Keynote Address: Sania Nishtar

Key Takeaways

• The progress of the past 25 years is real, but reversible. The global health architecture built since the MDG era has saved tens of millions of lives, and any new structure must be designed so these gains are not compromised. Early signs of reversal in child mortality make this urgent.
• The decline in ODA is a worldwide, structural shift, not a U.S.-specific event. Reform conversations need to start from the assumption that wholesale ODA mobilization, as it existed under the MDGs, is over. At the same time, the health sovereignty movement offers a genuine opening if the global system is willing to engage on fairer terms.
• Fragmentation at the country level is the most neglected piece of the reform agenda. Reform discussions tend to focus on institutions in Geneva, New York, and Washington, but the most damaging duplication shows up under one roof at a primary healthcare center. Fixing this requires donors to cede authority and pool resources behind governments with strengthened checks and balances.
• Reform must put the hard questions at the center. Distinguishing development assistance from financing of global public goods, addressing missing competencies (AI biothreats, NCDs, private-sector engagement), protecting fragile settings, and designing responsible transitions for high-impact institutions like Gavi and the Global Fund, these cannot be deferred to the next process.

“We’re transitioning many responsibilities to countries. One of the key things you have to do when you talk about country transitions is to give them authority and responsibility. You cannot be talking about country transitions and still hold the resources in your hand.”

– Sania Nishta, CEO, Gavi, the Vaccine Alliance