Global health is facing unprecedented tensions and challenges to its legitimacy. The health-related Sustainable Development Goals and progress towards universal health coverage are off track. Multilateral cooperation suffers from the influence of geopolitical tension. The future of global health will be less aid-based. It will be more dependent on domestic financing in low- and middle-income countries. It includes fairer markets for access to health technologies. It includes digitally mediated treatment guidelines and enhanced country capabilities.