The Seventy-eighth World Health Assembly (WHA78), held in Geneva from May 19 to 27, 2025, marked a decisive moment in global health diplomacy. Under the theme “One World for Health”, delegates from across the globe adopted major resolutions addressing climate change, antimicrobial resistance, noncommunicable diseases, and health financing—all with long-term implications for national health systems. But perhaps most consequential was the adoption of the first-ever WHO Pandemic Agreement, designed to codify a coordinated global response to future pandemics. Notably, the United States abstained from this landmark vote, raising questions about its evolving role in global health governance. As WHA78 sets the trajectory for international collaboration on urgent health issues, this article examines the assembly’s key outcomes and what they mean for U.S. public health, policy priorities, and global standing.

Strengthening Global Health Financing

Recognizing the escalating global health financing crisis, WHA78 approved a resolution emphasizing the need to bolster health financing mechanisms. This move comes in response to a projected 40% reduction in external aid for health in 2025, coupled with rising out-of-pocket expenses and disruptions in health services worldwide. The resolution underscores the commitment to achieving universal health coverage through people-centered primary health care.

Addressing Noncommunicable Diseases

For the first time, the assembly adopted resolutions specifically targeting lung and kidney health. The lung health resolution aims to combat respiratory diseases by addressing major risk factors like air pollution and tobacco use, promoting clean air policies, and integrating strategies with broader noncommunicable disease efforts. Similarly, the kidney health resolution calls for integrating kidney care into national health strategies, emphasizing prevention, early detection, and treatment.

Advancing Climate and Health Initiatives

WHA78 adopted the Global Action Plan on Climate Change and Health for 2025–2028, marking a significant step in integrating health considerations into climate policies. The plan provides a strategic framework for developing climate-resilient, low-carbon health systems, enhancing surveillance, and protecting vulnerable populations. This initiative positions health systems as integral to climate solutions.

Combating Antimicrobial Resistance

The assembly agreed to update the Global Action Plan on Antimicrobial Resistance (AMR), aiming for a 10% reduction in global deaths associated with bacterial AMR by 2030. This decision reflects the urgent need to address the estimated 4.71 million deaths linked to bacterial AMR as of 2021. The updated plan will adopt a multisectoral One Health approach, balancing the health of people, animals, and ecosystems.

U.S. Position on the Pandemic Agreement

A notable development was the adoption of the first-ever WHO Pandemic Agreement, designed to enhance global collaboration and ensure a more equitable response to future pandemics. However, the United States chose not to participate in the vote, with Health and Human Services Secretary Robert F. Kennedy Jr. criticizing the proceedings. This abstention highlights ongoing debates within the U.S. regarding international health governance and sovereignty.

Implications for the United States

The outcomes of WHA78 have significant implications for the United States. The resolutions on health financing, noncommunicable diseases, climate change, and antimicrobial resistance align with ongoing health challenges within the U.S., such as rising healthcare costs, the burden of chronic diseases, and the impacts of climate change on health. Engagement with these global initiatives could provide frameworks and support for addressing these domestic issues.

However, the U.S.’s decision to abstain from the Pandemic Agreement vote may affect its influence in shaping future global health policies. Balancing national interests with global health responsibilities remains a critical consideration for U.S. policymakers.

A Final Note

The Seventy-eighth World Health Assembly’s resolutions and initiatives underscore the interconnectedness of global health challenges and the necessity for collaborative solutions. As health threats transcend borders, the decisions made at WHA78 will shape the global health landscape for years to come.

When President Ronald Reagan unveiled the Strategic Defense Initiative (SDI) in 1983, critics dismissed it as science fiction, labelling it “Star Wars.” Forty-two years later, President Donald Trump has launched the “Golden Dome”—a similarly ambitious national missile defence programme designed to protect the United States from the evolving threats of hypersonic weapons, space-based platforms, and nuclear proliferation. While separated by decades, these two visions share both ideological ambition and strategic anxiety, yet they differ markedly in their geopolitical backdrops, technological realism, and public reception.

Reagan’s SDI emerged during the chilliest phase of the Cold War. The Soviet Union, then at the height of its global reach, had thousands of nuclear warheads aimed at U.S. soil. Reagan’s plan was to render nuclear weapons “impotent and obsolete” through space-based lasers and kinetic interceptors. The idea was not simply to shield the U.S. homeland, but to shift the strategic balance—forcing the Soviets into an arms race they could not economically sustain. Though SDI never became fully operational, its psychological effect on Moscow was profound, with some historians crediting it as one factor that hastened the Soviet collapse.

Fast forward to 2025. Trump’s Golden Dome has been pitched not only as a shield against conventional ballistic missiles but also as a deterrent against space-based and hypersonic threats from Russia, China, North Korea, and Iran. Its scope is continental, with an initial price tag of $175 billion and long-term estimates pushing past half a trillion dollars. In contrast to SDI’s reliance on unproven space lasers, Trump’s plan leans more on deployable ground-based systems, AI-enabled sensors, and cooperation with tech giants like SpaceX and Palantir. There’s also a significant geopolitical twist—Canada, under Prime Minister Mark Carney, is reportedly in talks to join under the NORAD umbrella, extending the Golden Dome northward and deepening North American defence integration.

But while Reagan’s SDI was born in a bipolar world dominated by the U.S.-USSR rivalry, Trump’s Golden Dome takes shape in a multipolar era marked by technological rivalry, cyber threats, and non-state actors. The battlefield has expanded beyond missile silos and submarines to include satellite constellations, drone swarms, and artificial intelligence. In Reagan’s time, space was still largely a frontier. In Trump’s, it is already a domain of conflict.

Another key contrast lies in the role of narrative. Reagan’s America was animated by Cold War idealism—a belief in moral clarity and Western superiority. His communication style—deliberate, reassuring, and visionary—helped sell SDI as part of a grander struggle for freedom. Trump, on the other hand, thrives on populist urgency. The Golden Dome is framed not in idealism, but in crisis: America must be defended, the border must be sealed, the skies must be watched. It is defence as doctrine, not diplomacy.

Moreover, Reagan’s initiative drew on the traditional military-industrial complex; Trump’s seeks to fuse it with Silicon Valley. While Lockheed Martin remains a key player, the involvement of Elon Musk’s SpaceX and Peter Thiel-backed Palantir signals a blending of defence and private innovation on a scale that Reagan never envisioned. This raises questions of transparency, oversight, and the growing influence of tech oligarchs in national security strategy.

Still, for all their differences, both initiatives reflect the same instinct: that technological superiority can secure national survival. Both presidents sought not merely to match adversaries, but to outpace them—to erect a shield so advanced it would deter conflict before it begins. Yet that ambition, noble as it may seem, comes with risks. SDI led to soaring budgets and scientific dead ends; the Golden Dome could become similarly mired in delays, cost overruns, or even cyber vulnerabilities if rushed to deployment.

As the world edges closer to a new era of great power competition—no longer just between Washington and Moscow, but now including Beijing, Tehran, and Pyongyang—the need for credible deterrence is real. Whether the Golden Dome succeeds where Star Wars faltered will depend on execution, innovation, and the ability to balance ambition with accountability.

What Reagan gave the world was a bold vision that helped shift the strategic balance of the 20th century. Trump’s Golden Dome may well do the same for the 21st. But just as Reagan’s dream ended in the lab rather than in orbit, so too must Trump’s vision be measured not by headlines, but by hardware.

Cape Town became the unlikely epicenter of a quiet but consequential shift in global energy politics this April, as South Africa officially launched its G20 presidency with an ambitious rethinking of energy transition strategies. Unlike the solar and wind-centric narratives that have dominated international climate forums, this moment was defined by the reassertion of nuclear energy as an indispensable pillar of future energy systems. Spearheading this effort alongside the G20 was the International Atomic Energy Agency (IAEA), entering its second year of formal collaboration with the forum.

This partnership—first initiated under Brazil’s presidency in 2024—signals more than policy continuity. It reflects a growing international recognition that decarbonization cannot be achieved through intermittency alone, and that nuclear energy, particularly small modular reactors (SMRs), offers a resilient, dispatchable option for both industrialized and developing economies seeking sovereignty and sustainability.

Africa’s Presidency, Africa’s Priorities

South Africa’s leadership of the G20 represents not just geographic symbolism but an ideological pivot. For the first time, the G20’s clean energy narrative is being shaped by a Global South nation with both operational nuclear experience and a continent-wide view of development. Minister of Electricity and Energy Kgosientsho Ramokgopa emphasized that nuclear power is not a luxury of the elite but a strategic necessity for ensuring energy justice, energy security, and scientific progress for emerging economies.

His framing of nuclear energy as foundational for sovereignty and digital-era advancement placed the technology squarely within a developmentalist agenda—one that resonates with many African states that have begun laying nuclear groundwork in partnership with the IAEA. Egypt, for example, is building four reactors, while Ghana and Kenya are developing infrastructure with a particular focus on SMRs. These countries aren’t chasing prestige—they’re seeking stable baseload power essential for health, industry, and education.

Reframing the Nuclear Narrative: Realism Over Rhetoric

The tone of the event and subsequent discussions reflect what Ramokgopa called a “return to realism”. This pragmatism contrasts sharply with earlier decades, where nuclear energy was often sidelined due to political risk and public skepticism. Today, however, the urgency of net-zero targets and a rising distrust in overpromised renewable timelines have created space for a more balanced dialogue.

Countries like Italy and the United Arab Emirates offered telling endorsements. Italy is restructuring its domestic policy to reintroduce nuclear via advanced modular reactors and a new regulatory framework, while the UAE’s Barakah plant—already powering a quarter of the country’s electricity grid—was highlighted as a case study in successful deployment. These examples point to a geopolitical shift: nuclear energy is being reframed not just as a tool of decarbonization, but of state resilience.

Money Talks: The Cost of Clean Energy Credibility

Despite growing enthusiasm, financing remains the Achilles’ heel of nuclear deployment. This issue was addressed directly in a dedicated session on project financing, featuring input from the IAEA, International Energy Agency, and G20 country delegates. Beyond technology, the central barrier is confidence: investors need assurance that nuclear projects will be delivered on time, on budget, and with sufficient political support to weather multi-decade horizons.

This is particularly acute for developing countries, where capital costs and creditworthiness are often limiting factors. Yet SMRs offer a promising inflection point, lowering barriers to entry through modularity, smaller footprints, and potential for public–private investment structures. What’s needed now is multilateral action to create financing instruments tailored to nuclear—such as green bonds, sovereign risk insurance, and regional project consortia.

From Forum to Framework: Will the G20 Lead or Linger?

The most significant implication of the IAEA’s engagement with the G20 under South Africa’s presidency is not technical—it’s institutional. By centering nuclear energy in high-level G20 dialogues, the conversation has expanded beyond national ambition to a shared recognition that decarbonization must be inclusive, reliable, and strategically financed.

This G20 cycle could mark the beginning of a new era in which nuclear energy is normalized not only for industrial powerhouses but for emerging economies across Africa, Latin America, and Southeast Asia. Whether this momentum materializes into long-term financing and deployment frameworks remains to be seen. But South Africa’s presidency has already ensured that the question is no longer whether nuclear belongs in the energy transition, but rather how it can be equitably scaled.

A Final Note

The IAEA’s collaboration with the G20 under South Africa’s leadership is more than a policy engagement—it’s a recalibration of global energy governance. By bringing nuclear power into a broader conversation about equity, resilience, and realistic decarbonization, this partnership positions emerging economies not as passive recipients of energy aid, but as architects of their own sustainable futures. What unfolds in 2025 may well shape the contours of a more inclusive and technologically balanced energy order.