Global health is often imagined as a borderless project, but this paper argues that the state remains central — reshaped rather than erased by globalization. From colonial medicine to the post‑war development era and today’s philanthropic regimes, powerful nations and corporations continue to influence priorities through funding, regulation, and intellectual property. The COVID‑19 pandemic exposed this architecture: vaccine nationalism, export controls, and unequal access underscored how sovereignty and empire still structure who is protected first. Yet resistance is growing, from TRIPS patent‑waiver campaigns to regional manufacturing in the Global South. Rather than transcending the state, the challenge is to transform it into a vehicle for solidarity and equity — renewing the unfinished promise of “health for all.” Produced by Cognivault — insight, intelligence, and innovation made clear.