Four decades ago, the main actors in global health were the World Health Organization (WHO), the United Nations Children's Fund (UNICEF) and the United States of America and Northern European countries (through bilateral cooperation). Today we are witnessing a proliferation of actors in this field, albeit with different roles, scope of action and levels of influence: WHO, UNICEF, the Joint United Nations Programme on HIV/AIDS (UNAIDS), UNITAID, the World Trade Organization (WTO), the World Intellectual Property Organization (WIPO), the United Nations Development Programme (UNDP), the Food and Agriculture Organization of the United Nations (FAO), the International Monetary Fund (IMF), the World Bank, the G7 and G20, G77+ China, the Non-Aligned Movement, the BRICS (Brazil, Russia, India, China, South Africa), the Global Fund, GAVI, COVAX, the pharmaceutical industry, Bill & Melinda Gates and other non-profit and for-profit foundations and nongovernmental organizations (NGOs). This research paper analyses the role of multiple actors (public, private and philanthropic) in global health and based on this, seeks to outline possible future scenarios. In particular, it examines the role of WHO, under whose auspices member countries have been negotiating for the past two years a reform of the 2005 International Health Regulations (IHR) and the possible adoption of a new international instrument to prevent and respond to future pandemics such as COVID-19. The implementation of these instruments, if adopted, would be in the hands of WHO, one of the main actors in global health.
