Countries stall over WHO finance reform plans ahead of crucial meeting

The World Health Organization flag above its headquarters in Geneva. (Credit: US Mission/ Eric Bridiers via Flickr)

As the World Health Organization’s executive board meets this week, two major issues – reforming its finances and pandemic response – are dividing consensus.  

A handful of powerful countries, including but not limited to the United States, remain hesitant over a plan to bolster the World Health Organization’s (WHO) finances by increasing member states’ annual contributions.

But US domestic politics, more than geopolitics, may be the bigger hitch for Washington in the negotiations, diplomatic sources in Geneva told Geneva Solutions and Health Policy Watch, rebutting media reports that US fears that WHO finance reform could increase China’s influence in the organisation.

On the eve of a critical WHO governing board meeting in Geneva that begins Monday, the US is engaging “constructively” over the proposed move to scale up fixed annual contributions by member states so that they eventually account for half of the organisation’s funding needs, the sources said.

But any US agreement to raise the WHO’s fixed contributions, however modest, would still have to win congressional approval at a precarious time when President Joe Biden’s Democratic majority is razor thin.

“It’s not just the United States, and I wouldn’t flash out only the US,” one source, speaking on condition of anonymity, said.

“The US is constructively engaging,” the source added, “But I think it’s mostly tricky for the US because they have a strict policy on assessed contributions - and WHO does not have a great standing in the US general public opinion.

WHO executive board likely to punt on two hard decisions

The WHO’s 34-member executive board, which meets twice a year and sets the agenda for the World Health Assembly in May, appears likely to delay making a decision on two critical issues: the first on sustainable WHO finance and a second move to toughen the pandemic response.

In light of the lack of consensus, typically required for member state decisions, the board will likely defer making any clear recommendations, leaving hard choices to the WHA, the organisation’s top decision-making body.

Efforts to strengthen the WHO’s response to future pandemics also face an uphill battle.  Last week, China demanded the deletion of critical language that would support giving the WHO faster access to outbreak sites from a document that etched the way forward.

At a special World Health Assembly session in November, WHO member states agreed to start negotiations on a new pandemic accord, which could take the shape of a convention or other multilateral legal instrument.

But if key clauses about access to outbreak sites, pathogen sharing, and other aspects of pandemic preparedness and response are watered down or deleted, the resulting international accord that will still take several years to negotiate, could wind up empty of any real meaning.

Pandemic accord and finance scale-up: linchpins in bigger reform plans

A new global pandemic accord, as well as a scale-up in assessed contributions are viewed as the linchpins in a series of broader reforms to the WHO proposed by a number of recent external reviews into pandemic response and its shortcomings – including an independent panel co-chaired by Helen Clark and Ellen Johnson-Sirleaf, former heads of New Zealand and Liberia respectively.

In the wake of those scathing reviews, initiating negotiations on a pandemic accord, treaty or convention, as well as reforming WHO’s finance became flagship causes for a large bloc of European, African and other member states – which see funding reform as critical to maintaining WHO’s central role in global health decision-making, post pandemic.

The US served as the co-chair of the Working Group on Pandemic Preparedness and Reform - with career health and human services diplomat Colin McIff reportedly playing a key role in swinging greater US administration support behind that proposal.

But that left China in stark opposition to some key provisions of the draft framework that would strengthen multilateral responses and most specifically the rapid outbreak access clause.

Europe and African Union key leaders in the financial reform moves

On finance, in contrast, Europe and the African Union have played key roles in supporting reforms that have received support, officially, from over 90 countries.

Although opponents to the plan is shrinking, a handful of influential nations, including the United States, Japan, Brazil and Argentina continue to resist.

“Russia apparently is now in favour of an AC (assessed contributions) increase, and India apparently, if I am not mistaken,” one source said on the eve of the EB meeting.

“But on the others, I think that hasn’t changed much. So, I just think there needs to be a further discussion and we will have to see where there can be consensus or a middle ground.”

The source played down recent reports that Chinese-US geopolitics may play a role in Washington’s considerations: “The influence of China or others, economically and politically, will not be decided in the WHO.

“And rather, if we are not putting UN agencies on a stable footing, with regards to independence and integrity, then we get a problem, I think, in the future.”

Assessed contributions paid by all 194 member states currently amount to only about 16 per cent of WHO’s annual budget - with the rest of the funding coming from so-called “voluntary contributions” by member states, with the United States the leading donor - along with the Bill and Melinda Gates Foundation.

Scaling up contributions – a little at a time

According to a draft proposal that emerged from a WHO Working Group on Sustainable Finance, the move to boost regular contributions to a 50 per cent level would be made gradually  beginning in 2023-24 and scaling up to the full 50 per cent by the 2028-2029 fiscal year.

For the US, in fact, the absolute amount of the assessed contribution would rise from about $115m in 2022-2023 to about $240m by 2028-29.   That, however, is relatively negligible in light of the US voluntary contributions which were more than $300m in 2019, according to the WHO finance dashboard - also suggesting that the obstacles are more political than financial.

The WHO has not updated that dashboard to include member state contributions for the 2021-2022 budget year.

Some mid-size and middle-income countries like Argentina and Brazil, are also reportedly concerned over absorbing new assessments in light of the economic toll of the pandemic.

At the same time, the investments required are small in comparison to the trillions of dollars lost to the pandemic - amounting to only about $600,000 a year for all 194 member states by 2028-29, observers say.

“If you look at the actual proposal, many of the bigger jumps come at a later stage, I really hope there is not a crunch in 2028,” said one source. “It’s not about funding, it’s about the question of control…I guess the issue is a matter of principle… How much do you trust the WHO that they will do something sensible with the money?”

China concerns

One European decision-maker told Geneva Solutions and Health Policy Watch that while there are some concerns regarding Chinese influence on the WHO “faith in the WHO seems to be big enough to actually trust them to do their job better – if they get more assessed funding and don’t have to run around to beg and shop around and hire temporary experts all of the time.”

The low level of funding from member states risks damaging the organisation's ability to react, the observer added.  “The greater fear is that of the WHO being incapable of doing its job in the next pandemic.”

From wild animal markets to DRC sexual abuse scandal: other topics on the agenda

This week’s EB meeting, which lasts through Saturday, will consider over two dozen issues in the WHO’s three strategic areas of action: health emergencies, universal health coverage, and “healthier populations”, which includes preventive health and climate and environment measures.

With respect to preventing future pandemics, the EB will also review  recommendations by the WHO, UN Environment Programme and the World Organization For Animal Health (OIE) - aimed at “ reducing public health risks associated with the sale of live wild animals of mammalian species in traditional food markets”.

Despite the unresolved debate over whether the SARS-CoV2 virus originated from a lab biosafety incident or in the food chain, there is widespread expert agreement about the huge  risks that wild animal breeding, slaughter, trafficking and sale in traditional markets pose generally in triggering future pathogen escapes from the wild, and pandemics.

The executive board will also review a report on WHO’s implementation of recommendations by an independent commission that examined allegations of sexual exploitation and abuse during WHO’s deployment to the Democratic Republic of Congo between 2018 - 2020, along with broader recommendations on strengthening WHO’s policies with regards to the prevention of sexual abuse.

The recommendations propose engaging an independent audit of WHO’s management of the issue, among other steps. News of the sex abuse scandal first came to light in 2020 as a result of a joint investigative report by the New Humanitarian and Thompson Reuters Foundation.

In September 2021,  WHO-appointed independent commission issued findings confirming the sex abuse reports and recommending an overhaul of the Agency’s sex abuse prevention and education practices.

This article was written in partnership with Health Policy Watch.