Insights into Editorial: USA threatens to stop money to WHO. How is it funded currently?

Context:

US President Donald Trump threatened to freeze US funding to the World Health Organization (WHO), saying the international group had “missed the call” on the coronavirus pandemic.

Trump said the body had “called it wrong” on COVID-19 and that it was very “China centric” in its approach, suggesting that the WHO had gone along with Beijing’s efforts months ago to under-represent the severity of the outbreak.

The American President declared he would cut off US funding for the organisation, then backtracked and said he would strongly consider such a move.

Key Facts about World Health Organization (WHO):

The World Health Organization (WHO), founded in 1948, is a specialized agency of the United Nations with a broad mandate to act as a coordinating authority on international health issues.

The U.S. government (U.S.) has long been actively engaged with WHO, providing financial and technical support as well as participating in its governance structure.

The U.S. is currently the largest contributor to WHO.

How is the WHO funded?

There are four kinds of contributions that make up funding for the WHO.

These are assessed contributions, specified voluntary contributions, core voluntary contributions, and PIP contributions.
According to the WHO website, assessed contributions are the dues countries pay in order to be a member of the Organization.
Assessed contributions (set amounts expected to be paid by member-state governments, scaled by income and population)
The amount each Member State must pay is calculated relative to the country’s wealth and population.
Voluntary contributions come from Member States (in addition to their assessed contribution) or from other partners. They can range from flexible to highly earmarked.
Voluntary contributions (other funds provided by member states, plus contributions from private organizations and individuals).
Core voluntary contributions allow less well-funded activities to benefit from a better flow of resources and ease implementation bottlenecks that arise when immediate financing is lacking.
Pandemic Influenza Preparedness (PIP) Contributions were started in 2011 to improve and strengthen the sharing of influenza viruses with human pandemic potential, and to increase the access of developing countries to vaccines and other pandemic related supplies.
In recent years, assessed contributions to the WHO have declined, and now account for less than one-fourth of its funding.
These funds are important for the WHO, because they provide a level of predictability and minimise dependence on a narrow donor base.
Voluntary contributions make up for most of the remaining funding.

The current funding pattern:

1. The United States is currently the WHO’s biggest contributor, making up 14.67 per cent of total funding by providing USD 553.1 million.
2. The US is followed by the Bill & Melinda Gates Foundation forming 9.76 per cent or USD 367.7 million.
3. The third biggest contributor is the GAVI Vaccine Alliance at 8.39 per cent, with the UK (7.79 per cent) and Germany (5.68 per cent) coming fourth and fifth respectively.
4. The four next biggest donors are international bodies: United Nations Office for the Coordination of Humanitarian Affairs (5.09 per cent), World Bank (3.42 per cent), Rotary International (3.3 per cent), and the European Commission (3.3 per cent). India makes up 0.48 per cent of total contributions, and China 0.21 per cent.
5. Out of the total funds, USD 1.2 billion is allotted for the Africa region, USD 1.02 billion for Eastern Mediterranean region, USD 963.9 million for the WHO headquarters, followed by South East Asia (USD 198.7 million), Europe (USD 200.4 million), Western Pacific (USD 152.1 million), and Americas (39.2 million) regions respectively. India is part of the South East Asia region.
6. The biggest programme area where the money is allocated is polio eradication (26.51 per cent), followed by increasing access to essential health and nutrition services (12.04 per cent), and preventable diseases vaccines (8.89 per cent).

Key Issues for the U.S. with WHO:

The U.S. government has long supported WHO and continues to be its largest donor at a moment when WHO is undergoing major reforms.

Going forward, there are several key questions regarding U.S. engagement with the WHO, including:

The extent to which the U.S. will continue its financial and other support of WHO and what role it will play in WHO’s governance and helping it enact needed reforms;

The progress made by WHO under the leadership of its new Director-General in improving the effectiveness of the organization and addressing its challenges; and

The quality of technical and governance partnerships between the U.S. and WHO, especially in the event of a new public health emergency or outbreak in the future.

WHO faces a number of institutional challenges:

The WHO faces a number of challenges including a broad mandate with limited, inflexible funding, bureaucratic complexity, and a track record of poor responses to recent health emergencies; reforms have been initiated to address some of these challenges.

A scope of responsibility that has grown over time while its budget has remained flat or been reduced;

A budget that has become less flexible with greater reliance on voluntary contributions often earmarked for specific activities;

A cumbersome, decentralized, and bureaucratic governance structure; and

A dual mandate of being both a technical agency with health expertise and a political body where states debate and negotiate on sometimes divisive health issues.

Way Forward: Reforming the World Health Organization:

As an intergovernmental body, WHO is not immune to global power-play as is being witnessed by reports of the director-general having shied away from naming the virus after the country where it originated China and delaying the declaration of a pandemic.

Moreover, only a quarter of its budget comes from contributions from UN member-states, and the real money to power its work is from voluntary funding by countries and organisations.

WHO, as a global convener, plays a key role in standard-setting in public health. This is a matter of much importance to the “haves” of the global economy, especially those with a vibrant pharmaceutical industry.

The United States is the largest contributor, but the Chinese have also recognised WHO’s importance.

The main decision-making body at WHO is the annual World Health Assembly (WHA), attended by all member-states.

With demands for a better, real-time response from WHO, the Executive Board (EB) should be made a standing body with the elected countries having Geneva-based permanent representatives on it. The EB should meet when required and direct action by WHO.