Some 75 years after the World Health Organization (WHO) was created to serve as the directing and coordinating authority in international health, the global health institutional architecture has become increasingly fragmented, confused, and inefficient. Many of the organisations, agencies and platforms have overlapping or closely aligned mandates, and operate in direct competition with each other for funding. COVID-19 has revealed many of the weaknesses of this system, but it also creates an opportunity to initiate once-in-a-generation reforms to consolidate and harmonise arrangements. Central to any reform efforts, however, must be a resolute, unwavering commitment to multilateralism, that is matched with practical, sensible measures to ensure a better prepared world for future health emergencies caused by pandemics, climate change, and biodiversity loss. The G7 as a group of democracies with strong historical ties to multilateralism must be at the forefront of such reforms and build inclusive alliances to uphold its values base.