Academic Publication: The EU's Global Health Leadership Challenge

Abstract

ENSURED researchers Óscar Fernández and Hylke Dijkstra have published a new article in The BMJ, arguing that the EU has the potential to fill the global health leadership vacuum left by the US – but must first overcome its own internal divisions.

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We are pleased to share that ENSURED researchers Óscar Fernández and Hylke Dijkstra (both at Maastricht University) have published a new journal article in The BMJ, one of the world's leading medical journals. The article, "Global health security and pandemic preparedness: Europe's leadership challenge," draws on ENSURED research on global health and the World Health Organization's (WHO) Pandemic Agreement.

The US's effective withdrawal from the WHO and other global health initiatives has created a leadership vacuum at a moment when experts warn that the risk of a new pandemic is higher than in 2019. Fernández and Dijkstra argue that the EU is, in principle, uniquely placed to step into this role. It is the WHO's top funder, possesses considerable regulatory expertise in cross-border health threats, and – as a multilateral project itself – can offer principled support for cooperative and inclusive global health governance.

The EU's sponsorship of the WHO Pandemic Agreement, finalised in April 2025, is held up as an example of this leadership potential. Yet the article also traces in detail how the EU has repeatedly undermined its own position. In the negotiations, an overriding focus on maintaining internal EU unity came at the cost of meaningful engagement with Global South countries. The EU was widely perceived as an inflexible negotiator, prioritising commercial interests and the stringent positions of member states with powerful pharmaceutical industries over the equity and benefit-sharing provisions that many were pushing for.

The work on the Pandemic Agreement is not yet finished. The most contested element – an annex on pathogen access and benefit sharing (PABS), which would govern access to pathogen data in exchange for equitable sharing of medical products and manufacturing benefits – remains unresolved, and negotiations have been extended beyond the May 2026 World Health Assembly deadline. Without it, the agreement cannot proceed to ratification.

Fernández and Dijkstra argue that breaking this impasse requires the EU to rethink its approach to leadership. Rather than defaulting to a Commission-led, lowest-common-denominator voice, the EU could allow like-minded member states to build joint platforms with Global South partners on key issues like technology transfer and equity. It could also draw inspiration from coalitions like the High Ambition Coalition within climate governance. A more flexible, win-win disposition that prioritises shared benefit over narrow interests would both advance the Pandemic Agreement and help the EU live up to its self-proclaimed role as a champion of multilateralism.

Read the full article in The BMJ.

Check out ENSURED's research on global health.