This short piece began as a spontaneous, from-the-heart intervention in the Emerging Voices for Global Health Google group – the kind of timely, unfiltered discussion that happens there from time to time. It was prompted by the broader ongoing conversations about “reimagining” global health, and specifically by the recent article “Global Health Governance as a Three-Body Problem” by Vinh-Kim Nguyen and Ilona Kickbusch (Geneva Policy Outlook, 26 Jan). Below you find my intervention from earlier this week.
I just stumbled on this piece from the Geneva Policy Outlook—two distinguished fellows at the Graduate Institute, no less—titled “Global Health Governance as a Three-Body Problem.” And honestly, I had to laugh. Not because it’s funny, but because it’s so perfectly Geneva: a bubble of highly paid, highly credentialed experts gazing at the world from the shores of Lake Léman, diagnosing “radical uncertainty” with physics metaphors while completely missing the actual gravitational pull that’s been warping global health for decades.
They borrow the “three-body problem” from orbital mechanics—where three celestial bodies interact chaotically, making prediction impossible—to describe climate, digital, and political transformations colliding in ways that allegedly render old governance models obsolete. Fair enough as far as analogies go. But let’s be real: the real three bodies in global health have never been climate, algorithms, and populism. They’ve always been Western hegemony, Western capital, and Western institutions—and now those bodies are wobbling because the rest of the world is no longer content to orbit quietly.
The authors fret about “technopolar” moments, fragmented sovereignty, eroded trust, and the collapse of universal values into “empty rhetoric.” They worry that the old multilateral architecture is gridlocked, that financing is drying up (cue Trump cuts), and that no single power dominates anymore. Translation: the West is losing its ability to unilaterally write the rules, and Geneva is having an existential crisis about it.
Notice what’s missing? Any serious reckoning with the Global South as an actor, not just a passive recipient of “adaptive management” and “scenario-building.” Africa barely registers except as a site where climate and epidemics will hit hardest. There’s no mention of how the pandemic treaty negotiations exposed the naked power imbalances—rich countries hoarding vaccines while preaching solidarity, or how the same institutions now wringing hands over “complexity” spent decades imposing structural adjustment that gutted African health systems.
This isn’t complexity theory; this is coping. The elegance of the three-body metaphor is that it lets the authors sound profound while dodging the simpler truth: the system was never broken by chaos—it was deliberately designed to extract, control, and contain. When the contained start pushing back (BRICS vaccine diplomacy, African states rejecting one-size-fits-all treaties, growing distrust of WHO pronouncements), suddenly everything is “non-linear” and “unpredictable.”
They call for agility, foresight, temporary alignments, narrative control. Fine words. But whose narratives? Whose foresight? The same circles that framed mpox emergencies in ways that conveniently stigmatized Africa while ignoring transmission in Europe? The same networks that pushed pandemic preparedness frameworks that look suspiciously like new conditionalities for aid?
Africa doesn’t need another Geneva prescription wrapped in systems theory jargon. We need sovereignty over our health data, our manufacturing, our regulatory decisions. We need institutions we control, not advisory boards in Switzerland telling us to be more “adaptive” while the old power centers regroup.
Read the piece if you want a masterclass in elite anxiety disguised as intellectual innovation. Me? I’ll take the radical uncertainty. At least it means the old certainties—certainties of exploitation—are finally crumbling.
One positive note, however: unlike many other (silo-ed) contributions to the “reimagining global health” debate, Nguyen and Kickbusch at least attempt a more holistic perspective, explicitly linking global health to planetary health (climate), technological developments (digital), and – most importantly – politics. That broader framing is a step in the right direction, even if the view remains firmly anchored from the shores of Lake Léman.