An urgent, global challenge exists at the intersection of climate change, public health, and equity requiring sustained, interdisciplinary action. With political polarization, institutional disinvestment, uneven global commitments, misinformation and scientific denialism, and escalating climate-driven health risks, including heat-related illnesses, wildfires and floods, infectious diseases, mental health distress, and worsening health disparities, universities are uniquely positioned to drive innovative and transformative solutions. This perspective, based on an international convening held at the Rockefeller Foundation’s Bellagio Center in November 2024, outlines four interlinked roles for universities and offers a call to action. First, universities must sustain and protect scientific discovery, counter misinformation and safeguard research integrity. Second, they must diversify funding to maintain resilience. This means reimagining partnerships with governments, communities and industry. Third, they must uphold academic institutional responsibility including commitment to ethical inquiry, evidence-based science, and their own contributions to greenhouse gas emissions and sustainability. Fourth, they must transform education, equipping the next generation of leaders with transdisciplinary skills to navigate climate–health challenges. The recommendations provide a pathway during tenuous political times for academic institutions to remain trusted spaces for evidence-based solutions and global collaboration.