Visa restrictions: A structural determinant of global health that must be confronted head-on
From “Visa Apartheid” to structural exposure
Visa restrictions can no longer be treated as a peripheral issue; they are a central concern in global health. In 2025 alone, thousands of researchers, public health officials, and clinicians from low- and middle-income countries (LMICs) were denied entry to high-income countries for conferences, training, and governance meetings, not for lack of credentials, but because they presented the wrong passport. These mobility constraints are not symmetrical as global health actors from high-income countries (HIC) rarely face comparable barriers when traveling to LMIC settings. Conversely, scholars and practitioners from LMICs routinely encounter what global health scholarship has long documented as “visa apartheid”, encompassing inequities in mobility, access, authorship, and epistemic authority; exclusions which have largely been framed as episodic injustices or ethical failures at the margins of an otherwise functional system [1–4].
The current wave of visa restrictions reveals a deeper structural problem: global health systems are built on assumptions of relatively unrestricted mobility that no longer hold. Although individual visa decisions and national policy shifts may be publicly visible and politically contested, their cumulative effects on who participates, who decides, and whose expertise travels remain insufficiently examined in global health governance debates [5,6]. Moreover, their harm profile seems to have shifted from the intermittent denial of access to structural weakening of institutions, particularly in low- and middle-income countries (LMICs) [7–9]. Viewed through this lens, visa regimens must be addressed at the systemic level given that they function as structural gatekeeping mechanisms that shape the global health ecosystem itself.
What is new is not exclusion itself, but its interaction with time-bound developmental processes central to health system performance. Meanwhile, this paradigmatic shift coincides with a convergence of forces reshaping the global health landscape: declining development assistance, restructuring of multilateral institutions, intensified calls for localization and country ownership, and growing geopolitical fragmentation [10–12]. Together, these dynamics expose the vulnerability and unsustainability of existing global health architectures that rely on cross-border mobility to ensure training pipelines, cross-country research and career progression, strengthen disease surveillance, and institutional participation in global governance.
Bain LE, Ojong SA, Sindi JK, Njei B, Omam L-A, Kyobutungi C (2026) Visa restrictions: A structural determinant of global health that must be confronted head-on. PLOS Glob Public Health 6(3): e0006178. https://doi.org/10.1371/journal.pgph.0006178