Standing in the Rose Garden on Tuesday afternoon, President Trump announced that the United States would freeze its contributions to the World Health Organization “while a review is conducted” into how the organization has responded to covid-19 and whether China has too much influence within WHO.
The move prompted widespread condemnation from the WHO itself, as well as from health experts and global leaders. So what is the WHO and what is its role? Here’s what you need to know about the politics of global health.
What is the World Health Organization?
Founded in 1948, the World Health Organization is a specialized U.N. agency designed to promote the highest possible health for all people. It has a near-universal membership, with 194 member-states. The United States has been active in WHO since the very beginning, hosting the conference in 1946 that led to WHO’s creation. The U.S. was also one of the first signatories to its constitution.
WHO’s constitution gives it a mandate to “act as the directing and co-ordinating authority on international health work” — a mission that is both expansive and restricted. The most important thing to realize is that WHO cannot mandate or impose policies on any member. It cannot dictate how a country structures its health care system. Neither can it set prices for pharmaceuticals nor unilaterally close borders when a disease outbreak occurs.
Instead, WHO plays two key roles. First, it acts as an information hub. If countries are wondering which drugs to stock in their health-care facilities, looking for policy advice on a wide range of health-related matters, or seeking data and technical recommendations, WHO is a one-stop organizational resource. It encourages countries to share their expertise and experiences in an ongoing manner. It also convenes the World Health Assembly every May, bringing all WHO member-states together to set the organization’s agenda.
Second, when a disease outbreak does occur, WHO acts as the coordinator for a global response. No country can stop the international spread of a virus on its own, and WHO has the unique mission to call attention to these outbreaks and foster global cooperation. It has the power to declare an outbreak to be a Public Health Emergency of International Concern (PHEIC), as it did for the novel coronavirus on Jan. 30.
WHO doesn’t necessarily have lots of money or personnel that it can deploy when it declares a PHEIC, but this designation sends a signal to the world that there’s a pressing health issue that requires coordinated action.
Where does WHO gets its funding?
For an organization with such an expansive mission, WHO’s budget is small. For 2018-2019, its total budget is $6.27 billion. To put that in context, Americans spent that same amount shopping online on Black Friday last year.
WHO gets its funds from two sources, but must then use these different pots of money in very different ways. The first source is assessed contributions, or membership dues required of each country. These funds make up about 20 percent of WHO’s overall budget, and the organization has complete control over how it wants to spend the money.
The second source is made up of voluntary contributions, which are donations that come from countries, philanthropic entities and private businesses. These voluntary contributions — roughly 80 percent of WHO’s budget — generally come in earmarked for a specific purpose, like polio eradication.
The United States has long been WHO’s largest financial supporter. For 2018-2019, the U.S. has pledged $893 million in total contributions, according to reporting in the Washington Post. The Bill and Melinda Gates Foundation, the world’s wealthiest philanthropy, is WHO’s second-largest contributor, followed by the United Kingdom. China ranks 15th, just behind Norway, in total contributions.
What are WHO’s constraints?
WHO’s ability to act effectively is hampered by two big limitations. First, the organization has little budgetary control. Because the overwhelming percentage of its finances come from voluntary contributions pledged to specific projects, WHO is largely implementing the priorities of its donors — whether those priorities line up with WHO’s own interests or the top challenges identified by low- and middle-income countries. WHO finds itself increasingly constrained and unable to reallocate funds when emergencies strike.
Second, WHO can’t impose its will on any country. It can’t force a country to share data, implement better vaccination policies or provide universal health coverage. Its ability to get member-states to follow global health guidelines depends largely on its persuasive power. As a result, the organization often finds itself caught trying to simultaneously navigate the worlds of both public health and geopolitics – and these interests are not always aligned. Last year, for example, WHO initially resisted declaring a PHEIC for the Ebola outbreak in the Democratic Republic of Congo in part of out of concern that doing so would devastate the local economy.
What effect will a freeze on U.S. funding of WHO have?
If WHO loses funding from the United States, it could have serious and long-lasting consequences. Right now, of course, a funding freeze could hobble WHO’s response to the coronavirus pandemic. U.N. Secretary General Antonio Guterres and others stress that now is the wrong time to deprive WHO of its resources.
Going forward, a diminished WHO budget will leave the organization less able to prepare for the next pandemic, as well as undermine WHO programs in poorer countries, like the effort to cut deaths from vaccine-preventable diseases in Africa. Less funding will ultimately work directly against WHO’s mission of promoting better health worldwide.
Ironically, freezing funding to WHO will also decrease the U.S. leverage to effect change within the system. By cutting off its funds to WHO, the United States will give up its long-standing leadership position in global health, leaving a vacuum that other countries will try to fill. This would give the U.S. even less influence in shaping the international community’s response to global health challenges at a time when the effects of these challenges are only becoming more pronounced.
Jeremy Youde is dean of the College of Liberal Arts and a global health politics researcher at the University of Minnesota Duluth. Follow him on Twitter at @jeremyyoude.