Authors: Alexandros Kentikelenis (Bocconi), Leonard Seabrooke (CBS)
Published in February 2025
Global health governance has never been more visible, yet it has rarely been more complex. International organisations, public–private partnerships, philanthropic foundations, and governments interact through dense funding relationships and layered decision-making structures. The COVID-19 pandemic brought this institutional ecosystem into sharper focus, but the system has been evolving for decades.
The NAVIGATOR working paper Institutional Landscape of Global Health Governance: The Role of Team Europe maps this governance arena through one central lens: Europe’s place within global health governance, and the extent to which the EU and its member states can translate major financial contributions into coherent strategic influence.
From multilateral health cooperation to a crowded governance landscape
Global health cooperation was long associated primarily with formal multilateral institutions. Today, it is shaped by a mix of organisations with very different mandates and governance models. This diversification has created a landscape where influence does not only flow through universal membership bodies, but also through targeted partnerships, funding mechanisms, and operational agencies.
Europe is a major contributor across global health initiatives. Yet financial weight does not automatically translate into political influence. The EU is often described as an “actor in construction” in global health, reflecting the limits of EU competences and the reliance on coordination among member states and EU institutions. In practice, European engagement is frequently organised through flexible coordination formats commonly referred to as “Team Europe.”
Four institutions, four models of global health governance
To make sense of the landscape, the paper focuses on four major organisations that represent different institutional profiles: the World Health Organization (WHO), UNAIDS, Gavi (the Vaccine Alliance), and the United Nations Population Fund (UNFPA). Together, they illustrate how global health governance combines normative authority, technical expertise, financing capacity, and operational delivery.
The WHO: central authority, constrained by funding and politics
The WHO remains the core multilateral institution for global health governance, combining technical guidance, norm-setting, and crisis response. At the same time, it operates through a complex internal structure where regional offices play a major role, and its long-term planning is shaped by an increasing reliance on voluntary contributions.
For Europe, the WHO highlights a recurring tension. European countries and EU institutions collectively contribute significant funding, but the EU itself is not a member and does not sit in the organisation’s key decision-making bodies. This makes influence heavily dependent on coordination between member states and sustained diplomatic engagement, especially in politically contested debates on preparedness and response.
UNAIDS: strong European support, limited EU presence
UNAIDS represents a highly normative institution that ties global HIV/AIDS governance to human rights, gender equality, and non-discrimination. Europe plays a major funding role, but support remains uneven across member states and the EU’s institutional presence is limited. The case illustrates how Europe can be central as a donor while still lacking a strong, formal role in governance structures.
Gavi: targeted effectiveness through a public–private partnership
Gavi embodies a different model: a highly focused partnership designed to expand vaccine access through financing and market-shaping power. Its governance structure brings together governments, foundations, UN agencies, development banks, civil society, and industry actors. Europe’s financial contributions have grown over time, and European engagement extends beyond funding to political support for vaccine equity initiatives and manufacturing capacity in partner regions.
UNFPA: a normative mandate in a shifting funding environment
UNFPA is a normative institution working on sexual and reproductive health and rights, with wide operational reach. Europe remains an important funding bloc, but global funding patterns can shift rapidly depending on domestic politics in major donor countries. This creates recurring questions about burden-sharing and the expectations placed on Europe to fill gaps and sustain programming.
What this means for Team Europe
Across these cases, one message stands out. Europe contributes significantly to global health, but influence depends less on the size of contributions than on the ability to act strategically and coherently across institutions. Structural constraints matter, including limited EU competences, fragmented representation, and the fact that decision-making power often sits with member states rather than EU bodies.
At the same time, the geopolitical context is shifting. If other major donors reduce their engagement, expectations for European leadership may rise. That would make internal coordination within Team Europe even more important, not only to sustain financing, but also to shape priorities and reinforce legitimacy in global health cooperation.
Looking ahead
Global health governance is unlikely to become simpler. The landscape will continue to combine universal institutions, targeted partnerships, and operational agencies with different strengths and limitations. In that environment, Team Europe’s effectiveness will depend on clarity of purpose, stronger coordination, and a sharper sense of where European leadership is both possible and legitimate.
