Decentralization as Decolonization: The Emerging Multipolar Order of Global Health Security

Since the 1960s, Third World Approaches to International Law (TWAIL) scholars 1 have argued that decolonization requires more than formal sovereignty; it demands equal participation by low- and middle-income countries (LMICs), particularly post-colonial states, in meaningfully shaping the rules of international order. The global health governance system, however, was largely constructed within a post-World War II order and, thus, reproduced rather than dismantled imperial hierarchies. Power and agenda-setting authority remained concentrated in former colonial states, Western hegemonic powers, and newly created international institutions that entrenched asymmetrical decision making. Over the past eight decades, global health governance has thus been disproportionately shaped by Global North actors, limiting the ability of many states to exercise meaningful agency and influence. The result has been a persistent erosion of principles of equitable global health and international law, including a core principle of participation, rooted not in the absence of legal recognition but in the centralized allocation of authority within global health institutions and organizations. 2