Developing and Validating a Global Governance Framework for Health: A Delphi Consensus Study

The COVID-19 pandemic exposed major deficiencies in global health governance, including fragmented authority, inequitable resource distribution, and weak compliance mechanisms. Although the WHO Pandemic Agreement (2025) addresses several of these gaps, significant operational and institutional challenges remain. This study aims to develop and empirically validate a Global Governance for Health (GGFH) Framework that strengthens leadership, financing, equity, and legal accountability across global, regional, and national levels.

A three-round Delphi study was conducted. Thirty-one experts from diverse sectors, including public health, international law, economics, environment, and diplomacy, evaluated 32 structured governance statements across seven domains. Experts rated all statements using a 7-point Likert scale. Consensus was determined using a strict threshold median ≥ 6; SD ≤ 1.35; ≥75% agreement. Open-text comments were systematically reviewed through thematic analysis. All statements were systematically mapped to the WHO Pandemic Agreement articles to identify areas lacking operational clarity or enforceability.

All seven governance domains achieved consensus by Round 3. High agreement emerged on strengthening WHO leadership, implementing sustainable and equitable financing mechanisms, embedding LMIC representation, establishing legal preparedness and capacity-building, and integrating independent accountability tools. Correlation and interdependence analyses demonstrated that governance goals form an integrated, mutually reinforcing system, with financing, equity, and legal frameworks identified as core enablers of effective treaty implementation.

The Delphi process validated a comprehensive and operational Global Governance for Health Framework. The GGFH complements the WHO Pandemic Agreement by addressing its unresolved governance, financing, and equity limitations and offers a structured roadmap to guide global pandemic preparedness and treaty implementation.