Covid-19: Trump halts WHO funding in move labelled “petulant” and “short sighted”BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1502 (Published 15 April 2020) Cite this as: BMJ 2020;369:m1502
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Should the WHO’s chronic disempowerment and impecuniousness concern us? A comparison of WHO funding with global defence spending and the estimated costs of the COVID-19 pandemic is thought-provoking.
COVID-19 has the potential to be a massive existential threat and, even if it ultimately turns out not to be, its successors might.
At this “critical time in human history,” (1) any serious financial threat to the World Health Organisation (WHO) has to be seen in the wider political, economic and social context.
To take the discussion forward, it may be of value to look at some financial numbers.
In 2018, total world-wide military expenditure amounted to US$1,822.0 billion, an increase of 2.6% from 2017. (2) This cash will have come from taxpayers. It is widely argued that the reason for spending his money is for deterrent purposes, in other words for the promotion of risk reduction. The USA was responsible for paying 36% of this money (US$656 billion) and the UK 2.7% (US$50 billion).
In comparison, this year COVID-19 will be responsible for a worldwide loss to national economies (and hence taxpayers) of at least US$1,000.0 billion and possibly up to US$2,000.0 billion.(3)
To put this further into context, when it comes to the WHO – an entity that is also in the business of the promotion of risk reduction – the total budget available in 2018-19 was slightly less than US$4.5 billion. (4) This is 400 times less than the total amount allocated in 2018 for defence-related spending.
It is hard to overestimate of what fundamental importance the activities undertaken by the WHO are. Indeed the WHO has many vital roles – quite possibly too many! - and with the current COVID-19 emergency, it is - as with past pandemics – delivering on its duties on pandemic alert and response front. (5) The initiation and coordination of as credible and united an international response to a pandemic as it is possible to achieve is absolutely essential, and is one of many reasons why the WHO is important. To achieve this, the WHO works with and through a wide variety of governments and organisations, over which it has no power whatsoever. During this pandemic, it has been noticeable that the WHO is only able to draw the attention of independent countries to relevant issues and to make recommendations - it is not empowered in any way to order or compel them to take action of any sort. (6) Given the incredible and undeniable importance of maintaining good health and well-being to every human being alive today, such a lack of power and autonomy being vested in the key international non-governmental organisation (NGO) with, in theory, prime responsibility for safeguarding such a vital area of human existence could seem anomalous, and it seems reasonable to ask why that should be so.
In fact, international NGOs such as the WHO are only ever as strong and autonomous as independent nations are prepared to make them, and up till now things have stayed more or less exactly the same as they were the day the WHO was founded after World War 2. It has been said that the organisation has “194 masters, and those 194 masters don’t necessarily have the same agenda”, and it has forever been hamstrung by chronic under-funding.(6) When looked at from this perspective, President Donald Trump’s recent move to withdraw US-sourced funding (7) could be interpreted as being symptomatic of a larger and wider international trend towards declining levels of trust in global organisations.(8)
Overall, it is possible that if one stands back, jettisons the age old “received wisdom” that it is essential for the peoples of the world's well-being to “arm itself to the teeth”, (9) and pauses for a moment to reflect, one could perhaps end up concluding that at this moment in time taxpayers’ money might not be being spent in ways that preserve the most human lives and generate the greatest value for money. This is most certainly not in any way saying that military capacity and defence capability are not extremely important – they most definitely are, and indeed the United Nations charter makes it clear that in international law there exists the inherent right of a Nation State to use force in response to an armed attack.(10) However, people also need defending from lethal pandemic infections, and it has now for certain become clear that it is not wise to, on the one hand, pay whatever it takes on a military front and yet, on the other hand, systemically starve the systems that enable an international health response of essential resources. That said, fortunately not everyone is completely unwilling to take out and open their wallet and, recognising the organisation’s importance to international infection prevention and control, the Bill and Melinda Gates Foundation have very recently entrusted the WHO with US$150 million to “help speed up development of vaccines, treatment and public health measures” to help the fight against COVID-19. (1)
Prevention is always a much better option than cure, and we absolutely must ensure we plan effectively for the future. As part of this, it may be that the COVID-19 experience is telling us that the time has come to consider greater empowerment of the WHO. At the very least there surely must at some time soon be a serious conversation about this – it is too important a matter for one not to be initiated, and in a forthcoming post-pandemic world national and international priorities and budgets will need to be carefully looked at.
The authors would definitely welcome a wider debate on this and related issues.
1. Fletcher ER, Vijay SL. “African Health Leaders, Scientists Protest US Decision To Suspend WHO’s Funding; Gates Announces $150 Million More For COVID-19 Emergency.” Health Policy Watch, 16 April 2020. https://www.healthpolicy-watch.org/scientists-african-health-voices-prot...
2. “Global defence spending is at a record high – four charts that show where the money goes.” World Economic Forum, 30 April 2019. https://www.weforum.org/agenda/2019/04/4-harts-that-show-the-state-of-gl...
3. “Coronavirus update: COVID-19 likely to cost economy $1 trillion during 2020, says UN trade agency.” UN News, 9 March 2020. https://news.un.org/en/story/2020/03/1059011
4. “WHO Programmatic and Financial Reports.” World Health Organisation, 2020. https://www.who.int/about/finances-accountability/reports/en/
5. “Strengthening health security by implementing the International Health Regulations (2005): Global Outbreak Alert and Response Network (GOARN).” World Health Organisation, 2020. https://www.who.int/ihr/alert_and_response/outbreak-network/en/
6. Bort R. “Why the World Health Organization’s Response to COVID-19 Is Crucial to the Future of Public Health.” Rolling Stone, 31 March 2020. https://www.rollingstone.com/politics/politics-features/world-health-org...
7. Allen L. “Defunding the WHO was a calculated decision, not an impromptu tweet.” The Conversation, 20 April 2020. https://theconversation.com/defunding-the-who-was-a-calculated-decision-...
8. Cornish L. “In an era of declining trust, how can NGOs buck the trend?” Devex, 16 February 2017 https://www.devex.com/news/in-an-era-of-declining-trust-how-can-ngos-buc...
9. “Tooling up: Military spending around the world is booming.” Economist, 28 April 2019. https://www.economist.com/international/2019/04/28/military-spending-aro...
10. ICRC. “How does law protect in war?” Online casebook, 2020. https://casebook.icrc.org/glossary/self-defence
Competing interests: No competing interests
To: Tedros Adhanom Ghebreyesus
Director General and Team,
The World Health Organization,
Dear Dr. Tedros and Team,
We the undersigned have noted with concern the recent personal and institutional attacks against you and WHO. We want to let you know that the world and humanity needs the institution of the World Health Organization (WHO) now more than ever. In the wake of the COVID -19 pandemic the technical guidance and leadership of the WHO that you and the leadership team in Geneva, Regional and Country Offices round the world is valued and appreciated.
A number of us were members of the Commission that released the report “The Neglected Dimension of Global Security: A Framework to Counter Infectious Disease Crises” in 2016. Having reviewed a wide range of options for a coordinated global response to infectious diseases, we concluded that the WHO is best placed to play the leadership and coordinating role and that if there was no WHO, we would have to invent one.
This is why we are writing to you to let you know that at this critical time in human history, it has fallen upon you and your WHO team to carry the singular responsibility of leading and coordinating the global charge to stop COVID -19 from killing more people and wreaking more collateral economic and social damage to the world.
We would like you to know that we have noted some of the attacks that have been leveled at WHO and to you personally. We know that some of these attacks are motivated by a number of factors that have nothing to do with your leadership of the WHO.
We are delighted and encouraged that despite these attacks you and WHO are committed to continue to focus on saving lives and controlling the pandemic with statements such as “No time to waste. Let’s focus on saving lives. Collaboration across party lines important to ensure national unity to fight the virus more effectively. National unity is a foundation for global solidarity. When we do this, we quarantine political covid. Stop politicizing #COVID19”.
We are equally encouraged by the timely financial support that has been extended to WHO by Governments and Non-State Actors at this critical time and we call for all governments, rich and poor including the Private sector to come forward with the urgently needed additional financial support to WHO in the spirit of global solidarity.
1. Francis Omaswa, Executive Director, African Center for Global Health and Social Transformation (ACHEST), Kampala, Uganda.
2. Nigel Crisp, House of Lords, UK
3. Suwit Wibulpolprasert, International Health Policy Program (IHPP Thailand), Ministry of Public Health, Thailand
4. Miriam Khamadi Were, Member, Champions of AIDS-Free Generation, Nairobi, Kenya
5. Marietjie de Villiers, AFREhealth President, Professor in Family Medicine, Stellenbosch University, South Africa
6. Hon. Keith Martin MD, PC , Executive Director, Consortium of Universities for Global Health, Washington, DC, USA
7. Peter Berman, Professor and Director, School of Population and Public Health, University of British Columbia, Vancouver, Canada
8. Yoswa Dambisya, Director General, East, Central and Southern African Health Community, Arusha, Tanzania
9. Nelson Ssewankambo, Makerere University College of Health Sciences, Kampala, Uganda
10. Tsion Firew, Special Advisor to the Minister on Emergency Care and Strategic Partnerships, Federal Ministry of Health, Ethiopia
Competing interests: No competing interests