The WHO is an institution you should care about and take its side.

You will have seen some reporting this week on the dismal state of WHO financing. In particular, two reports from Health Policy Watch’s Elaine Fletcher (here and here) and one from Priti Patnaik over at Geneva Health Files. In this post, I put my nerd hat on and delve a bit more deeply into the numbers. Bottom line: it’s terrible but not existentially terminal. For context, do read my previous posts on the Executive Board deliberations in February (here and here). But what I really want to do is to persuade you that the WHO is an institution that needs our support. More practically, it needs Member States to support it financially. Below is Snyder’s lesson #2 – Defend Institutions – from his 2017 book On Tyranny (the image below is from the graphic version). Trump wants the WHO to fail. We can’t let that happen.

We’ve known since February that the hoped for increase in the base segment of the WHO’s program budget 2026-27 from $5bn to $5.3bn is not going to happen. Further, we know that the Program, Budget and Administration Committee (PBAC) had proposed that the Secretariat consider reducing the base segment to $4.9m, noting that that would reflect negative nominal growth. Thanks to Patnaik and Fletcher, who shared an email from the WHO’s DG, we now know that the Secretariat is going to present to Member States in May a revised budget of $4.2bn – more than a billion $ less than the original proposal. How does that figure compare to the base segment of previous biennia program budgets? Well, it’s significantly higher than it was in 2020-2021 when the budget was $3.8bn. So, cast your mind back a few years and consider that the WHO was operating as well as it could then with nearly half a $bn less than it will soon have at its disposal. I am not saying that this is a good thing. It most definitely is not! But it does remind us that with continued support the WHO could continue to operate and would not face an existential threat.

What prompted this post is Fletcher’s most recent article, which has the headline: WHO Budget Crisis Bigger Than Previously Thought – $2.5Billion Gap for 2025-2027. It’s worth unpacking this claim a bit. The $2.5bn figure – shared via a ‘town hall’ meeting of WHO staff on Tuesday this week – comes from $1.8bn of yet ‘to be mobilised’ financing plus an already existing shortfall of $600m plus an extra, but unattributed in Fletcher’s article, $100m. Here is the graph that was shared with staff and journalists.

We’ve known for some time that there was a deficit in the WHO’s financing. A deficit of $520m was flagged in the WHO’s most recent (2023) audited financial statement, for example, and I guess it has increased since then. What is curious about this ‘financial outlook’ graph, though, is the unusual period (2025-2027). It’s not normal to be reporting on a biennium budget’s outlook this early.

The PBAC provides regular updates on the financing of the WHO’s program budget. We typically get the first update at the EB in January/February following the approval of the budget. For example, the 2022-23 program budget was approved in May 2021 and PBAC provided an estimate in January 2022 of what % of the budget it expected to be funded (including projections). At 74%, the outlook was described as “promising”. The following May, at WHA76, we learned that the budget was 91% financed. The point I’m making is that we wouldn’t normally expect an outlook or projection of budget financing for the 2026-2027 program budget until January 2026 (NB: we don’t even know yet whether the $4.2bn budget is going to be approved). We have never had comparable outlooks for previous biennial program budgets as early as this. So, it’s not that surprising to learn that the projections are low (57% financed). The $1.8bn shortfall could be explained by pointing out that the real work of mobilising financing hasn’t started yet. I’m not saying it’s not going to be a struggle – with the US out of the picture, it most definitely will be – but we might be wise not to read too much into the projections at this early stage.

It’s interesting to read in Fletcher’s report the reply from Rahul Thomas, the WHO’s Assistant Director of Business Operations, in answer to the question why the Biden administration hadn’t paid its dues. It’s not been widely understood that some Member States – particularly the US – are tardy with their payments to the WHO. This is especially important for assessed contributions because they are supposed to be predictable. That is part of their value (along with being 100% flexible) because the Secretariat knows when it will be receiving them and can plan effectively.

Let’s be blunt here – Biden has really shafted the WHO. In 2022 the US only paid 50% of its ACs and paid none of its ACs in 2023. According to Fletcher’s report, Thomas confirmed that the US has not paid its 2024 ACs either. Until the Secretariat publishes its yearly summary document – intimidatingly titled “Status of collection of assessed contributions, including Member States in arrears in the payment of their contributions to an extent that would justify invoking Article 7 of the Constitution” – for 2024 (it will be referenced as A78/23 and is the publication to watch out for at WHA78) we won’t know exactly how much the US owes. By my calculation, it owed approx $50m for 2022, $100m for 2023 and $130m for 2024. It will also owe $130m for 2025. Biden could have paid all of this money – $410m – but chose not to. We must wait a few weeks before we can assess the scale of his betrayal.

Clearly, the WHO is in financial difficulty. Buoyed by the increase in financing that came its way as a result of the Covid-19 pandemic, it had begun to grow – as it should. After a period of two biennia during which there was no increase in its base budget, the Secretariat was feeling sufficiently confident to propose a modest increase. Tedros has made a compelling case for why it makes financial sense to invest in health in the report All for Health, Health for All. It is very simple – invest $1 in the WHO and it will yield a $35 return in terms of improved health outcomes. As I’ve argued many times previously, the sums of money involved to fully finance the WHO are relatively small. The original budget proposal for 2026-27 – $5.3bn – would buy you 2/3rds of one nuclear submarine. And the shortfall that the organisation is now facing – let’s stick with the $2.5bn from Fletcher’s article for now – is easily affordable to its Member States who should now up their game and commit to WHO’s Investment Round.

The time has come, returning to Snyder’s lesson from his book On Tyranny, to choose an institution that you care about and defend it. Member States can and should choose the World Health Organisation. It will save you money in the long run, it’s an opportunity to stick two fingers up at Trump – see, we can and will support a multilateral organisation that you desperately want to fail – and it saves thousands and thousands of lives Every Single Day.

Andrew