Changing roles in global health governance following COVID-19

Background: The Global Health Governance (GHG) response to the COVID-19 pandemic has been criticized, particularly regarding vaccine management, and changes in the roles of GHG actors have been recommended. Aim: To investigate the perception of experts regarding changes in the roles of different GHG actors following the COVID-19 pandemic. Methods: This study used a 3-round Delphi survey to collect data from 30 global health experts between May and December 2022. The GHG roles investigated were stewardship, production of guidelines and policies, promotion of solidarity and collaboration, and management of global health challenges. Social network analysis was performed and collected data was converted into a 1-mode network. Degree centrality and Eigenvector centrality were calculated using the UCINET 6.757 modelling programme. Results: There were variations between the current and future roles in degree centrality and eigenvector centrality for the 19 GHG actors in each of the 4 functions investigated. For stewardship, WHO, governments and the World Bank had the highest degree centrality and eigenvector centrality during both the current and future periods. In terms of production of guidelines and policies, WHO maintained the highest current and future eigenvector centralities, while research agencies, UNICEF and Gavi upheld their current eigenvector centrality measure. For the promotion of solidarity and collaboration, WHO had the highest centrality measures, followed by UNICEF, governments and Gavi. Regarding the function "management of global health challenges", WHO lost its position to UNICEF as the most central, while UNDP, FHI 360 and research agencies were predicted to have a more central role in the future. Conclusion: The findings position WHO as the current and future top actor in stewardship, production of guidelines and policies, and promoting solidarity and collaboration, and UNICEF as the upcoming most central actor in managing global health challenges. Governments were major actors in all GHG functions except for managing global health challenges. Funding actors were central in all GHG functions, indicating finance as an important factor in obtaining a central role in GHG. Research organizations received a high centrality rating, indicating their importance in GHG.