This chapter examines the profound shift in global health governance, arguing that the traditional Western-dominated system is giving way to a new multipolar order shaped by rising powers like China and India. It analyzes the distinct mechanisms through which these nations exert influence, including financial contributions, strategic health diplomacy, and the push for institutional reform. Through detailed case studies, the analysis highlights the divergence in approach, contrasting China's state-led, top-down model with India's market-driven, cooperative strategy. The manuscript explores the dual implications of this transition, identifying significant challenges such as fragmentation and institutional gridlock, while also highlighting opportunities to decolonize global health and reduce North-South inequalities. It concludes that the future of global health governance will be defined by a complex interplay of competition and cooperation, with the ultimate outcome impacting the achievement of the Sustainable Development Goals and the very definition of global health itself.