The present moment is the most difficult period for global health and development since the year 2000. Official development assistance (ODA) for 2025 has fallen by 23%, the steepest annual decline on record. The OECD's forecast in 2025, already grim in projecting a drop of 9% to 17%, has been overtaken by a reality more severe than the worst-case scenario.

Against this backdrop, the Tsinghua Global Development and Health Communication Centre (GDHCC) and Caixin Media co-hosted a roundtable entitled "Weather the winter: the causes of global health and development at a crossroads" during the second Caixin London Atlantic Dialogue last week. Experts from the International Committee of the Red Cross, the London School of Hygiene & Tropical Medicine, the Malaria Consortium and Tsinghua University took part, offering their observations and recommendations for navigating a deepening winter in global health and development.

The year 2025 also marks the first time this century that the number of deaths of children under five has risen – from 4.6 million to 4.8 million. Meanwhile, 720 million people are living in hunger. Famine, a word many hoped had been consigned to history, has re-emerged in Gaza and Sudan. Beyond this, 2.6 billion people worldwide still lack access to the internet, a widening digital divide that deepens global inequality.

Even at such a crossroads, investment in public health and development remains one of the most rewarding investments, as the panel widely agreed. This investment is considered not only for its short-term economic returns but for its medium- and long-term social impact. History shows that investment in global health can yield extraordinary human welfare progress. Several milestones warrant recollection: smallpox was eradicated in 1980, an achievement that has since prevented at least 60 million deaths at no further cost; polio has been reduced by over 99.9% since 1988, when an estimated 350,000 new cases occurred each year; in 1990 more than 12 million children under five died each year, a figure that has now fallen below five million – a decline of 60%. Since 2002, the Global Fund to Fight AIDS, tuberculosis and malaria has helped save more than 65 million lives. Gavi, the Vaccine Alliance, has immunized over one billion children in lower-income countries since 2000, preventing an estimated 17 million future deaths. These figures underscore what global solidarity can deliver.

Amid geopolitical uncertainties, the question of how to sustain public health investments is inseparable from the broader effort to build a shared world of health and achieve the Sustainable Development Goals. The panel addressed global health financing, public health resilience and the infodemic.

Professor Zhou Qing'an, director of the GDHCC, joined as a guest speaker. He observed that artificial intelligence is profoundly transforming the ways content is produced, disseminated and risk-managed, with a growing number of media outlets and institutions pursuing integrated operations that span data collection, precision dissemination and risk control. He also stressed that the development of artificial intelligence brings accompanying risks, including the spread of misinformation and the erosion of public trust, and noted that the "infodemic" has become a major challenge in global health governance. During the discussion, Professor Zhou introduced the centre's concept of "Global Public Goods for Information," arguing that only a sustainable and reliable mechanism for information production and sharing can provide long-term support for international cooperation and public trust.

The other panelists offered their own reflections on global health and development from a range of perspectives. Philip Spoerri, director of the ICRC London Office, drew on extensive experience in international humanitarian operations to underscore the critical importance of political will in sustaining public health services and international cooperation in the midst of global conflicts and crises. Janet Seeley, professor at the London School of Hygiene & Tropical Medicine, highlighted the ways in which scientific innovation accelerates infectious disease control and the significance of trust in healthcare institutions and medical workers for strengthening health resilience. Tarekegn Abeku, principal advisor at the Malaria Consortium, brought practical experience and specific data from malaria prevention and grassroots public health projects across Africa to examine the interplay among global health financing, disease control, and the development of community health systems.

The panelists emphasized that stronger political commitment, enhanced information sharing and deeper international cooperation are key directions for future global health governance. China serves as a notable example of international collaboration in addressing major global health challenges. The country has not only eliminated polio and malaria within its own borders, but has also committed to supporting other developing countries, particularly in Africa, to eliminate major infectious diseases and to help build a healthier world for all. Almost at the same time, African leaders, meeting at the World Health Summit Regional Meeting in Nairobi from April 27 to 29, declared that two decades of reliance on foreign health aid must come to an end, prompted by a steep decline in global health funding. While Africa bears over 25% of the global disease burden, it accounts for less than 3% of health expenditure. African nations are now pushing to strengthen domestic health financing.

"If winter comes, can spring be far behind?" The world can be confident that the spring of global health and development, too, is drawing near.