Geopolitics has shaped the era of modern technology - the internet was a child of the Cold War - and we are now seeing digital technology shape the next phase of geopolitics. Digital technology has upended traditional geopolitical boundaries and has emerged as a powerful force in recent times. In health, this has significance and the “disruption” caused by digital technologies, from Big Data to Artificial Intelligence (AI), holds both potential benefits and risks within health systems. The development of new digital technologies to diagnose, treat and deliver care requires examining whether current systems of governance for facilitating and diffusing innovation in health are adequate. This includes addressing issues of ownership of technologies and how this affects countries, particularly low-and-middle income countries (LMICs), as well as access to technologies, which can potentially narrow the “digital divide” or exacerbate it. Power dynamics emerge between innovators (health technologies and the accompanying infrastructure) and users as well as state and non-state actors (traditional and emerging actors). While information is seemingly democratised, it is not always clear as to who controls information and the narrative, both within and across countries. Misinformation, as observed during the COVID-19 pandemic, can influence public health behavior, if unchecked. Moreover, issues of net neutrality, sanctions and policies by governments to restrict flow of information can have consequences for development and use of technologies as well as on how information is received by people. The rise of surveillance systems, by states and “Big Tech” can be beneficial in times of crises (for example, to assist with contact tracing) as well as on protecting data privacy and ensuring cybersecurity. “Digital diplomacy” is also playing a role in how systems for interoperability of infrastructure and data sharing across countries develops. The rapid rise of AI has spurred experts in the field to call for a pause in development and reflect on how society can cope with changes. More broadly, these issues beg a deeper introspection on how technological changes align with societal values, take ethical considerations into account, bring equitable benefits and maintain public trust. This will allow for a better understanding of the role of geopolitics in shaping the way forward including collaboration on the norms and regulations for the effective use of technology to facilitate the dramatic transition to the digital age.