Shifting power in global health: Time for Malaysia to lead the way

AS THE Asean chair this year, Malaysia faces a critical opportunity –not only to guide regional diplomacy but to establish itself as a global leader in reshaping and decolonising global health.

As a member of the Organisation of Islamic Cooperation (OIC) and a partner country of BRICS, Malaysia is uniquely positioned to influence global health engagement with emerging economies, while promoting South-South cooperation and knowledge-sharing.

The global health landscape remains deeply entrenched in colonial legacies, economic disparities, and power imbalances.

Even during the Covid-19 pandemic, the world witnessed the failure of wealthy nations and pharmaceutical companies to release their stranglehold on vaccines, leaving hundreds of millions without access to life-saving treatments.

These dynamics perpetuate systemic health disparities and unequal access to resources, particularly for low- and middle-income countries (LMICs), which house much of the global population.

The global health system: A call for change

Malaysia is well-positioned to challenge the entrenched structures that dominate global health, particularly the increasing influence of private foundations and financial actors.

These entities often shape global health policy through elite forums such as the World Economic Forum (WEF) and the World Health Summit (WHS).

While multi-stakeholder engagements are often heralded as solutions, they have frequently resulted in the capture of governance by powerful private interests, reducing transparency and accountability to the very populations they claim to serve.

To counter this, Malaysia can play a pivotal role in advocating for robust democratic controls over global health governance through intergovernmental mechanisms like the World Health Assembly (WHA). Structural and financing reforms to the World Health Organization (WHO) could better align global health priorities with the needs of LMICs, ensuring that the health and well-being of these nations are central to global policy decisions.

A legacy of inequity: The need for global health reforms

Historically, Western nations have controlled global health research, innovation and distribution. This has led to repeated failures to prioritise the health needs of poorer countries.

For example, millions in LMICs lack access to treatments for diseases like Hepatitis C and dengue fever. These inequities continue to disproportionately affect regions in Africa, Asia and Latin America, leaving vulnerable populations without the medical resources they desperately need.

However, Malaysia has already demonstrated significant leadership in global health. Our Health Ministry was a founding partner of the Drugs for Neglected Diseases Initiative (DNDi) in 2003, which has delivered 13 safe and affordable treatments for diseases that primarily affect the Global South, including a treatment for Hepatitis C.

In 2013, Malaysia played a key role in advocating for the Framework Convention on Tobacco Control (FCTC) and successfully pushed for the exclusion of tobacco trade from the Trans-Pacific Partnership Agreement (TPPA), setting an example for other countries in the region.

Malaysia is currently spearheading efforts to combat dengue fever through the creation of the South-South Diagnostic Alliance, working alongside nations like Sri Lanka, Thailand, Vietnam and Brazil.

Beyond government efforts, Malaysian academics and health professionals are at the forefront of tackling global health challenges.

Malaysian institutions host several WHO collaborative centres, including the Arbovirus Reference and Research Centre at Universiti Malaya.

Furthermore, Malaysia helped establish the United Nations University International Institute for Global Health (UNU-IIGH) in Kuala Lumpur in 2006, a leading institution for critically analysing global health governance and policies.

The path forward: Recommendations for Malaysia's leadership

Given its strong track record, Malaysia is well-placed to lead the charge for reforming global health governance and ensuring it reflects the needs of the majority.

Recent discussions at UNU-IIGH have underscored the urgent need for governments to regulate the commercialisation of health and strengthen public institutions to safeguard national sovereignty.

Malaysia can play a key role in implementing these recommendations, advancing inclusive, equitable and sustainable global health systems.

Here are several areas where Malaysia can assert its leadership:

1. Reclaim the global health discourse

Malaysia can champion a more inclusive, participatory global health discourse. This would involve dismantling the structural barriers that often prevent countries from the Global South from meaningfully participating in shaping global health policies.

By hosting international dialogues and conferences, Malaysia can help shift the focus of global health decision-making from the Global North to the Global South, ensuring that the perspectives and priorities of these regions are adequately represented.

2. Inclusive health governance

Malaysia should deepen its engagement with intergovernmental institutions, both regionally and globally, to advocate for a more inclusive and legitimate governance model.

A global health system that prioritises the concerns of LMICs will better reflect the needs of the most vulnerable populations. By ensuring that global health policies are shaped by the voices of those most affected by health inequities, Malaysia can help to create a more just and effective global health system.

3. Sustainable global health financing

Malaysia must lead the effort to ensure that global health institutions like the WHO are well-financed and accountable. With the potential withdrawal of US funding for the WHO, Malaysia and other nations in the Global South can take on greater responsibility for the financing of global health.

By contributing to sustainable funding models and ensuring strong democratic governance, Malaysia can help guarantee that the WHO serves the interests of all nations, not just the wealthiest.

4. Partnerships for technology transfer

Malaysia can foster equitable knowledge exchange and technology transfer within Asean and across the Global South.

This includes investing in research and development that benefits local populations, facilitating access to essential medicines and medical technologies, and promoting collaboration between local research institutions and international organisations.

By ensuring that innovations are accessible to all, Malaysia can help democratise global health knowledge, governance and practice.

5. Strengthening regional cooperation

Malaysia must advocate for stronger health cooperation both within Asean and with other regional bodies. This includes facilitating shared resources, mutual support and knowledge transfer across member states.

Regional collaboration on issues such as public health emergencies, workforce development, and the ethical governance of emerging technologies like AI will be critical in addressing shared health challenges, demographic pressures and just climate transitions.

Conclusion: A vision for global health justice

This vision for Malaysia’s leadership in global health is rooted in the country’s long-standing commitment to justice, equity and solidarity with the Global South.

As Asean chair, Malaysia has a unique opportunity to lead by example, proving that an inclusive, sustainable and just global health system is not only possible but within reach.

Now is the time for Malaysia to step up, shift the balance of global health power, and create a future where health equity is the norm, not the exception.

Dr Unni Krishnan Karunakara is the interim director of the United Nations University Institute for Global Health (UNU-IIGH) and was the international president of Médecins Sans Frontières (MSF) from 2010 to 2013.

UNU-IIGH, based in Kuala Lumpur, serves as the UN's think tank on global health, facilitating the translation of global health research into policy and action while connecting UN member states, academia, agencies and programmes.