THE year 2025 served as another stress test for global health. Funding from the Global North proved increasingly unreliable, supply chains remained vulnerable to geopolitical shocks, and long-standing assumptions about global solidarity, coordination and leadership were exposed as fragile.

Yet the most important lesson was not about scarcity. It was about misalignment. Even as innovation continued to grow in the Global South, access lagged behind–revealing that the core weakness of global health lies not in scientific capacity, but in how power, priorities, and decision-making are structured. 

As the world looks ahead, the question is no longer whether the Global South can deliver fit-for-purpose health solutions. It is whether the global health system is willing to let it do so.

The implementation of the South-South Diagnostic Alliance (SSDxA) in Malaysia during 2025—a public-private partnership (PPP) aimed at improving access to affordable diagnostics—underscored a key conviction: the main hurdle is not technical capacity but accessibility. Specifically, the initiative highlighted the critical need for direct dialogue among innovators, clinicians, regulators, and end-users within endemic settings. Here, we share the vital lessons learned from the first year of the initiative's implementation.

Across Asia and other endemic regions, researchers, clinicians, and manufacturers already possess the expertise needed to develop diagnostics and therapies tailored to local realities–—an observation repeatedly reinforced through SSDxA’s engagement with regional stakeholders. What 2025 made clear is that innovation alone is insufficient when it remains filtered through top-down models that privilege Western standards, regulatory assumptions, and funding preferences. The continued reliance on ‘gold standard’ technologies–often costly, complex, and poorly suited to resource-constrained settings–has become a barrier rather than a benchmark of quality.

This structural problem is especially visible in diagnostics. While global discourse often emphasizes molecular and high-complexity tools, frontline health systems require solutions that are affordable, robust, and deployable at scale. SSDxA’s experience confirmed that when development pathways are shaped externally, access is delayed, costs rise, and local intelligence is sidelined. The insistence on replicating Western regulatory and development pathways has entrenched South-North-South collaboration models that dilute local ownership.

The lesson from 2025 is that fit-for-purpose technology must take precedence over the ‘gold-standard’ bottomless pit. 

Developing countries in the Global South offer a compelling case for why this shift is both feasible and necessary. Countries such as Thailand, Malaysia, South Korea, and Vietnam have invested heavily in diagnostics innovation, clinical research, and regulatory capacity. Regional frameworks like the ASEAN Medical Device Directive are designed to ensure safety and effectiveness while reflecting local conditions. Yet these systems remain undervalued in global health, where Western regulatory approval is still treated as the ultimate arbiter of legitimacy.

For instance, the case of gonorrhea diagnostics underscores the consequences. Recent analyses show that despite clear demand for accessible point-of-care tests, development efforts remain skewed toward technologies misaligned with the realities of endemic settings. There is little doubt that a country like Thailand could develop its own fit-for-purpose diagnostic solutions–particularly through South-South collaboration with partners such as Malaysia for innovation, Brazil for manufacturing expertise, and countries like South Africa and Zambia facing similar public health challenges. What stands in the way is not technical capability, but structural interference that SSDxA has encountered in practice.

This is where the next phase of Product Development Partnerships (PDPs) must begin. 

For decades, PDPs and public-private partnerships (PPPs) have successfully helped address market failures in global health. But the Covid-19 crisis revealed their limitations. Many have become increasingly centralized, costly, disconnected from the communities they serve.

The escalating costs inherent in the operational methods of these organizations, even for basic factors like their location, challenge their value as research funding conduits in the post-COVID era of constrained resources. This scrutiny questions their traditional significance and efficiency. 

Our experience establishing a PPP in Malaysia has already highlighted essential guiding principles. To move forward, PDPs must be reimagined as Global South-anchored platforms focused on access rather than innovation for its own sake. Their primary role should be project management and coordination–facilitating direct dialogue between innovators, clinicians, patients, manufacturers, and regulators in endemic countries. Research capacity already exists; what is missing is a mechanism to connect and align it with real-world needs. 

Governance reform is essential. Decision-making bodies but also, as importantly, expert committees, must be composed solely of representatives from endemic countries. Other stakeholders may participate as observers, but leadership must rest with those closest to the disease burden. SSDxA’s early experience suggests this is not ideological, but practical.

Equally important is a cultural change in how global health initiatives are designed. A bottom-up approach begins with listening to patients and frontline physicians. This requires restraint from institutions accustomed to acting as gatekeepers–by controlling funding, setting agendas and establishing standards for instance–must exercise restraint and display a willingness to allow local experience to drive strategy. The role of the PDP is to translate this input into structured, validated plans which are tested and refined by experts in endemic settings.

Prioritizing simplicity in initial innovation and project choices minimizes reliance on external entities and fosters self-sufficiency. Simple diagnostics development and repurposed drugs build confidence, reduce dependence on external actors, and align with the financial realities of endemic countries, thus empowering endemic countries to also share the financial burden and risk. Complexity can follow once systems are strengthened, while insisting it upfront only perpetuates technical and financial dependencies.

Regulatory alignment must also change. Development pathways should be built around local and regional regulatory frameworks, not imported wholesale from the Global North. The Asean Medical Device Directive, for instance, and similar systems are not compromises. They are fit-for-purpose solutions that reflect how health care is actually delivered. Let’s use them. 

Industrial partnerships should follow the same logic. Priority should be given to manufacturers in endemic countries or the broader Global South, particularly those open to technology transfer and long-term collaboration. Interestingly, we have learned that smaller firms in the Global North may also be valuable partners as they share similar access constraints and incentives.

Finally, strategic focus matters. Global South-led PDPs should concentrate on diagnostics and drug repurposing, since clinical research ecosystems are already strong and clinical trial capacity increasingly robust in the Global South. With few exceptions, the development of new chemical entities remains premature in many regions. Diagnostics and drug repurposing, by contrast, represent an area of immediate opportunity and impact. 

The lesson of 2025 is not that global health lacks solutions. It is that solutions are being slowed, distorted, or blocked by systems that no longer reflect reality. Moving forward requires a shift from control to collaboration, from gold standards to fit-for-purpose tools, and from gatekeeping in the Global North to leadership by the Global South.

Time and time again, the Global South has demonstrated its ability to lead. But are governments, policymakers, and global health decision-makers ready to let go of the South-North-South dependency model they continue to rely on, at times unconsciously, even as they claim to champion equity, self-reliance and local leadership?

Jean-Michel Piedagnel is the Director of the South-South Diagnostic Alliance (SSDxA) and the former Director of South-East Asia for the Drugs for Neglected Diseases initiative (DNDi).

** The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the position of Astro AWANI.