Podcast Summary: This Week in Global Development

Episode: Could Taxes Fix the Global Health Funding Crisis?

Date: October 2, 2025
Hosts: Rumbi Chakamba, Adva Saldinger, David Ainsworth
Guests: Sarah Jerving and Andrew Green (Global Health Reporters)

Overview

This episode delves into the growing funding crisis in global health, sparked by the withdrawal or reduction of international aid, particularly from the US. The hosts and guests discuss the Accra Reset—a new Africa-led vision for development financing, the planned phase-out of major health institutions like UNAIDS, the implications of the US “America First” Global Health Strategy, and whether domestic taxes—especially health taxes on harmful products—can realistically fill the funding void. The episode also previews upcoming debates at the World Health Summit and the evolving political landscape around global health agreements.

Key Discussion Points & Insights

1. The Accra Reset: Toward Country-Led Financing and Less Aid Dependence

[00:55–03:35]

• The Accra Agenda, led by Ghana’s president, was born out of an African Health Sovereignty Summit in August.

• Its vision: move from donor-driven models to country-led systems and shake up legacy “siloed” approaches.

• Focus on partnerships with the private sector and new business models, with health as a "proof of concept" that could expand to food security, climate, and more.

• Launch of a President’s Council and a high-level advisory group to steer reform and ensure sustained political support.

  “It’s not a rejection of the legacy aid system, but a recognition that after the Sustainable Development Goals expire in 2030, the world shouldn’t just come together and create a new set of goals. What the world needs … is business models and institutions and plans.”
  — Sarah Jerving [02:25]

2. The Waning Role of Global Health Institutions

[03:35–05:53]

• US policy is shifting towards bilateral (country-to-country) agreements, and away from relying on major multilateral organizations and NGOs.

• Concern over “America First” policies sidelining established health agencies and the ramifications for long-standing funding and coordination structures.

• The planned accelerated phase-out (“sunsetting”) of UNAIDS, previously scheduled for 2030, but now pushed to 2026 under new UN reforms, sparking civil society backlash.

  “With [US] money withdrawn, it’s a question of what [global health institutions] are capable of doing... If they’re not positioned within the architecture … if they’re being cut out.”
  — Andrew Green [04:30]

  “There was immediate outcry, especially from civil society...If you pull [UNAIDS] out of the conversation, you also pull NGOs out. I think there’s a real fear that [vulnerable] communities are going to be left behind.”
  — Andrew Green [05:53]

3. The “America First” Global Health Strategy and Policy Rifts

[07:10–09:26]

• The new US strategy and a related Congressional bill prioritize direct, bilateral health “compacts” with governments, potentially excluding multilateral partners like the Africa CDC.

• Diplomatic concerns from African organizations; the US clarifies it’s not an absolute exclusion but a marked shift in preference.

• Multilateral relationships may “also come into play,” but emphasis is now on government-to-government relationships.

  “Compacts would not necessarily include multilateral institutions like Africa CDC, but … we’re likely to see continued use…just a greater emphasis on the abstract relationship.”
  — Sarah Jerving [08:40]

4. Economic Case for Health & Changing Investment Narratives

[09:26–10:20]

• Growing focus on the ROI (return on investment) from health interventions: malaria and NCD (non-communicable diseases) now framed as affecting national economies and security, not just public health.

• Language has shifted away from “public good” to “this makes sense financially; this is going to keep Americans safe.”

  “Now it’s really coming to the fore…to justify [private sector] involvement, there’s a real push to focus on the money that can be saved.”
  — Andrew Green [09:57]

5. Showdown Over NCD Declaration at the UN

[10:20–14:16]

• At the UN NCD High-Level Meeting, the US (with only Argentina also objecting) unexpectedly refused to sign a widely supported NCD declaration.

• RFK Jr. represented the US, referencing abortion language (not present in the declaration) and calling for WHO reform.

• The process was upended and will require a General Assembly vote.

• Industry lobbying diluted the original draft; the most ambitious targets for health taxes on products like sugary beverages and tobacco were removed.

  “A key component…was introducing health taxes…. WHO and others … have pushed for really high taxes, and of course the industry doesn’t want them at all.”
  — Andrew Green [13:19]

6. Can Health Taxes Bridge the Funding Gap?

[15:12–18:18]

• With donor funding shrinking, health taxes (on tobacco, alcohol, sugary drinks, etc.) are touted as ways to raise domestic resources.

• Estimated to raise up to $3.7 trillion globally over the next decade (per Bloomberg-supported research), but feasibility is questioned.

• Challenges: industry pushback, weak regulatory/enforcement capacity, and the need for demonstrable impact to maintain popular and political support.

• Real-world example: Zimbabwe’s health tax not delivering promised cancer care improvements, leading to criticism and flagging support.

  “There’s been a switch … to focusing on how much money countries can make if they implement these taxes… I have to admit, I was a bit skeptical.”
  — Andrew Green [15:41]

7. The Broader Domestic Tax Challenge

[17:42–19:22]

• General reluctance to tax in many African countries, shaped by mistrust of government—people don’t see tangible services in return.

• Historic commitment: the Abuja Declaration, setting a 15% health budget target, rarely achieved due to lack of political will and competing fiscal priorities.

  “You need to have that trust … that the citizens are paying into a system they’re going to benefit from. That can be tricky.”
  — Sarah Jerving [18:18]

8. Looking Ahead: The World Health Summit & Further US Moves

[19:22–22:29]

• The upcoming World Health Summit will center on NCDs and the future of global health architecture.

• The event is Europe-centric, with strong industry presence—civil society largely absent.

• One major topic: How Europe (and other regions) will respond to US leadership retreat and funding shifts.

  “WHS is a Europe focused, industry-heavy gathering…The voices you’re missing are civil society. They’re really not very present.”
  — Andrew Green [21:44]

Notable Quotes & Memorable Moments

• On Accra Reset Vision:
  “What the world needs in this reset is…business models and institutions and plans…partnerships with the private sector are…a more appropriate way to move forward.”
  — Sarah Jerving [02:25]

• On the Decline of Multilaterals:
  “It does seem like it’s private sector and government first, and then everyone else taking a step back.”
  — Andrew Green [04:40]

• On the Loss of UNAIDS and Community Concerns:
  “If you pull them [UNAIDS, NGOs] out of the conversation…there’s a real fear that they’re going to be left behind.”
  — Andrew Green [06:12]

• On Health Taxes as Funding Solution:
  “Institutions…say countries can raise up to 3.7 trillion if they implement these taxes over the next five to ten years…I have to admit, I was a bit skeptical.”
  — Andrew Green [15:41]

• On Africa’s Tax Collection Challenges:
  “There is a really strong outcry at the suggestion of raising taxes…you need to have that trust in the government that…citizens are actually paying into a system they’re going to benefit from.”
  — Sarah Jerving [18:18]

Timestamps for Key Segments

• Accra Reset Explainer: [01:09–03:35]
• US Strategy & Shifting Roles: [04:27–05:53]
• UNAIDS Sunsetting Debate: [05:06–06:52]
• America First & Bilateralism: [07:31–09:26]
• Economic Case for Health Spending: [09:26–10:20]
• NCD Declaration Drama: [10:20–14:16]
• Challenges with Health Taxes: [15:12–17:42]
• Trust and Domestic Resource Mobilization: [17:42–19:22]
• World Health Summit Preview: [20:40–22:29]

Conclusion

This frank, behind-the-scenes discussion draws a picture of a global health financing system in flux: long-standing aid models are crumbling, political and economic imperatives are transforming how health is funded and framed, and new mechanisms—chiefly via domestic taxation—face daunting implementation hurdles. The episode closes by previewing ongoing Devex coverage and the crucial conversations still to come at the World Health Summit and beyond.