This paper highlights the ailing state of global health governance as evidenced by the lack of progress on the Millennium Development Goals (MDGs), in particular the goals related to health. Policy coherence within the global health governance system is not evolving fast enough to ensure that trade and development issues related to public health, particularly concerning access to medicines, are effectively aligned at national, regional and multilateral levels. The paper briefly reviews the WTO Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement and the 2001 Declaration on the TRIPS Agreement and Public Health. A case study outlines the manner in which "TRIPS-plus" provisions in selected US free trade agreements (FTAs) have undermined multi-level policy coherence in trade, development and public health. The discussion then identifies three unique governance mechanisms of the G8 that make the group a potentially powerful catalyst for innovation in global health governance, and assesses the opportunities that the 2008 G8 Hokkaido Summit may offer. The paper concludes by offering recommendations for enhancing multi-level policy coherence and for strengthening the system of global health governance.