Renewing multilateralism through health agenda: Brazil’s 2025 BRICS Chairship

Background

Many of the current global geopolitical trends in 2025 repeatedly exposed the limitations of traditional multilateralism to deliver effective, timely, and equitable responses to cross-border challenges [1]. Mid and late XX centuries’ institutions – including the United Nations, the World Health Organization (WHO), and a range of Bretton Woods structures – have struggled to adapt to the rising complexity of global risks and increasing demands for inclusion and equity from the Global South [2]. The struggle to promptly respond to new threats has been particularly evident in public health governance: from the response to the COVID-19 pandemic and enduring vaccine access inequity, to insufficient progress on tackling social determinants of health, to emergencies triggered by conflict or environmental disasters. Against this backdrop, the credibility of a North-centric, hierarchical governance has diminished, creating space for new alternatives coming from different actors [3].

It is within this context that BRICS countries emerge as a pivotal force for renewing multilateralism. By placing the priorities of emerging economies at the center, BRICS can address many of the main global challenges through a new approach. The bloc’s mechanisms and institutions are progressively gaining depth and operational capacity, and an irrefutable relevance in today’s geopolitical landscape.

The Brazilian chairship of BRICS in 2025, under the leadership of President Luiz Inácio Lula da Silva, achieved its mission to bring to light many global challenges. Under the theme of “Strengthening Global South Cooperation for More Inclusive and Sustainable Governance”, Brazil has positioned health not merely as a technical agenda, but as one of the best displays of the bloc’s ability to deliver practical, measurable results to address those challenges.

In the next section, this policy perspective paper will explore most of the key challenges the Brazilian chairship has chosen as priorities at the BRICS health track in 2025, also mentioning the main results each working group achieved, pointing a clear direction for BRICS countries to enhance cooperation and solving common issues.

The Brazilian chairship’s health agenda links innovation, equity, and cooperation through a set of interdependent priorities. The following sections present the key health priorities advanced under Brazil’s 2025 BRICS chairship. Each priority illustrates how the bloc is translating political commitment into practical cooperation that strengthens public health systems and promotes technological sovereignty. The paper first examines the Partnership for the Elimination of Socially Determined Diseases (SDDs), a landmark initiative linking health equity and sustainable development. It then explores progress in regulatory convergence among medical product authorities and innovations in digital health and artificial intelligence, which support more inclusive access to care. Subsequent sections highlight collaborative work through the Network of National Public Health Institutes (NPHIs), the BRICS Tuberculosis (TB) Research Network, and the Vaccine Research and Development (R&D) Center, followed by emerging areas such as nuclear medicine and the BRICS Health Journal as a platform for science diplomacy. Together, these initiatives demonstrate how BRICS countries are building a shared architecture for health cooperation that reinforces multilateralism and advances global health equity.

Partnership for the Elimination of SDDs

BRICS members marked a major milestone during Brazil’s 2025 chairship with the creation and launching of the Partnership for the Elimination of SDDs. Founded on the understanding that health inequalities are rooted in inequity, deprivation, and structural barriers, the Partnership was designed to mobilize the accumulated expertise of BRICS countries toward cooperation. Its five pillars (systems strengthening, intersectoral action, innovation, sustainable finance, and global advocacy) represent a multisectoral approach, strongly rooted in the Rio Political Declaration on Social Determinants of Health from 2011^1,2.

For Brazil, one of the objectives of the Partnership is to advance international recognition and implementation of the concept of socially determined diseases. Through this lens, the BRICS initiative underscores the intrinsic link between public health progress and broader socioeconomic development.

The idea of the Partnership is deeply rooted in the Brazilian experience on the Healthy Brazil: “Unity to Care” (In Portuguese: Brasil Saudável: “Unir para Cuidar”) program, established in February 2024³. It is the world’s first national initiative dedicated to eliminating eleven diseases and five vertical-transmission infections as public health problems by 2030. Coordinated by the Ministry of Health alongside thirteen other ministries, it acknowledges that diseases such as tuberculosis, leprosy, malaria, human immunodeficiency virus/acquired immunodeficiency syndrome, and viral hepatitis are rooted in social determinants including poverty, inadequate sanitation, and racial and territorial inequalities. Guided by five strategic directives – combating hunger and poverty, reducing inequities, empowering health workers and civil society, fostering science and innovation, and expanding sanitation infrastructure – the program achieved impressive milestones during its first year, such as the WHO certification of lymphatic filariasis elimination and a 30 percent rise in preventive tuberculosis treatment.

The Brasil Saudável program shows that it is possible to approach public health as a combination of health promotion through, disease prevention, treatment, and rehabilitation with the guarantee of access to safe drinking water, basic sanitation, adequate nutrition, quality education, decent housing, and opportunities for work and income.

In Brazil, income, education, gender, race, and territory are not merely abstract social determinants, they are concrete vectors that shape the processes of illness and death. Therefore, the goal of the partnership is to address SDDs through an intersectoral approach that is people-centered and attentive to racial, territorial, and gender inequalities.

Until the end of 2025, it is expected that the partnership will have developed its joint roadmap to 2030, which will contain operational guidelines for integrating initiatives into universal health coverage, pilot projects for local, community-based elimination of target diseases. Nevertheless, countries will retain full autonomy to choose their levels of participation based on national priorities and capacities, ensuring broad flexibility and voluntariness of any actions taken under the Partnership⁴.

This initiative represents progress in strengthening South-South cooperation and amplifying collective influence in global health governance, particularly in the lead-up to the High-Level Dialogue on Social Determinants of Health at the United Nations General Assembly in 2025.

Harmonization of medical product regulatory authorities

BRICS members are also deeply involved in advancing voluntary regulatory convergence through the BRICS Medical Products Regulatory Authorities initiative. Building on a revised memorandum of understanding to include new members, the bloc convened thematic online seminars with special focus on technical capacity and trust-building, notably led by the Brazilian Health Regulatory Agency (In Portuguese: Agência Nacional de Vigilância Sanitária, ANVISA).

This memorandum of understanding – signed by the original five member countries’ regulatory authorities: ANVISA (Brazil), the Ministry of Health and Federal Service for Surveillance in Healthcare (Russia), the Central Drugs Standard Control Organisation (India), the National Medical Products Administration (China), and the South African Health Products Regulatory Authority (South Africa) – is a strategic framework, which began negotiations in 2019 during the 5th Meeting of Health Regulatory Authorities in Brasília. It establishes concrete mechanisms for technical cooperation including information sharing on regulatory processes, exchange of good reliance practices, support for quality and safety initiatives, collaboration in multi-country clinical trials, and joint efforts to combat substandard and falsified medical products.

By positioning the memorandum of understanding as a common ground among all BRICS members, Brazil is stressing that regulatory harmonization is essential for realizing the bloc’s vision of enhanced pharmaceutical sovereignty and equitable access to health technologies⁵. During the Meeting of BRICS Medical Products Regulatory Authorities in June 2025, attended by representatives from both original and new member countries, Brazil orchestrated discussions on revising and expanding the existing framework to accommodate new regulatory systems and updated institutional arrangements⁶.

During Brazil’s 2025 chairship, BRICS countries reaffirmed their commitment to strengthen collaboration among their regulatory authorities. They agreed to focus on practical, forward-looking initiatives. The main areas identified include:

• information sharing and reliance practices;
• multicountry and international clinical trials;
• combatting substandard and falsified medical products;
• joint training programs and technical workshops; and
• exchange of regulatory officers and reviewers.

Under this priority, members agreed to create a working group to organize thematic seminars, coordinate reviewer exchanges, and support joint assessments and capacity-building. They also expressed interest in developing a BRICS-wide training calendar to align schedules and resources. In parallel, countries will expand information sharing and strengthen coordination with WHO collaborating centers and other international partners to follow recognized best practices⁷.

Infrastructure for specialized care in remote areas

The technological infrastructure for specialized care in remote and hard-to-reach areas represents one of the most innovative dimensions of Brazil’s chairship, acknowledging the importance of Internet of Things, artificial intelligence, big data analytics, and telemedicine to deliver intelligent, sustainable, and resilient healthcare solutions.

Through a series of structured working group meetings coordinated by the Brazilian Ministry of Health, BRICS countries have engaged in extensive dialogue on overcoming geographical barriers that disproportionately affect rural, indigenous, and vulnerable populations across member nations. This year, the agenda specifically addresses the dual challenge of expanding access to high-complexity treatments while strengthening local technological development capacities, aligning with Brazil’s National Strategy for Digital Health 2020-2028 and complementary programs including the Unified Health System (In Portuguese: Sistema Único de Saúde, SUS) Digital, the National Health Data Network (In Portuguese: Rede Nacional de Dados em Saúde, RNDS), and Telehealth initiatives.

This theme was also prioritized during this year considering BRICS countries share a range of public health challenges regarding specialized care, despite their different socio-economic and cultural realities, including areas with high population density or remote and hard-to-reach locations, inequities in access to health services, and quality issues, which primarily affect rural, indigenous, and low-income populations [4][5]. These issues limit the impact of health policies, resulting in significant inequalities in life expectancy and quality of life. As discussions were developed, intelligent, sustainable and resilient hospitals were identified as a key interest to all countries. In this sense, BRICS members produced a summary report and action recommendations, emphasizing localized technology integration; social and environmental sustainability; staff training for digital health tools; and collaborative knowledge sharing to accelerate adoption of these solutions throughout the BRICS and partner countries⁸.

Public health institutes and research networks

The establishment of the BRICS Network of Research in Public Health and Health Systems and the BRICS Network of National Public Health Institutes both represent a groundbreaking institutionalization of multilateral health cooperation under Brazil’s chairship. The first one was built upon Russia’s foundational work in September 2024 with the First BRICS Experts Meeting on Public Health, while the latter was heavily based on Oswaldo Cruz Foundation’s (FIOCRUZ) expertise from organizing the successful G20 NPHIs Conference in 2024.

The objective of the Network of National Public Health Institutes is to foster cooperation and mutual support in public health, including the analysis of the health systems of the BRICS countries. The consolidation of a structured Work Program to implement research, training, and technical cooperation actions is one of the main results of the Network’s work in 2025.

The Conference held in Rio de Janeiro from September 15–17, 2025, marked the first time BRICS convened national public health institutes to coordinate their activities in supporting bloc-wide health objectives, addressing the previous fragmentation of health initiatives across different networks.

The operational framework the Brazilian chairship intends to reach consensus promotes integration between scientific evidence generation and policy implementation. NPHIs would be recognized as indispensable institutions that generate scientific evidence to inform public policies and actions for the protection and improvement of population health. The Conference was structured discussions around six strategic themes related to the health track as a whole: health surveillance and emergency response, strengthening national health systems, social determinants of health addressing inequities, and climate change and health equity as a pathway to the 2025 United Nations Climate Change Conference, and combating hunger and poverty.

BRICS members agreed to form a working group on regulatory cooperation. This group will organize thematic seminars, coordinate reviewer exchanges, and support joint assessments and capacity-building. Brazil also plans to create a BRICS-wide calendar to align activities and share expertise. In addition, countries should expand information sharing and strengthen collaboration with WHO collaborating centers and other international partners to apply global best practices. The Brazilian chairship’s success in establishing this Network hopes to create a replicable model for multilateral cooperation that addresses structural asymmetries through evidence-based policy coordination and capacity-building initiatives tailored to Global South contexts⁹.

Artificial intelligence and data governance in health

Artificial intelligence (AI) and health data governance form one of the most strategic priorities of Brazil’s 2025 BRICS chairship. This agenda builds on the Ministry of Health’s pioneering work through the Secretariat of Information and Digital Health (In Portuguese: Secretaria de Informação e Saúde Digital, SEIDIGI), created in January 2023 as one of the first ministerial departments in the world dedicated to health digitalization. Brazil hosts the Technical Meeting on Health Data Governance to position itself as a reference point within BRICS for discussions on data policy, regulation, security, and interoperability. The country brings strong experience to this dialogue through the SUS Digital Program, which connects all 5,564 municipalities, and the RNDS, which manages health data nationwide¹⁰.

The operational framework developed through Brazil’s BRICS AI Working Group directly mirrors the Ministry of Health’s approach to digital health: digital health culture and permanent education, technological solutions and digital health services, and interoperability with data analysis and information dissemination. Brazil’s experience with the largest universal health system globally provides unique insights for BRICS cooperation in AI applications for health system management, epidemiological surveillance, precision medicine, and emergency response capabilities.

Brazil’s AI implementations have achieved measurable improvements in diagnostic accuracy, resource optimization, and access equity, particularly through telemedicine platforms that enable specialist consultations across continental distances and the My Digital SUS (In Portuguese: Meu SUS Digital) application providing integrated patient data access. The Ministry of Health’s commitment to ethical AI development, aligned with best practices for transparent algorithms, robust data protection, social participation, continuous impact evaluation, and professional capacity-building, inspires the chairship to bring discussions on responsible AI governance frameworks and learn even more from other member countries¹¹.

Tuberculosis Research Network

The BRICS TB Research Network is one of the most strategic and mature initiatives under Brazil’s 2025 chairship. It builds on the network created in 2017 after the Xiamen Declaration. The initiative responds to a critical reality: BRICS countries together account for more than 40% of the global tuberculosis burden, 40% of TB-related deaths, and at least half of all multidrug-resistant and rifampicin-resistant TB cases worldwide [6].

Brazil’s leadership of the 18th BRICS TB Research Network Meeting in Brasília, demonstrated the country’s domestic expertise through its National TB Research Strategy. The BRICS network’s comprehensive agenda encompasses four critical thematic areas – vaccines and prevention, diagnostics, therapeutics, and public health implementation – with specific emphasis on developing innovative point-of-care diagnostics, safer and shorter treatment regimens, effective pre- and post-exposure vaccines, and digital health tools integrated with artificial intelligence for enhanced TB care and monitoring¹².

Brazil’s 2025 chairship prioritized advancing the network’s 2025-2029 strategic framework through structured discussions on resource mobilization strategies, with particular emphasis on engaging multilateral financial institutions.

The Declaration emerging from the May 2025 meeting aims to establish concrete commitments to develop new vaccines and conduct Phase III clinical trials across BRICS countries. The network’s evolution an innovation hub for TB technologies puts BRICS countries in a strategic position, with the potential to influence global TB control strategies through collaborative research platforms that address the broader social and economic determinants driving the TB epidemic across emerging economies.

As the network figures between the most established priorities in the BRICS Health track, it promptly highlights the need for strengthened international cooperation, sustainable financing, and coordinated regulatory efforts. During this year, members acknowledged the urgency of addressing underinvestment in TB research through the mobilization of financially strong institutions, multilateral bodies, and the private sector, advocating for long-term investment strategies¹³.

BRICS Vaccine R&D Center

The BRICS Vaccine R&D Center is one of the initiatives carried out by the member’s research institutes and companies. The Center is in position to combine efforts and strengthen cooperation in the development and distribution of vaccines and the creation of lines of anti-epidemic defense.

While the Center’s initial research priorities included selection of platforms for accelerated vaccine development and identification of primary vaccination goals for the BRICS countries based on national and global priorities, the Russian presidency in 2024 outlined an ambitious goal: the creation of the Electronic R&D Stock.

This R&D Stock would be a network between the members’ vaccine research and development stakeholders, where information regarding products could be shared to identify potential cooperation opportunities.

In this context, the Brazilian chairship chose to go ahead with the Russian proposal and is focusing efforts into converting this idea into reality. So far, the BRICS Health Ministers XV Meeting Declaration has reaffirmed the political support for the BRICS Vaccine R&D Center activities, while the Brazilian chairship confirmed that it would take into consideration all proposed initiatives aimed at strengthening the BRICS Vaccine R&D Center, such as the Electronic R&D Stock initiative.

During the second semester of 2025, monthly meetings have been held regarding the Vaccine R&D Stock, mainly focused in creating an institutionalized viable space for information sharing between members. Of course, the many variables on this matter are much more than could be possible to accommodate in a few months of work. But not only does the Brazilian chairship rests assured of every members willingness to go forward on this initiative but also trusts that this will be a continued effort throughout following presidencies¹⁴.

Nuclear medicine

Nuclear medicine has emerged as one of the key areas of cooperation among BRICS countries, particularly following the establishment of the BRICS Nuclear Medicine Working Group during the Johannesburg Summit in 2023. The group consolidated an initiative to strengthen collaboration among member countries in developing nuclear technologies applied to healthcare, aligning with the objective of building more inclusive and sustainable governance among Global South countries.

The First International BRICS Forum on Nuclear Medicine, held in Saint Petersburg on June 20–21, 2024, brought together over specialists from all member countries and established important guidelines for future cooperation, focusing on four main objectives: mapping installed capacities and existing gaps among BRICS countries; identifying best practices for production, control, and distribution of radiopharmaceuticals; stimulating the creation of regional centers of excellence and technical training centers; and proposing common funds to support innovation and collaborative clinical trials.

BRICS countries present different stages of development in nuclear medicine, creating significant opportunities for technology transfer and expertise sharing. Brazil maintains considerable infrastructure on the matter. Russia significantly expanded its radionuclide therapy capacity since 2010, while Iran has consolidated as one of the world’s top three radiopharmaceutical producers, manufacturing approximately 70 different types and exporting to 15 countries. Also, Indonesia is building its own industrial complex for nuclear medicine products.

The prospects for nuclear medicine cooperation within BRICS are promising, especially considering the complementarities among member countries and the political commitment established in the 2024 Health Ministers’ Declaration. Regulatory cooperation emerges as a fundamental element for discussion, considering that Brazil has legislation for radiopharmaceutical registration and production by industrial pharmacies; India uses the Radiopharmaceutical Committee of the Atomic Energy Regulatory Board; Russia allows in-house production within national specific regulation; and Indonesia adheres to the Pharmaceutical Inspection Cooperation Scheme. The XV BRICS Health Ministers’ Declaration of 2025 further reinforces this commitment by acknowledging the need for cooperation in nuclear medicine and radiopharmacy within the BRICS Nuclear Medicine Working Group framework.

BRICS Health Journal

The BRICS Health Journal plays a central role in strengthening scientific collaboration among member countries and amplifying the collective voice of the Global South in global health research. By promoting peer-reviewed studies across disciplines, the journal supports the production and circulation of scientific knowledge that reflects the realities and priorities of BRICS nations. It serves as a bridge between health research, policy, and practice, enabling the translation of evidence into concrete action that improves population health outcomes.

Beyond its scientific function, the journal represents a practical instrument of science diplomacy. It creates a shared space where researchers, policymakers, and institutions can engage in dialogue, exchange data, and jointly define research agendas. Through this collaborative platform, BRICS countries demonstrate their ability to generate knowledge that not only meets national needs but also contributes to solving global challenges. The journal embodies a cooperative approach to innovation – one that values equity, inclusiveness, and mutual learning.

During Brazil’s 2025 chairship, strengthening the BRICS Health Journal proved to be a very fruitful asset. Efforts focused on expanding its reach, improving its visibility and indexing, and encouraging submissions that document joint projects, comparative analyses, and regional innovations. These actions aim to position the journal as a reference for evidence-based policymaking and as a tool to connect health diplomacy with scientific progress.

In the long term, the BRICS Health Journal has the potential to shape global health governance by showcasing how South–South cooperation can generate solutions with worldwide relevance. By giving visibility to shared research and by fostering scientific independence, the journal helps balance the global flow of knowledge and reinforces the idea that science – when collaborative and open – can be a foundation for solidarity, resilience, and health for all on a planetary scale.

Final remarks

In a challenging global context marked by overlapping crises that have not spared the health sector, such as security threats, political instability, and the constant attacks suffered by multilateralism, cooperation among our countries becomes desirable and indispensable.

The Brazilian chairship of BRICS has advanced a health agenda aimed at aligning technical cooperation with the political commitment to health equity and capacity-building. The formal launch of the Partnership for the Elimination of Socially Determined Diseases at the BRICS Leaders’ Meeting, thereby reaching the highest political level of the bloc, represents a source of great satisfaction as it reflects the recognition of health’s strategic role as both a driver of sustainable development and a means of reducing inequalities.

The momentum generated by the July Summit provides a critical foundation for advancing a set of high-priority initiatives before the conclusion of the Brazilian chairship. The Partnership on SDDs will be further consolidated through the development of a roadmap, while the BRICS Vaccine R&D Center seeks to broaden its portfolio by establishing an Electronic R&D Stock and fostering deeper cooperation among participating members.

In September of 2025, the in-person conference of NPHIs constituted a significant milestone by creating a structured platform for knowledge exchange. This forum is designed to strengthen both policy formulation and technical capacity for responding to emerging health challenges. Concurrently, efforts in digital health and artificial intelligence are being expanded, with member states prioritizing regulatory harmonization of digital products, as well as AI-driven applications in clinical and public health contexts, and capacity-building in data governance and cyber resilience. The establishment of a dedicated working group in this domain is anticipated to further institutionalize these efforts.

The integration of new members and partners from the Global South, several of whom formally joined or deepened their association in 2025, represents an important dimension of the BRICS expansion. Their participation introduces diverse perspectives and localized priorities, thereby reinforcing the responsiveness, inclusivity, and global representativeness of ongoing and future initiatives.

In conclusion, Brazil’s 2025 BRICS chairship health agenda articulate and concretely advances a renewed approach to multilateralism. The results of each priority, particularly the launching of the Partnership for the Elimination of SDDs, exemplify how an ambitious, integrated agenda can transform multilateral rhetoric into actionable outcomes. With robust political will, cross-sectoral leadership, and steadfast investment, BRICS countries are devoted to set the example for the Global South’s protagonism on the world stage.

In line with the theme of the Brazilian chairship “Strengthening Global South Cooperation for More Inclusive and Sustainable Governance”, it is important to highlight the need to reinforce the WHO as the legitimate specialized agency within the multilateral system for coordinating global health. To fulfill its mandate, the WHO requires our commitment to provide predictable, adequate, and sustainable financing. BRICS support for the Organization, by fostering cooperation among countries to ensure equitable access to essential health technologies and services, holds the potential to decisively contribute to enabling all people to attain the highest possible standard of health.

The work carried out under the Brazilian chairship throughout this year has gone beyond Brazil’s national priorities, it reflects a collective vision: that of a cohesive, forward-looking BRICS, committed to the structural transformation of health systems. A BRICS that leads by example that chooses cooperation over competition, and that places human dignity at the center of its decisions and commitments.