Trump’s suspension of WHO funding is a disaster for the world’s health

Nuclear option.
Nuclear option.
Image: REUTERS/Leah Millis
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On Tuesday, when most of Geneva—where the headquarters of the World Health Organization (WHO) are located—was already long asleep, US president Donald Trump announced he would suspend funding to the global public health agency, pending an investigation into what he called its “role in severely mismanaging and covering up the spread of the coronavirus.”

The announcement, while expected, is catastrophic for the WHO. It throws several of its key health programs—funded in part by US contributions—into disarray, including the agency’s emergency fund to help at-risk countries across the world fight the coronavirus pandemic.

Why did the US pull its funding from the WHO?

The Trump administration had been threatening to pull US funding from the WHO for weeks, unsatisfied with its early handling of the crisis and its relationship with China. In a press briefing last week, Trump announced a funding freeze and then immediately reversed it.

The US president appears to have three major problems with the WHO. He accuses the organization of being too quick to accept the information China provided in the early days of the pandemic and to praise China for its response, even though we now have evidence that China initially covered up the existence of the virus. The US is not the only country that has accused the WHO of pandering to China during the course of this crisis. But the WHO has repeatedly defended its relationship with China, noting that it’s essential to obtain vital information and access, and denied accusations that it was imbalanced in its praise of the country’s response. In January, Trump himself praised China’s handling of the pandemic:

The second complaint is that the WHO contradicted a decision the US made on March 11 to close its borders to all foreign nationals who had recently visited China, Iran, and 28 European countries. In its official recommendations, the WHO cautioned that “denial of entry to passengers coming from affected areas are usually not effective in preventing the importation of cases,” although they “may have a significant economic and social impact.”

Finally, Trump has also expressed frustration that the US pays a disproportionate share of the WHO’s operational budget in comparison to China. The US is required to cover 22% of overall mandatory contributions, while China is expected to cover 12% in 2020-21, even though it has a population of 1.4 billion people and a GDP of $13.6 trillion.

What will happen to the WHO without US funding?

If confirmed, the loss of US funding would be a disaster for the WHO, several of its key health programs, and for the world’s response to Covid-19.

The WHO’s annual budget is about $5 billion, less than half that of the US Centers for Disease Control and Prevention (CDC). As a specialized agency of the UN, the WHO’s revenue comes from assessed and voluntary contributions. Assessed contributions are essentially mandatory membership dues—UN member states are required to pay a share determined by their size and wealth. Voluntary contributions, meanwhile, make up about 80% of the WHO’s total budget (pdf, p. 2), but the organization cannot depend on them from year to year. These voluntary funds can come from member states, international organizations, and nonprofits, and are typically earmarked for specific projects.

As of the end of March, the US had yet to pay its 2020 bill of $115,766,920 for assessed contributions. The country also has approximately $80 million outstanding from other years.

The WHO can also raise funds to deal with extraordinary public health emergencies. As part of its Covid-19 response plan, it has asked for an initial sum of $675 million to support at-risk countries through April 2020. As of April 9, it has received about $356 million, with another $61 million pledged from various donors. The US has contributed about 4% of that.

If the US pulls its funding from the WHO, the gap could leave other crucial public health programs under-funded as well. In the WHO’s 2018-19 budget, the most recent one for which data is available, significant US contributions went to polio eradication, increasing access to essential health and nutrition services, and to combating vaccine-preventable diseases.

What happens now?

It’s not clear when or how much of the US’ funding will be suspended. In his speech, Trump said the review would last 60 to 90 days. Presumably, said Ian Johnstone, professor of international law at the Fletcher School at Tufts University, this means the US will not pay the assessed contributions it owes the WHO for 2020, and stop all voluntary contributions, including donations to the Covid-19 fund. But it’s also possible Trump will decide, once the review is over, to reinstate the funding.

It’s also not clear whether Trump even has the authority to do this. The US Constitution gives the power of the purse to Congress, and especially the Democrat-controlled House of Representatives. In fact, Congressional Democrats told The Wall Street Journal (paywall) that “the president does not have the unilateral authority to withhold the United States’ contribution to the World Health Organization.” But the administration believes it can bypass congressional approval, notably by rerouting the funding to other public health agencies or projects.

This wouldn’t be the first time the US withheld funding from multilateral groups for political reasons. In the 1980s, it temporarily stopped paying the United Nations “on the ground that the organization is inefficient, wasteful and often contrary to American interests,” according to The New York Times. And in 2011, the US froze its funding to UNESCO after the organization granted the Palestinian territories full membership. Six years later, it withdrew from UNESCO altogether.

What does this mean for the US?

This is just the latest in a series of moves the Trump administration has made to withdraw the US from global treaties and back away from multilateral institutions. “There’s a pattern here,” Johnstone said, and pulling the WHO’s funding “is consistent with that pattern. It just happens to be the worst possible timing from the point of view of the World Health Organization.”

Analysts say isolating the US from these institutions weakens its standing in the world, and cripples the global response to public health crises like Covid-19. “The prospect of being able to work collectively with most, if not all, of the countries in the world, other than through the WHO or through existing institutions, is slim,” Johnstone said. “It is sending a signal that the US doesn’t see much value in working with and through international organizations.”

It also raises the question of who will step into the roughly $400-million-sized-hole the US leaves behind. “If the US steps back from global leadership,” Johnstone asked, “who’s going to step up?”