…I asked Steve, the guy behind the counter at my local newsagents. For someone who lives on the Welsh borders, Steve is surprisingly well informed about global health diplomacy in Geneva. Steve: What Senegal said. Me: What what said? Steve: Senegal. And it’s a place not a thing. Me: I know what Sen…where Senegal is. Steve: Do you though? Name two. No, name one of its bordering countries. Me: Ermmm. I don’t particularly like Steve. But he’s right. If you want to know what’s next for WHO financing, the Senegal representative has ten (count them) recommendations for the WHO’s Secretariat (1:42:28).
Andrew
(Ed.: I don’t think that’s enough for your reader. Me: Do I look like I haven’t got better things to do? Ed.: Frankly, yes.)
Sigh, ok, OK! In addition to what Senegal said, here are some other things to consider in relation to the immediate future financing of the WHO – i.e. the upcoming 2026-27 program budget. My previous post covered progress towards implementing the 2024-25 budget; this post is looking more towards the horizon.
“We need some immediate wins” Tedros told Member States of the Executive Board (EB) on Tuesday. By which he meant they have to fill the gap in flexible funds that will result from the US (and now Argentina) not paying their assessed contributions. At $261m per biennium, the US’s contribution is a not inconsiderable sum. And remember, the US hasn’t paid what it owes for 2024-25 and won’t be contributing to 2026-27 either – Biden could and should have paid, but he didn’t. So come 2026-27, the WHO will be shy of half a billion in fully-flexible funding. When Tedros says “immediate” he means ‘like right now’ immediate. And his idea for the way to get those flexible funds is for Member States to ‘un-earmark’ some of their ‘earmarked’ voluntary contributions. In case you don’t have the energy to get to the end of this post, let me just emphasise up front that Tedros is not asking Member States to pick up the US’ tab. No, WHO is just going to have to manage with less money. But Tedros is keen to ensure that he has enough flexible funds. Think of it less a quantity request and more a quality request.
Sounds easy, probably isn’t. Part of the reason for launching the Investment Round (IR) was to encourage flexible funding. Some donors such as the UK have pledged large sums in fully flexible funds to the IR (good Member State!) But there’s an obvious gap (an elephant in the room, one might say) in contributions to the IR – obvious enough for the delegate from Germany to make an oblique reference to it during his intervention. Yes, I’m talking to you AMRO/PAHO. Not one single Member State from the Americas region has pledged anything to the IR – not even Brazil, which hosted the launch of the IR.
Anyhoo, back to the discussion on the proposed program budget 2026-27. You can watch it here, and you’ll need to read documents EB156/27 and EB156/4. Since the discussion, the Secretariat has published EB156/INF./6 Assessed contributions: draft calculations for the year 2026, which is important in the light of China’s intervention at the EB and its request for clarity. But more on this document below. If you haven’t already, do have a read of an earlier post I wrote on the 2026-27 budget. For reference, below are the figures from the original proposal:
As you can see, the Secretariat was proposing an increase from $4968m to $5324m for the base programmes (i.e. all the health work that the WHO is mandated to do). As the figure below shows, this increase would allow the budget to more or less correspond in real terms to pre-Covid levels of financing.
PBAC reviewed the draft program budget figures (see EB156/4) in light of the US withdrawal from the WHO, guided by three options from the Secretariat: 1. To proceed as currently proposed; 2. Reduce the budget to the level of the Programme budget 2024–2025, but add the increase for the global technical centres; 3. Reduce the budget in the light of the current economic and financing situation. Noting that the US withdrawal meant that the WHO could not proceed as though it were ‘business as usual’, PBAC discussed and agreed to propose to the EB a decrease in the base segment to US$ 4.9 billion.
In its discussion, the PBAC noted three things: first, $4.9bn “reflected a negative nominal growth” (not to mention real terms growth – could we have a revised calculation for that, please); second, if Member States were going to commit to a further increase in their assessed contributions for the biennium 2026-27, then the Secretariat would need to present Member States with some updated figures tout de suite (they have now done this in the recently published document EB156/INF./6); and third, the WHO’s core functions, “including in the areas of data and innovation, accountability and the strengthening of country capacities” would need to be protected.
On that second point – Member States committing to further increases in their assessed contributions – you’ll recall that this is something Member States agreed to do back in 2022 (Decision WHA75(8) – see Annex 4). Here’s the relevant text:
(e) that the Seventy-fifth World Health Assembly, recognizing the important role of assessed contributions in sustainably financing the Organization, request the Secretariat to develop budget proposals, through the regular budget cycle, for an increase of assessed contributions to contribute to financial sustainability of WHO and with its aspiration to reach a level of 50% of the 2022–2023 base budget1 by the biennium 2030–2031, while aiming to achieve this by the biennium 2028–2029 (my emphasis).
And here’s the widely-distributed illustration of AC increases across the bienniums:
In 2021, the Working Group on Sustainable Financing did a preliminary calculation of how much each Member State’s ACs would increase, which was also widely distributed (see the Annex). For example, China’s ACs would increase from $57m for 2021 to $69m in 2025, $93m in 2026 and rise to $131m by 2029. Note, however, that this calculation is based on a UN scale of assessments of 12%. The problem is that China’s economy has grown and so has its scale of assessment. In 2025 it increased to 15% and in 2026 it will be 20%. This means that it is going to pay significantly more in ACs than the WGSF’s illustrative calculations. As EB156/INF./6 shows, in 2025 China will pay $88m (15% scale) and $138m in 2026 (20% scale). None of this is particularly surprising – every Member State knows that its assessed contributions are linked to the size of its economy and every Member State has had sight of the stepwise increase in ACs to WHO that would allow a 50% by 2028-29.
However, it appears to have caught China off guard. Or maybe the penny is beginning to drop that, in the event of a US withdrawal, it will become the largest contributor of assessed contributions to the WHO. Perhaps understandably, as we heard from the Chinese delegate at the EB (1:58:40), China is calling for ‘time out’ while it reviews its commitments, requesting the Secretariat for clarity in how the AC calculations will be made to help it assess the feasibility of it contributing 20% in 2026 in addition to the phased increases that Member States agreed ‘to aspire to’ back in 2022. To be fair, the calculations are not easy to get your head around. EB156/INF./6 introduces us to the “78% model”. We’re likely to hear quite a lot about this model in the coming months. Probably best if I just quote directly from the document:
In this model, in the light of recent developments, the assessed contribution of the United States (corresponding to 22% of all assessed contributions) is excluded for the purposes of calculating the budget, irrespective of the extent to which it may be payable during the relevant period (see footnote 3). The assessed contribution of the United States would not be redistributed among the remaining WHO Members and Associate Members. Instead, WHO would adopt a budget that would be financed on the basis of a reduced level of contributions, i.e. without the assessed contribution of the United States.
Without the benefit of a PBAC representative standing over my shoulder to talk me through the calculations, I think the Annex is presenting three important quantities of financing for each Member State. First, it calculates the ACs due in 2025 based on the scale for 2025. For China, that = 15.25% and comes to $88m (rounded up). Second, we have the ACs for 2026 based on the revised UN scale for 2026. For China, that = 20% and comes to $115m. In this calculation, the additional ACs that the WGSF recommended are not included. Third, we have the ACs for 2026 based on the scale for 2026. In this calculation, the additional ACs are included. For China, that = $138m.
The Annex, then, is a table of all Member States’ ACs for 2025 and 2026, comparing the old (up to 2025) and the new (2026-2028) UN scales of assessed contributions, and also taking into account the proposed increase of 20% as per Member States’ sustainable financing commitments. One thing I’m unclear about is why the Secretariat is requesting an additional 20%? Where did that figure come from? The table above, for example, shows 20% above the baseline for 2024-25, 35% above for 2026-27 and 40% above for 2028-29. But let’s park that query for now. You may be wondering why the model is called the 78% model? It’s called that because the US pays 22% of the total ACs (or did) so the model is calculating how much the WHO would receive minus that 22% (i.e. 78%). At the end of the Annex, there are these data for the total amount of ACs from all Member States:
| 2025 net assessment (US$) (old scale) including the US contribution | 578 149 530 |
| 2025 net assessment (US$) (new scale) (without 20% increase in ACs) including the US contribution | 578 150 430 |
| 2025 net assessment (US$) (new scale) (without 20% increase in ACs) minus the US contribution | 447 837 460 |
| 2026 net assessment (US$) (new scale) (with 20% increase in ACs) including the US contribution | 692 968 210 |
| 2026 net assessment (US$) (new scale) (with 20% increase in ACs) minus the US contribution | 537 395 280 |
China has requested the Secretariat provide some additional AC increase ‘scenarios’ – e.g. how much would it cost if the ACs were increased by 5%, 10% and 15%. I can understand that China, now the biggest contributor of ACs, would need to be clear how much it is committing to, and how that amount is calculated. Additional funding for health is a hard sell, politically, for any health minister. But remember that Tedros is asking all Member States to be more flexible with their flexible funding. This is the “immediate win” he needs right now. China does not contribute much to the WHO by way of voluntary contributions, so it would not be required to do much to make those VCs more flexible – unlike other Member States. So, there will be pressure on all Member States’ health ministers to make the case back home for more flexibility. It’s not just China’s problem. Some Member States (Chile, for example) were lamenting the additional sums involved, claiming that ‘times were tough’, ‘belts needed to be tightened’, etc., etc. Chile is an interesting case. It currently gives $5m in ACs across the 2024-25 biennium. Looking at EB156/INF./6, the additional costs would require it to pay an extra $165 thousand for 2026. I’m pretty sure that, if push came to shove, the Chilean MOH could find an extra $165k.
Poland was right, this is a “wakeup call” for member States. And Spain’s delegate is also correct to ‘rally the troops’: “we should not limit ourselves to hasty survival plans”. Member States should continue to ‘think big’ in terms of their support for sustainably financing the WHO. At a minimum, they should commit to ensuring that the ‘aspiration’ of flexibly funding the base budget by 50% by 2030 becomes a reality. Now is not the time to start chipping away at that commitment.
Andrew
