Health & Geopolitics

In this article about geopolitical dynamics as a determinant of future health architectures, I examine observations that understand the success of health and efforts to compensate for diseases and health crises as global events.

Introduction: The Inextricable Entanglement of Health and Power Politics

The COVID-19 pandemic exposed the illusion that health is a neutral, technocratic space beyond geopolitical interests. As the SWP report shows, major powers like the USA and China have long used global health policy as an arena of systemic rivalry – for example, through targeted control of supply chains or blockades of transparent pandemic agreements 1 3. This instrumentalization not only endangers acute crisis management but also undermines the long-term ability of societies to shape health sustainability (“Doing Future”).

The World Health Organization (WHO) estimates that 25% of the global disease burden is directly attributable to political-economic factors – proof of the urgency of geopolitical analyses in the health sector. The USA has announced plans to leave the WHO. USAID is currently unable to continue its work as usual due to a review.

Geopolitical Conflict Lines as Amplifiers of Health Risks

Pandemic Preparedness in the Shadow of Great Power Rivalry

The currently stalled negotiations on the WHO pandemic agreement illustrate how power claims paralyze global health architectures.

• Transparency clauses fail due to resistance from China and Russia, who perceive surveillance mechanisms as an infringement on sovereignty 1

• Regulations on technology transfer are blocked by the EU to protect pharmaceutical patents 4

• The USA strategically uses vaccine diplomacy to expand its influence zone in Southeast Asia 5

These blockades cement a system in which pandemic preparedness becomes hostage to short-sighted power calculations – with direct consequences: According to the Robert Koch Institute, political data blockages extend the outbreaks of new pathogens by an average of 17 days 1.

Medical Supply Chains as a Geopolitical Weapon

The COVID-19 crisis revealed the vulnerability of globalized production networks.

• China specifically reduced exports of medical protective equipment in 2020 to mask domestic supply shortfalls – an act of “sanitary realpolitik” 3

• India's export stop on AstraZeneca vaccines disproportionately affected African countries as 84% of their vaccine imports came from Indian production 5

Such dependencies transform health goods from public to strategic resources that are prioritized to national interests in the event of conflict.

Systemic Consequences for Health Cultures

Erosion of Multilateral Trust Structures

The “politicization of health” (Kickbusch) destroys collective ability to act:

• Vaccine nationalism during COVID-19 reduced the willingness to share data with the WHO by 43% 4

• Geopolitical Polarization hinders cross-border research alliances – exemplified by the stagnation of the Global Genome Initiative to Combat Antimicrobial Resistance 2

This fragmentation is reflected in local health cultures: European surveys show that 68% of citizens now view international health cooperation as an “elite project without benefit” – a breeding ground for isolationist health policies 4.

Climate Change and Health: The Geopolitical Blind Spots

Although climate change is described in the BMG strategy paper as “the greatest health threat of the 21st century,” energy policy interests block effective measures.

• Oil states prevent WHO guidelines to reduce fossil fuels

• The EU continues to subsidize factory farming, although zoonosis risks increase by 22% as a result 2

These contradictions show: without geopolitical conflict resolution mechanisms, health goals remain subordinate to economic and power-political calculations.

Fields of Action for a Viable “Doing Future”

Neurodiplomacy in Health Policy

Modern negotiation must specifically address limbic system reactions (fear, status competition).

• Trauma-Sensitive Dialogue Formats: Considering historical experiences (e.g., colonial medical crimes) in vaccination campaigns in the Global South 5

• Resource Buffering: Building strategic reserves of medical goods outside geopolitical conflict zones – analogous to the German gas reserve, which impressively documented international dependence 1. Who are our partners?

Digital Sovereignty as a Health Guarantee

The COVID-19 pandemic accelerated the digitization of the health system, yet infrastructures remain vulnerable.

• 78% of African health data is stored on European servers – a neocolonial dependency relationship 3

• China’s “Health Silk Road” (New Silk Road) strategically uses telemedicine exports to expand digital influence zones 5

A solution may lie in decentralized blockchain architectures for health data, combining national sovereignty with global interoperability.

The Paradigm Shift: From Disease Control to Conflict Prevention

Health Competence as a Peace Dividend

Investments in local health systems act as conflict prophylaxis

• Every dollar invested in primary health care saves 16 US dollars in military conflict costs (WHO estimate 2024)

• The training of community health workers in the Sahel region reduced violent land conflicts by 31% through improved food security 2

Ethical Algorithms in Resource Allocation

Artificial intelligence must balance geopolitical power asymmetries.

• Fairness Audits for Vaccine Allocation Algorithms to correct structural disadvantages of the Global South

• Predictive Analytics to identify geopolitical crisis hotspots with high zoonosis risk

Health Future as a Collective Security Project

The notion that health can be secured on a national solo effort or through technocratic expert committees is obsolete. As the 2024 Gaza conflict showed, where 92% of hospitals were destroyed by combat operations, health vulnerability and geopolitical instability are inextricably linked 5. A “Doing Future” in healthcare therefore requires …

1. Transformation of the WHO into an effective authority with binding sanction mechanisms

2. Development of hybrid financial instruments such as Pandemic Bonds, which link private capital with public health goals

3. Integration of health impact assessments in all foreign policy decisions

Only through this synthesis of realpolitik conflict analysis and visionary cooperation architecture can it be prevented that the next pandemic – or climate catastrophe – again becomes collateral damage of geopolitical power games. The alternative is a world where health degenerates into the privilege of geopolitical winners.