A rising Asia brings to the global arena a new set of increasingly influential players with their own values, histories and strategic considerations. It remains to be seen if these shifts will lead to a clash or convergence in the management of global issues. The critical issues include Asian actors’ treatment of sovereignty, their preferences on institutional design, and conceptions of their role in global governance. Global health is fraught with a whole range of collective action problems, which we are failing to address effectively with existing institutional arrangements. This is in part because these institutions are embedded in an anachronistic world order in which Asia is governed rather than governing. Bridging this disconnect will require multiple adjustments. Existing actors involved in setting global health rules will need to adjust to take into account opportunities, constraints and perspectives from the Asian region that may have thus far been neglected. At the same time, Asian state and nonstate actors need to be engaged as co-shapers of the global order – not just in terms of material contributions to existing initiatives, but also in terms of leadership and ideas for reforming and strengthening current institutions.
Governance structures at the global level are not only shaped by state actors, but can be shaped in part by bottom-up policy processes. This is a reflection of the degree to which domestic environments allow for non-state actor participation, as well as how these local actors are connected to transnational networks and discourses.
The implementation of global rules remains dependent on local capacity and political will. As such, more donor attention (including Asian donors) could be called to the institutional weaknesses in the Asian region.
While regional organizations remain focused on maintaining stability, the FCTC experience has shown that regional distrust can be overcome in the presence of leadership and with inclusive national-level policy processes.
Emerging multipolarity threatens to deepen strategic competition between powerful and rising states, thereby further fragmenting efforts to govern global health. Such competition could be mitigated by empowering a greater range of actors in Asia with interests in advancing health needs.
Asian state and non-state actors have an opportunity to play a bigger role in reforming existing global health governance institutions. One way to facilitate this stronger governance role is to foster inclusive dialogue and constructive debate on the importance of global health governance in the region.
Sovereignty is asserted in a variety of ways across different global health issues, and policy responses should therefore be similarly diverse, tailored to the specific factors present in each context.