Will America Halt Funding to World Health Organisation (WHO)?

A US review of the WHO's handling of the pandemic will take around 60 to 90 days, after which a decision over whether to resume funding will be made.

APRIL 21, 2020 -- The World Health Organisation (WHO) says it is "laser focused… on saving lives and leaving no one behind", as it withstands a significant blow to its financial might after President Trump's announcement that the United States is halting funding to the WHO pending a review of its actions around the COVID-19 pandemic.

A US review of the WHO's handling of the pandemic will take around 60 to 90 days, after which a decision over whether to resume funding will be made.

At a coronavirus press briefing earlier this week, Mr Trump accused the WHO of "severely mismanaging and covering up the spread of the coronavirus". A briefing note on the announcement added that the WHO had "failed" American taxpayers, who provide $400 million to $500 million to WHO each year.

As the largest single contributor to WHO funding, the US decision is a serious threat to global public health, experts said.

"This is a tragedy," stressed Prof David Heymann, consultant to the WHO on COVID-19, and professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine (LSHTM) in an interview with Medscape News UK.

"As an American, I'm very disappointed that the US should be put in a position where the important leadership they have shown through NIH [National Institutes of Health] and CDC [Centers for Disease Control and Prevention] is now limited only to the US."

'Longstanding & Generous Friend'

A formal WHO response has not yet been made to President Trump's announcement, however, in a tweet, WHO Director-General, Tedros Adhanom Ghebreyesus, said that: "The United States has been a longstanding & generous friend to @WHO & we hope it will continue to be so. We regret the decision of @RealDonaldTrump to order a halt in funding to WHO."

In a news conference on Thursday Dr Hans Kluge, WHO regional director for Europe, acknowledged that this would not be a good time to receive a cut in funding from the United States because the world is in the midst of the COVID-19 crisis. "But WHO are laser focused for the time being on saving lives and leaving no one behind, and we count very much that our long-standing supporter and friend, the United States of America, and its people will continue to support WHO."

However, there is still a chance that President Trump will not deliver on his announcement. Groups like Rotary International and the Bill and Melinda Gates Foundation have written directly to the president expressing their concerns, said Prof Heymann.

"The Democratic Party is also working to block this, and of course this has to take on a status beyond a declaration and pass several committees within Congress," Prof Heymann said. "Hopefully committees that understand the importance of WHO would be in favour of not cutting the funding."

Making Health Political

Mr Trump has been criticised for his own management of the pandemic by acting too slowly to stop the spread of the coronavirus. Other experts have been reacting via the Science Media Centre.

Dr Gail Carson, director of network development at the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), drew attention to the political agenda that arguably underpins this threat to public health. "My plea would be to not make health political, particularly at this time."

Echoing Dr Carson, Prof Peter Piot, director of LSHTM, also expressed dismay in this respect. "Halting funding to the WHO is a dangerous, short-sighted and politically motivated decision."

Global Health Experts Rally Round to Support WHO

Contrary to causing a fissure in WHO, the US announcement appears to have unified support from other member states and experts in global health. WHO was "overwhelmed by the expression of support not only of European countries, but globally", added Dr Kluge.

Dr Piot remarked: "We must stick together. Solidarity is crucial to defeating this virus."

Richard Horton, the editor-in-chief of The Lancet, tweeted that Donald Trump's decision to defund the WHO was "a crime against humanity … Every scientist, every health worker, every citizen must resist and rebel against this appalling betrayal of global solidarity."

The American College of Physicians (ACP) said in a statement it was "gravely concerned" that President Trump's decision will "undermine the effort to make progress on the COVID-19 pandemic in the US and across the world.

"We urge the President to immediately restore US funding to WHO, and for Congress to take appropriate action to ensure its continued funding."

Bill Gates tweeted: "Halting funding for the World Health Organization during a world health crisis is as dangerous as it sounds. Their work is slowing the spread of COVID-19 and if that work is stopped no other organization can replace them. The world needs @WHO now more than ever."

Dr Carson, who is also an infectious disease consultant from the University of Oxford, noted that without continued full international cooperation "the [corona]virus will circle the world again… There is plenty evidence of all the good WHO has done during this pandemic. Perhaps the US reviewers might even come out with recommendations on how WHO could be strengthened and supported more."

WHO Global Commitments

The outpourings of support not only apply to the WHO's work in relation to their handling of the coronavirus pandemic, but importantly, they extend to the wider long-term commitments of the organisation to global health for the public, patients, and health workers.

Prof Heymann remarked that as a result of the halt in funding, clinicians involved in WHO-coordinated research might also be on the unfortunate receiving end of this decision. "WHO right now is implementing a multicentre trial of hydroxychloroquine in many countries including developing countries. These programmes might be stopped because they are carried out on standardised proposals of the NIH [National Institutes of Health] and [the] Wellcome Trust, for example."

Regarding the importance of diagnostic testing to the practising clinician, he added that: "The WHO is really the only group qualified to assess new diagnostic tests as they emerge. Clearly countries are doing this too, but the WHO serves as the global standard to enable recommendation."

Some experts have raised concerns that any threat to WHO's funding could cut off a lifeline for low- and middle-income countries and place hundreds of millions of people at risk.

"The US has long been a leader in global health, and we must not reverse course now," said the presidents of the US National Academies, Marcia McNutt, National Academy of Sciences; John L. Anderson, National Academy of Engineering; and Victor J. Dzau, National Academy of Medicine, in a joint statement. "The US Government should maintain its leadership position in global health as a matter of urgent national interest and as a global public benefit that enhances America's international standing."

Which Kind of Funding Will the US Halt?

In 2018-2019, the US provided about 15% of the WHO budget. There are two forms of funding provided by the US to the WHO – a so-called assessed contribution and an extra budgetary contribution. "As yet, it is unknown whether the US might block one or the other or even both forms of funding," said Prof Heymann.

The voluntary contribution is donated for priorities chosen by the donating government. For the US, it is polio eradication, among other things. "If it's the extra budgetary funding, this would have clear and terrible impact on polio eradication activities which are at a crucial point," Prof Heymann said.

However, he added that if it is the assessed contribution, the impact would be absorbed by the secretariat in some way. "They [WHO] would certainly continue to do what they're doing so well now, which is the technical collaboration across all countries despite geopolitical tensions. This will continue and WHO's strength is in providing analysed information rapidly that helps countries control outbreaks."

But Prof Heymann sounded a note of warning, pointing out that if the US does not provide funding to the regular WHO budget, then sanctions exist that could arise within the governance structure. These sanctions apply to all member states if funding is missed. "But I don't think WHO has ever taken this action."

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