Global Health Governance as a Three-Body Problem

By Vinh-Kim Nguyen and Ilona Kickbusch

How should we think about the future of global health from our vantage point in Geneva, its purported capital? A little more than six months after the shock and brutality of the incoming Trump administration’s cuts to global health funding, it might seem that the dust is finally beginning to settle. A loose consensus has emerged that countries need to take on more responsibility for supporting the health of their populations and that new mechanisms of financing need to be developed. There is a more open debate accepting that the moral posturing of “the global” has mostly disintegrated to empty rhetoric and that universal values are hard to defend as a reference point in a multipolar world. 

Increasingly, the response has been to start rethinking the “architecture” of the very complex global health ecosystem. New organisational structures and entities, commissions and boards are proposed to unlock the organisational and political gridlock, as for example in the papers prepared for the new Wellcome Trust initiative on Rethinking Global Health. The drive to re-engineer and re-imagine is understandable and indeed necessary. It also may reflect the bias of global policymakers and pundits, those stationed in the infamous Geneva “bubble”. But it runs the risk of misreading how fundamentally the landscape has changed; that in fact there may no longer be any landscape at all, but rather a constantly shifting force-field. 

Framing Global Health Governance as a Three- Body Problem 

Contrary to the many who aim to “simplify” the system and “do more with less,” we argue for complexity. We propose to turn to physics for some answers on how to frame and approach the global health challenge. The three-body problem in physics describes the impossibility of finding a general solution for the trajectories of three gravitationally interacting bodies, because their movements create nonlinear, chaotic, and constantly shifting dynamics. When we apply this metaphor to global health, it can illuminate why governance, cooperation, and outcomes are so difficult to predict or control. The impossibility of predicting future direction and velocity of these interacting bodies is a classic mathematical conundrum that has informed the development of chaos theory. It has been popularised by Liu Cixin in his novel by the same name (made into a popular Netflix series as well as a Chinese Tencent video series). He imagines what it might be like for a civilisation to survive on a planet revolving around three suns. 

Global health governance and diplomacy must now navigate a gravitational landscape that has resulted from three powerful and distinct emerging gravitational fields – climate, digital, and political, themselves interacting with each other, generating what can only be called radical uncertainty in the years to come. 

We take this metaphor to argue that global health is currently facing a three-body problem. Global health governance and diplomacy must now navigate a gravitational landscape that has resulted from three powerful and distinct emerging gravitational fields – climate, digital, and political, themselves interacting with each other, generating what can only be called radical uncertainty in the years to come. 

The Challenge of Climate, Digital and Political Transformations 

These three transformations act like interacting gravitational fields: each has its own mass and momentum, but their pull on one another produces non-linear, hard-to-predict effects. Taken together, these driving forces or major transformations amplify and distort each other, and policy solutions in one domain can destabilise another. 

Firstly, climate transformations are warping what was once the linear historical and epidemiological narrative of health development is the inescapable reality of climate change. Its scale defies comprehension, and its effect is so strong that it is registering in the very matter of our planet, as expressed by the term Anthropocene. The accelerating and exponential effects and interactions of this gravitational force will have knock-on and unpredictable effects on health across the planet, as we are already seeing with epidemics, heatwaves, and environmental toxicity. But they already strain and stress the siloed multilateral architecture from which global health has emanated. 

In parallel, digital transformations, information technology, and the tech industry have multiplied in strength – in a few short years, we have gone from dial-up modems and the early internet to artificial intelligence. The companies that pioneered these technological innovations have become powerful oligopolies and, by many measures, richer and more powerful than many nation-states, exerting real geopolitical influence. A “technopolar” world is emerging, a form of technological feudalism where tech firms scrape our data to develop profitable algorithms ever more sophisticated in their ability to influence our beliefs and our behaviour. Polarisation, alienation, and loneliness have proliferated, amplified by social media. Tech has powerful applications for improving health and well-being, but it has become an area where highly personal data is used to generate immense profit. Tech companies seemingly operate outside of national controls through infrastructure that nations depend on, as well as algorithmic and data power. Digital sovereignty - the ability of nation states to control what happens with their citizens’ data - represents a counterforce, but remains highly fragmented. 

Today, predictable “orbits” of cooperation are elusive; instead, the system produces chaotic but bounded dynamics, much like in celestial mechanics – as when the European Union is forced to describe its uneasy relationship with China along three categories: partner, economic competitor, and systemic rival.

Finally, and perhaps most obviously, political transformations have ushered in political fragmentation. We have witnessed a radical disruption of a long historical configuration anchored around the tension between the left and the right, developed and developing countries, and donors and recipients. Today, predictable “orbits” of cooperation are elusive; instead, the system produces chaotic but bounded dynamics, much like in celestial mechanics – as when the European Union is forced to describe its uneasy relationship with China along three categories: partner, economic competitor, and systemic rival. This disruption that perhaps started with the collapse of the Soviet Union is visible everywhere today in the rise of populism, a widespread rejection of elites (whether global or national, colonial, gender-based, or racial), and the consequent breakdown in trust of science and established institutions. The traction of even the most robust global health interventions is greatly reduced. Without US hegemony, no single actor can dictate trajectories, alliances constantly shift, and even small perturbations (e.g., a pandemic, a new AI tool, a trade dispute) can disproportionally alter the system’s balance. 

Towards a Three-Body Solution  

Global health futures can no longer be modelled with linear projections; strategies will require complex systems thinking and agility in response. Most existing governance approaches do not allow this, as they remain bound in a governance gridlock incapable of making timely, effective, and coordinated decisions.

Global health futures can no longer be modelled with linear projections; strategies will require complex systems thinking and agility in response. Most existing governance approaches do not allow this, as they remain bound in a governance gridlock incapable of making timely, effective, and coordinated decisions. Global health diplomacy resembles a chaotic orbit — it must navigate many centres of gravity, often with conflicting agendas. Stable agreements are rare and temporary rather than long-term, requiring constant adjustment and course correction. The “three-body problem” metaphor shows why global health challenges will not be resolved by simple governance models. Just like in physics, the system can only be understood through approximation, simulation, and adaptive management, not fixed solutions. Stability, when achieved, is fragile and temporary, and small shifts can create large-scale, unexpected consequences. On the other hand, working towards temporary alignments that “anchor” the system, but provide no actor with stable dominance. Foresight, scenario-building, and the control of narratives will gain more importance than ever. 

About the Authors 

Vinh-Kim Nguyen is the Co-Director, Global Health Centre and Professor of Anthropology and Sociology at the Geneva Graduate Institute. 

Ilona Kickbusch is the Founder and Chair of the International Advisory Board, Global Health Centre and Distinguished Fellow at the Geneva Graduate Institute.