Canada’s Wise Self-Interest: Dr Orbinski on Leadership After the Rupture in Global Health

In a single year, the foundations of global health cooperation have shifted dramatically. Funding flows have been disrupted, multilateral commitments weakened, and long-standing assumptions about shared responsibility have been unsettled.  The architecture of international public health, which once appeared durable and was built over decades through cooperation, coordination, and collective investment, is now under visible strain.

At the heart of this disruption is a deeper philosophical break: the erosion of what Dr. James Orbinski describes as “wise self-interest” – the principle that protecting the welfare of others is inseparable from protecting our own long-term security and prosperity.

The weakening of global health institutions affects migration patterns, economic stability, humanitarian crises, and geopolitical credibility. When multilateral systems vacillate, countries that depend on rules-based cooperation are exposed. Yet exposure also creates opportunity: an opportunity to reaffirm the value of shared responsibility and to exercise leadership grounded in both moral conviction and strategic calculation.

It was in this context that Dr. Orbinski, a humanitarian, physician, and Principal of Massey College, delivered his keynote address at A Changed America on 27 January 2026. His remarks examined what the rupture in global health means in material and human terms, and what role Canada might play in a fragmenting international system.

The Material Consequences of a Fractured Order

During his remarks, Dr. Orbinski emphasized that the consequences of this rupture are already unfolding, deepening inequality across the world. Decisions made by great and middle powers carry consequences beyond their own borders. The erosion of multilateral commitments has material and human costs, especially for countries in the global South already confronting humanitarian crises, armed conflict, and fragile health systems.

Dr. Orbinski argued that the post-1945 international order, far from perfect, provided a framework for cooperation in health care delivery, humanitarian assistance, and human rights that remains relevant today. He reminded the audience that the International Liberal Order was the product of human choice following the Second World War. It represented an unprecedented attempt to organize global cooperation around the pursuit of the public good.

Central to this architecture was the principle of wise self-interest, which highlights humanity’s interdependence. Taking care of others’ welfare is not merely an ethical gesture; it is the most effective way to safeguard one’s own long-term security and prosperity. As Dr. Orbinski put it: “It is wise self-interest to care about the welfare of others.”

For resourceful and powerful states, concern for vulnerable populations is both moral and practical. By supporting those most at risk, states help create global health conditions that reduce the spread of disease, prevent humanitarian crises, and ultimately protect their own populations from those same threats.

What the Post-1945 Order Achieved

Dr. Orbinski acknowledged the imperfections of the post-1945 international system while emphasizing its achievements. Despite its limitations, it delivered measurable progress in global health: reductions in child and maternal mortality, advances in disease eradication, and improved access to treatment for conditions such as malaria, tuberculosis (TB), and HIV.

Institutions like the World Health Organization (WHO) – the United Nations’ lead agency on global health – played a central coordinating role. The fund-based structure of global health governance, alongside humanitarian organizations within and beyond the UN system, established frameworks that supported vulnerable populations, particularly women and children.

The United States was a central pillar of this system, accounting for roughly 40 percent of global health spending. Its contributions supported humanitarian care, epidemic response, vaccine distribution, nutrition programs, and assistance for marginalized communities. Over time, American leadership shaped global health priorities and strengthened international coordination.

However, Dr. Orbinski argued that recent U.S. funding cuts have dismantled core elements of this architecture. He described the approach as executed “with coldness, callousness, and the capricious use of power… with complete disregard for any sense of the good, any sense of our collective responsibility for each other, and a complete disregard for a standard public health principle.” The result, he shared, is a rapid erosion of multilateral commitments with immediate material and human consequences.

The Human Cost of Withdrawal

Under the “America First” approach, global health funding has been abruptly reduced. Preventable and treatable diseases – including TB, HIV, pneumonia, childhood diarrhea, and malaria – are again claiming lives at alarming rates in vulnerable regions.

Beyond mortality, funding cuts have destabilized critical scientific and training institutions such as the Centers for Disease Control and Prevention (CDC) and the Fogarty International Center. These institutions have trained health professionals worldwide, strengthened epidemiological expertise, supported surveillance systems, and built research capacity. Their work has produced benefits far beyond U.S. borders.

According to Dr. Orbinski, dismantling such structures can occur quickly. Rebuilding them – along with the trust and institutional knowledge they embody – could take at least a generation. The erosion of global health capacity is therefore a structural weakening of global resilience.

Canada’s Exposure – and Opportunity

It is within this context that Dr. Orbinski turned to Canada’s potential role. As a middle power, Canada has long depended on functioning international institutions and shared rules to exercise influence. Therefore, when those rules weaken, Canada’s strategic environment becomes more volatile. Yet rather than presenting this exposure as a vulnerability alone, Dr. Orbinski described it as an opportunity.

Drawing on the principle of wise self-interest, he argued that Canada has historically demonstrated a lower tolerance for extreme inequity than its closest neighbour. This has shaped its international reputation and enhanced its credibility in moments of crisis. In a fragmented system where major powers tend to retreat inward, middle powers must step forward to sustain cooperation.

Two Paths to Leadership

Dr. Orbinski outlined two complementary avenues for Canadian leadership in global health and humanitarian action.

The first is values-based. Canada can reaffirm its humanitarian tradition by recognizing that in an interconnected world, responsibility extends beyond borders. Therefore, relieving suffering elsewhere protects shared human dignity and strengthens global stability.

The second is pragmatic. Canada has long been regarded as a reliable and constructive partner in multilateral cooperation. Canada can translate its values into measurable impact by strengthening partnerships and investing strategically in effective coordination mechanisms.

These approaches are mutually reinforcing. While moral clarity without institutional competence is insufficient, institutional investment without an ethical foundation lacks legitimacy. Together, they position Canada as a steady and principled actor at a time when such leadership is needed.

Strategic Priorities

While acknowledging that Canada cannot replace the United States, Dr. Orbinski emphasized that leadership must be grounded in realism. Strategic focus, institutional competence, and resource discipline are essential.

First, he identified vaccine development and distribution as a priority area in which Canada already has scientific and technological capacity. Second, he argued that Canada could develop a clear policy to support essential humanitarian structures, such as the United Nations Office for the Coordination of Humanitarian Affairs (OCHA). Reform of global health and humanitarian governance must also address the need to strengthen funding mechanisms and their management.

Leadership After the Rupture

Dr. Orbinski was clear: there is no return to the world as it was. This is not a moment for mourning or nostalgia. It is a moment for renewal. Leadership in global health today requires vision, strategic clarity, disciplined thinking, partnership, and respect for human dignity. For Canada, acting in its wise self-interest means recognizing that protecting lives elsewhere is inseparable from protecting its own long-term security and prosperity.

In a fragmenting international system, the principle that once sustained global health cooperation remains true: caring for others is a shared human effort and a strategy. And for middle powers such as Canada, a strategy grounded in wise self-interest may be the most credible path forward.