A key meeting of the WHO’s executive board has spawned an upswell of calls to overhaul the UN agency’s funding, with leaders saying failure to invest in global health left the world ill-prepared for the COVID-19 “tsunami of suffering”.

letter signed by a host of leaders including Helen Clark and Ellen Johnson Sirleaf, co-chairs of the Independent Panel for Pandemic Preparedness and Response, and Gordon Brown, WHO Ambassador for Global Health Financing, decried the world’s “ailing approach to investing in global public health, and universal health coverage”, laid bare by the COVID-19 pandemic.

The WHO executive board at it’s 150th session nominated Dr. Tedros Adhanom Ghebreyesus, for WHO Director-General position to be decided at the World Health Assembly in May 2022. Photo: WHO.

They said repeated warnings to strengthen defences against pandemics had been ignored, “leaving the world dreadfully ill-prepared almost two years ago for the tsunami of suffering to come”.

“The funding problems of the WHO are not new, but rather have been playing out over decades,” they wrote in the widely published letter. “They are symptomatic of an overall failure to invest sufficiently in global public health. This must stop now.”

Advocates for change say the health body is currently both underfunded and financially constrained. Only 16 per cent of the WHO’s finances currently derive from governments’ membership dues, with “no strings attached”, the letter explains.

“The overwhelming remainder is provided as voluntary contributions, often with tight and sometimes restrictive conditions.”

The issue of financing was being discussed at the 150th meeting of the executive board running from 24-29 January.

separate letter, sent to board members on 22 January and undersigned by more than 50 non-profit organisations, said: “Every major international review panel that has assessed the COVID-19 pandemic has identified WHO’s limited and unpredictable financing as a needed area for reform.

“The world needs a strong, sustainably financed WHO that is not subject to the political influence of its donors or the whims of funding flows.”

However, the WHO’s biggest funder, the United States, has been cautious of calls to increase the “no strings attached” funding, instead preferring to continue most of its funding through voluntary contributions, allowing it to check the money was used for the purposes it was given.

It comes against a backdrop of longstanding US wariness over the WHO, which culminated in President Donald Trump announcing his intention to withdraw from the WHO in 2020 due to concerns over Chinese influence during the pandemic, a move reversed by his successor Joe Biden.

However, Kate Dodson, vice president for global health strategy at the UN Foundation, who delivered this letter on behalf of signatories, told SciDev.Net that the “vast majority” of WHO Member States were keen to progress improvements to the way the WHO is financed.

“But Member States need to act on full consensus on this,” she added. “Majority won’t alone prevail. If they don’t act by May 2022’s World Health Assembly, this agenda may succumb to the common maxim: after panic, comes neglect. We may miss this window.”

The executive board meeting saw WHO director-general Tedros Adhanom Ghebreyesus nominated uncontested for a second term in a procedural vote on Tuesday. He will almost certainly be re-elected at the World Health Assembly in May.

Congratulating him on Twitter, WHO chief scientist Soumya Swaminathan said the WHO, as the only global health agency, needed sustainable finance “to deliver on its huge mandate”.

Lawrence Gostin, director of the WHO Collaborating Center on National and Global Health Law at Georgetown University, in the US, told SciDev.Net that the WHO’s budget was “wholly incommensurate with its global responsibilities”.

“Its budget is less than the size of many US teaching hospitals and one-fourth the funding that CDC [Centers for Disease Control and Prevention] gets,” he explained.

“The funding WHO needs isn’t a lot for rich countries like the US and European countries,” he added. “We currently have the WHO we deserve because we give it so little funding. We need a formula that will sustain WHO capacities to fight this pandemic and for future health emergencies.”

WHO Member States leading on the sustainable finance agenda came up with a set of recommendations in November. These include stepwise increases in assessed contributions from Member States to 50 per cent of the base budget by 2029 – roughly doubling most members’ contributions.

Voluntary contributions should also have a higher degree of flexibility, the draft report of the Working Group on Sustainable Financing suggested.

Additionally, improvements in transparency around budget setting and prioritisation by the WHO Secretariat is needed, believes Dodson, as well as a close look at budget efficiencies.

“The blueprint is there,” she said. “And … the vast majority of Member States support it. But there are some fence-sitters and some detractors … who need to continue to be persuaded this is the path toward a stronger, higher performing World Health Organization.”

This piece was produced by SciDev.Net’s Global desk.

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