On World Health Day 2026, the World Health Organization (WHO) calls on people everywhere to come “Together for health. Stand with science”. In the WHO’s framing, standing with science means not only respecting evidence, but also sustaining the cooperation and trust needed for effective global health action. That is the right message. But in a more fragmented geopolitical landscape, the real question is whether governments are still willing to defend the cooperation, fairness, and institutions on which the application of global health science depends.

Global health research can save lives, strengthen resilience, and generate substantial social and economic returns. However, these gains depend on countries being willing to share knowledge, build trust, and turn evidence into collective action. This has become increasingly difficult, as global health is under pressure from geopolitical rivalry, donor fragmentation, and more transactional forms of cooperation. In such settings, science itself risks being subordinated to bargaining power: data-sharing becomes conditional, surveillance politically contested, and research partnerships more asymmetric.

The United States’ withdrawal from the WHO and the recent bilateral health deals pursued by the Trump Administration illustrate how far the transactional logic of cooperation has advanced: global health is being recast from a field of solidarity into an instrument of geopolitical leverage. The US government has signed transactional health agreements with 14 African countries, raising serious concerns about sovereignty, data control, and health security. Yet partner countries are not without agency: Zambia resisted a proposal tying health funding to access to copper and cobalt, while judicial scrutiny in Kenya stalled implementation of a health deal with the United States. Transactional deal-making not only complicates cooperation to protect global health, but also erodes the multilateral basis for effective prevention and response to pandemics, antimicrobial resistance and climate-related health risks.

This shift has direct consequences for Germany’s own global health policy. In a more transactional global health landscape, the question is no longer whether Germany supports global health, but whether it also protects the conditions under which science can function across borders: data-sharing, trusted surveillance, collaborative research, and institutions that turn evidence into action. Seen in that light, the recent review of the Federal Government’s Global Health Strategy is highly relevant. It confirms the continued importance of global health and places stronger emphasis on prevention, climate-resilient health systems, pandemic preparedness, and multilateral health governance up to 2030. At the same time, the new BMZ strategy foresees that global health will be addressed more strongly through reform of the global health architecture, division of labour with other donors, and multilateral approaches. In principle, this is the right response to an increasingly fragmented global health landscape. Germany is right to defend multilateralism at a time when trust in international cooperation is under strain, and to link health more closely to resilience, prevention, and governance. The real test, however, is one of coherence: whether this higher level of ambition is matched by credible implementation. In practice, this means three things:

First, it requires moving beyond a traditional donor role towards a more reform-oriented approach. This can be done by using Germany’s financial and political weight not simply to preserve existing institutions, but to make global health organisations that translate scientific evidence into action, such as Gavi and the Global Fund, more equitable and better coordinated. This includes stronger collaboration across these organisations in line with the Lusaka Agenda, with a clearer focus on reducing fragmentation for partner countries.

Second, it means taking scientific research on the interlinkages of environmental and human health seriously, by integrating a One Health logic into implementation that links prevention and response more consistently with climate, water, and environmental health. Otherwise, the wider ecological and social drivers of health risk, from deforestation and biodiversity loss to climate change and intensive farming, will insufficiently be addressed.

Third, there are strong reasons to preserve bilateral engagement alongside multilateral efforts, particularly in fragile contexts where local anchoring, flexibility, and political responsiveness often prove essential. This matters not only for effective implementation, but also for the trusted relationships on which data-sharing and scientific cooperation frequently depend. In this way, Germany could combine multilateral strength with local responsiveness, especially where multilateral institutions alone cannot always react quickly enough.

World Health Day 2026 carries an important political message. To stand with science means more than praising evidence. It means defending the trust, fairness, and institutions that allow science to serve the common good. At a time of growing geopolitical fragmentation, the real test is whether governments are willing to treat global health not as a bargaining chip, but as a global public good.

In March 2026, Iran closed the Strait of Hormuz in response to attacks by Israel and the USA. If this closure persists, serious consequences for the global economy are inevitable, given the strait’s importance for oil and gas transport and resulting price hikes. Less attention has been paid to date to implications for food production and food security in the Global South, especially Asia and Sub-Saharan Africa, but also Brazil. The looming problem is linked to fertiliser supply, particularly nitrogen. Nitrogen (N), phosphorus (P) and potassium (K) are essential macronutrients, with N fertilisers being most important, both globally and in Africa. Global supply chains for P and K rely on deposits in Morocco and Canada, respectively, but nitrogen fertilisers do not originate in natural deposits. Before the 20th century, sources like manure, compost, guano and Chilean saltpetre were utilised for supplying crops with nitrogen. However, these sources were limited and insufficient to cater to the needs of a growing world population.

A crucial innovation was the Haber-Bosch process (HBP), developed in the early 20th century. Today, 98% of ammonia is produced this way, which allowed for huge increases in yields. The process synthesises ammonia (NH₃) from hydrogen (H₂) and nitrogen (N₂). Whereas nitrogen is easily obtained via Direct Separation of Air, this is not feasible for hydrogen, as atmospheric concentration of H₂ is very low. Instead, steam methane reforming (SMR) dominates, processing natural gas with steam under high pressure and temperature to yield H₂ and releasing CO₂. While effective for decades, this fossil-based pathway is no longer future-proof.

Nearly all ammonia production depends on natural gas and the traditional HBP, creating two problems. First, greenhouse gas emissions from conventional N-fertiliser production have to be lowered as part of industrial decarbonisation strategies. Second, very long supply chains go from only around 500 NH₃ plants in the world, tied to gas fields or pipelines to import ports and from there to the farm gate. How vulnerable these supply chains are, can currently be observed. In addition, price fluctuations for natural gas directly affect fertiliser affordability, as seen in the early 2020s and again today.

Africa as an under-fertilised region

Global fertiliser use rose from 55 kg/ha in 1972 to 134 kg/ha in 2022, but regional differences are stark. In 2022, East Asia applied on average 321 kg/ha, Latin America 187, and the EU 124. Application rates in Sub-Saharan Africa remained extremely low at an average of 18 kg/ha, up from 10 in 1972. Data from the FAO show that Africa has the lowest food security of any world region. Causes include conflicts, disasters, climate change, and COVID-19, but low fertiliser use may add to long-term food insecurity. Poor plant nutrition reduces yields, nutritional content, and biomass for soil health. In addition, declining soil fertility may drive land expansion and deforestation.

Two African Union (AU) declarations addressed this: the Abuja Declaration (2006) set a target of 50 kg/ha by 2015, which was clearly missed. The Draft Nairobi Declaration (2024) reiterated the goal, embedding it in broader soil health strategies and referring to both mineral and organic fertilisers.

Technological innovations which may lead to local ammonia production and reduce dependency of farmers from international supply chains

A way forward may be decentralised, climate-neutral ammonia production based on electrified HBP fed by renewable energies. These solutions have achieved high technological readiness, and a first plant of this type has been implemented on an export-oriented large farm in Kenya. Research implies that these solutions may become cost competitive in a few years and contribute significantly to food security, especially in “under-fertilised” African countries.

Another technology currently being developed, though still at an early stage of readiness, is the recovery of ammonia from wastewater. This approach holds promise not only for generating ammonia but also for mitigating a growing challenge in many African countries: the eutrophication of water bodies caused by excessive nitrogen inputs into surface and groundwater, a problem exacerbated by rapid population growth.

Small-scale ammonia projects, for instance in the mode of public private partnerships, may be linked to e.g. cooperatives or rural villages. Development programmes could integrate these innovations with agricultural development and soil health initiatives, as proposed in the Nairobi Declaration. In addition, electrolysis-based ammonia is a nearly climate-neutral product, but remains difficult and potentially hazardous to handle, transport and store. This should be addressed through related programmes of capacity building, standardisation, and quality assurance.

Dr Andreas Stamm is a geographer and senior researcher in the research department “Transformation of Economic and Social Systems” of the German Institute of Development and Sustainability (IDOS).

Dr Christine Bosch is an agricultural economist and is currently a postdoctoral researcher in the Department of Social and Institutional Change in Agricultural Development at the Hans-Ruthenberg-Institute of the University of Hohenheim.

Fernanda Nan is an International Business Professional with specialisations in Law, Sustainability, Compliance -Auditing Standards, Circular Economy Agribusiness and Energy. She is guest lecturer for the seminar “Accountability, Ethics, and Governance” at Hochschule Osnabrück, Germany, and teaches “Global Sustainability Business” at the Faculty of Engineering of the University of Montevideo (UM).