issues which need to be tackled. So let me take a stab at 3 issues that need to be addressed urgently – but with an understanding that they cannot be solved overnight.

The first is the institutional fragility of international health organizations, starting with the budget crisis at the World Health Organisation, which is confronting a 20% cut in funding for 2026–2027. The restructuring of the work of the organization raises concerns about the WHO’s capacity to lead effectively in times when multilateralism is out of favor and new challenges loom. This in turn impacts on the second big issue: weakened global solidarity amid shrinking trust. This will play out in the negotiations on a Pathogen Access and Benefit–Sharing System (Pabs), which remain to be negotiated for the Pandemic Agreement to take the next step in acceptance and ratification. The USA is of course no longer part of these negotiations. The third big issue is the lack of intersectoral and systemic action to address the consequences of the climate/health interface not only in relation to resurgence of vector borne diseases and their global spread, but also to non-communicable diseases. If taken seriously just these three issues will keep health diplomacy busy leading up to 2030. But it needs to be done to give global health a new and sustainable base for action.