By Nelson Aghogho Evaborhene - 03 August 2026

When African leaders gathered in Accra in August 2025 for the African Health Sovereignty Summit, they did so against the backdrop of a rapidly changing geopolitical and global health landscape. The adoption of the WHO Pandemic Agreement three months earlier marked a historic achievement for global health diplomacy, while the amended International Health Regulations (2005) established a strengthened legal framework for pandemic prevention, preparedness and response. 

Yet these important institutional reforms coincided with a profound transformation in the political and economic environment required to implement them. The return of President Donald Trump to the White House accelerated a shift in United States foreign policy characterised by withdrawal from the WHO, the dismantling of much of the USAID, and significant reductions in global health and development assistance. Across Europe, governments also redirected development budgets towards domestic fiscal pressures and defence spending in response to a deteriorating security environment. As official development assistance became more constrained and geopolitical competition intensified, many countries, particularly across Africa, questioned whether the prevailing architecture of global health governance remained fit for purpose.

The summit marked the beginning of what would become the Accra Reset, an initiative that sought to reposition Africa from being a recipient of global health decisions to becoming an active architect of global governance reform. Rather than focusing narrowly on pandemic preparedness, the discussions centred on a broader vision of health sovereignty—strengthening domestic institutions, expanding regional manufacturing, mobilising sustainable financing and reinforcing African leadership. Underpinning these ambitions was a recognition that Africa's long-term health security could no longer depend on a development model built on predictable external assistance or on a governance architecture designed for a different geopolitical era.

The Accra Reset did not emerge in isolation. It built on earlier efforts to reform the global health architecture, most notably the Lusaka Agenda, launched in December 2023 as the culmination of the Future of Global Health Initiatives process. The Lusaka Agenda articulated a shared vision for strengthening country ownership, increasing sustainable domestic financing, improving strategic and operational coherence among global health initiatives, and aligning external investments with nationally defined priorities. In doing so, it represented an important step towards improving the effectiveness of the existing global health financing ecosystem. Its primary focus, however, was on improving the coordination and performance of global health initiatives within the existing architecture rather than addressing the broader geopolitical shifts reshaping global health cooperation. As these wider political and economic pressures intensified, the debate moved beyond financing alignment towards a more fundamental question: how should global health governance itself evolve in a changing international order?

It was within this context that the Accra Reset rapidly evolved beyond the Accra Summit. In September 2025, on the margins of the 80th United Nations General Assembly, President John Dramani Mahama formally launched the Accra Reset: Reimagining Global Governance for Health and Development, elevating it from a continental conversation to a global political agenda. Building on this foundation, the Accra Reset can be interpreted as broadening the discussion beyond the performance of individual global health initiatives to the wider governance architecture within which they operate. In doing so, it raises broader questions about how global, regional, and national actors can organise collective action in an increasingly fragmented and multipolar world. Subsequent engagements at the G20 under South Africa's Presidency, the World Economic Forum in Davos, the African Union Summit, and the establishment of the High-Level Panel on Reform of the Global Health Architecture and Governance suggested an ambition to position the initiative within wider debates on the future of global health governance.

Beyond the Accra Reset itself, the language of health sovereignty has gained traction across global health policy discussions. Following the Accra Summit, Africa CDC expanded its earlier New Public Health Order vision into the Africa Health Security and Sovereignty Agenda (AHSS). While the New Public Health Order had focused on strengthening public health institutions, workforce, manufacturing, financing, and partnerships across the continent, the AHSS Agenda reframed these priorities within a broader ambition of health sovereignty and reform of the global health architecture. In doing so, Africa CDC translated the political aspirations articulated in Accra into a continental institutional framework, further embedding health sovereignty within African health governance. The concept subsequently gained wider international recognition. At the 2026 World Health Assembly, WHO Director-General Tedros Adhanom Ghebreyesus remarked that "the echoes of Accra are now resounding in Geneva, and around the world." This convergence suggests that health sovereignty is evolving beyond a regional political aspiration into a broader policy narrative shaping debates about the future of global health governance

Beyond Health Sovereignty: Towards Governance Coherence

The growing prominence of health sovereignty reflects a broader transformation in global health governance. As geopolitical fragmentation deepens, official development assistance contracts, and confidence in multilateral cooperation comes under increasing pressure, governments and regions are seeking greater control over the financing, production, regulation, and governance of health systems. The Accra Reset has been widely presented as an African-led effort to reposition the continent from a policy taker to an agenda-setter in shaping global governance. Yet health sovereignty is not a singular concept. Rather, competing interpretations are emerging, each reflecting different political priorities and approaches to international cooperation. The challenge is therefore no longer simply whether countries should pursue greater health sovereignty, but what form that sovereignty should take.

The Accra Reset emerged from a distinctly African vision of health sovereignty. At its core was the recognition that the continent's dependence on external financing, limited capacity to produce, procure, and deploy essential health products, and constrained influence over global health decision-making had become strategic vulnerabilities exposed by successive public health emergencies. During the COVID-19 pandemic, Africa produced only around 1% of the vaccines used on the continent, illustrating the risks of dependence on external manufacturing and fragmented global supply chains. Against this backdrop, health sovereignty sought to translate the principle of self-determination into practical reforms by strengthening domestic public health institutions, expanding regional manufacturing, mobilising sustainable financing, and increasing African leadership in global health governance. While early continental initiatives focused primarily on vaccine manufacturing, this vision has since evolved into a broader ambition to strengthen Africa's capacity to produce, procure, regulate, and finance a wider range of essential health products. In this sense, the Accra Reset presents health sovereignty not as disengagement from international cooperation, but as a means of participating in it from a position of greater capacity and agency.

At the same time, alternative interpretations of health sovereignty are beginning to reshape global health governance. Recent initiatives, including the America First Global Health Strategy, similarly emphasise national control but pursue it through bilateral partnerships negotiated directly with individual governments rather than through multilateral institutions. Such approaches reflect a broader shift towards more selective and strategically negotiated forms of cooperation. While bilateral arrangements can mobilise much-needed financing and technical assistance, they also raise important questions about data governance, pathogen sharing, reciprocity, equitable access to medical countermeasures, and the relationship between national interests and collective regional priorities.

Yet neither regional self-reliance nor bilateral engagement alone is sufficient to address the governance challenges confronting pandemic preparedness. Infectious diseases, pathogen surveillance, scientific collaboration, emergency financing, supply chains, and the development and distribution of medical countermeasures all transcend national borders. Consequently, even as countries strengthen domestic and regional capacities, the effectiveness of preparedness will depend on sustain cooperation among governments, regional organisations, multilateral institutions, financing mechanisms, scientific networks, and the private sector. Health sovereignty may reduce structural dependence, but it cannot eliminate the need for collective action.

The central question therefore shifts from sovereignty itself to governance. As authority, financing, and implementation become increasingly dispersed across national, regional, bilateral, and multilateral arrangements, preparedness depends not only on capable institutions but also on how effectively these different governance arrangements reinforce one another. In this evolving architecture, the regional level assumes a pivotal role by connecting national priorities with broader international cooperation. Regional institutions can aggregate national interests, coordinate implementation, engage bilateral partners, and strengthen participation in multilateral processes.

Viewed through this broader lens, the significance of the Accra Reset lies less in the specific reforms it proposes than in the governance questions it brings into focus. Rather than presenting sovereignty and multilateralism as competing alternatives, it suggests that stronger regional institutions can reconcile national ownership with international cooperation. Whether current reform efforts ultimately reshape global health governance remains uncertain. However, for Africa, achieving the vision of health sovereignty will depend not only on strengthening domestic and regional capacities, but also on positioning regional institutions as the principal interface through which national priorities are translated into effective engagement with bilateral and multilateral partners. Ultimately, the future of global health governance will depend not only on stronger institutions, but also on governance arrangements capable of connecting increasingly diverse actors into a coherent, equitable, and resilient system.

Nelson Aghogho Evaborhene is a PhD Fellow in International Studies at Roskilde, University and the PandemiX Centre for Interdisciplinary Study of Pandemic,Signatures, Denmark.

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