Could the World Health Organisation survive if Trump stopped funding it?

The hypothetical scenario of a second Trump presidency becomes a reality in January and there’s already talk in Trump’s transition team of a withdrawal from WHO ‘on day one’. This is just talk for the time being, though. We don’t yet know whether Trump is going to continue to support WHO, but that isn’t going to stop me and every other armchair carpist out there from venturing our opinions over the coming weeks. Prepare yourselves.

The FT article suggests that there is ongoing discussion within the transition team about what to do, which is moderately reassuring. But that’s all we know. If you do a basic google search of [[transition team member] AND World Health Organisation] you get next to nothing. The transition team, it turns out, has had very little to say in public recently about its view of WHO. The only slightly useful snippet of information I could find was a BBC News profile of Elise Stefanik. Stefanik is going to be the next US ambassador to the UN, so her perspective is likely to have some weight. However, Stefanik has little to no experience of international affairs and is a staunch supporter of Israel. Criticism of Israel from other members of the UN for its genocide of the Palestinian people has prompted her to argue for a “complete reassessment of US funding of the United Nations”. At the very least, I would expect such a reassessment to happen.

Having spent most of my academic life arguing that WHO should receive more funding from its donors than it does, I’m tempted to now argue – I mean, if we’re going to explore seriously the consequences of Trump leaving the Organisation in January – that the tiny amount of funding WHO receives might turn out to be a blessing. We can do some sums, if you like. The graph below shows the US assessed and voluntary contributions to WHO for the period 2018-2024. The data for 2018-2023 are from WHO’s governance webpages and for 2024 from WHO’s Budget Portal.

As you can see, 2022 saw a spike in VCs due to Covid. But 2024 is interesting. What accounts for that spike? Typically, the US is tardy in its payments, preferring to pay its ACs in the second half of the biennium (2024-25). So, it wouldn’t have been surprising to see the 2024 blue column in the low hundreds or even zero. Similarly for the 2024 red column – you’d expect half the amount reported. And yet, the Portal is reporting that the US has paid up front everything it owes WHO for 2025 – all its ACs and all its VCs. I’m old school and prefer to use the WHA documentation rather than the Portal, so I may be misinterpreting the Portal data for 2024. But, it clearly states “updated until 11-2024”. So maybe Biden has done the right thing, anticipated what Trump might do if bills are not paid, and settled all debts? If that’s the case, then good for him [NB: see my comment at end of this post for an important update].

Anyway, I digress. The point I’m getting round to making is that the US contributes a ball-park half billion $ to WHO every year (or 15% of WHO’s annual budget, very approximately). It looks like WHO is good for 2025, but come 2026 and assuming that Trump has walked away, then that’s the shortfall the Organisation is looking at. Now, you can wring your hands and explete all you like, but the fact of the matter is that half a billion a year is – well – fuck all! Remember that the WHO has 193 other member states besides the US. Do the maths. No? Ok, let me do it for you: $2.6m per member state, per year to cover the US contribution. Just saying.

So, could the WHO survive if Trump stopped funding it? Financially, of course. Member states would just need to step in and pay a bit extra. Politically, I like to think so too because of all the public good reasons everybody knows about. Member states need the WHO, and they know it. If Trump leaves in January, my advice would be ‘let him go’. Like a child that walks off vowing never to return, he’ll come back – eventually. And he’ll have lost all of his toys in the process.

Andrew

Postscript (24/12)

I’m adding to this post as a PS as events unfold (and also in the Comments below). China’s influence at WHO is a perennial topic of conversation and zombie conspiracy theory. It’s come up again recently – for example, in the FT piece (linked to at the start of this post). Here’s the relevant text: “He [Gostin] warned that if the US left the WHO, European countries were unlikely to step up funding and China might try to wield more influence. “It would not be a smart move as withdrawal would cede leadership to China,” he said. 

It puzzles me why people worry so much about China vis a vis WHO. I mean, if you care about one Member State (MS) unduly influencing WHO, doesn’t it bother you at all that the US has been doing that aggressively for the entire lifetime of the Organisation? If Trump leaves WHO, it just means that one MS that has massively influenced WHO may soon not be doing that anymore, and other MSs would then have more of a say over what gets done. That’s not necessarily a bad thing! The other thing to think about is that influence is not just about the money. It is about the money, of course, but not just about that. On the money = influence argument, take a look at the graph below. China ranks 8th.

So, if you’re worried about new kids on the bloc influencing WHO by virtue of their economic clout, then you should worry about the six remaining donors that give more money to WHO than China before worrying about China. But that aside, influence comes in many shapes and sizes, including by consultancy firms like McKinsey (a useful conduit of influence for the Gates Foundation) or funders such as The Welcome Trust, both of which have their hand on the policy-development levers. So, when it comes to the China/influence/WHO nexus, keep a check on that knee-jerk!

Postscript (04/01)

WHO’s Executive Board is meeting 3-11 Feb and is starting to publish its documentation on its webpage. A familiar document to WHO watchers is the annual report from the DG on Financing and implementation of the WHO’s Programme Budget (EB156/26). By way of an update to the top donors to WHO I gave above, below is a figure taken from the report showing the top 10 contributors as of September last year. Note that this is midway through the biennium.