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The response to COVID-19 exposed a lack of African capacity to influence global health decision-making and policy. A more general recognition of limited African voice has also been reflected in reform debates within Global Health Initiatives (GHIs) as well as in more traditional sites of geopolitical power, such as the United Nations Security Council. Yet, whereas the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) was once heralded as the innovative partnerships for health, its governance structure has not kept pace with emerging global norms that advocate for greater African representation, national ownership, sustainable development and greater aid effectiveness.