Devex CheckUp: WHO's financial crisis deepens

Last Friday, I reported that the World Health Organization faces a $600 million funding shortfall for 2025, as WHO chief Tedros Adhanom Ghebreyesus spelled out in his email to staff, announcing how “despite our best efforts, we are now at the point where we have no choice but to reduce the scale of our work and workforce.”

Reductions will begin at headquarters — which some staffers say will bear the brunt of the cuts, though all levels of the organization will be affected. WHO is also looking at merging divisions, departments, and units, and relocating Geneva functions, such as in Berlin where the WHO Hub for Pandemic and Epidemic Intelligence is located.

Future financing appears to be bleaker.

In a recent presentation to member states, a copy of which I’ve seen, preliminary analysis of WHO’s financial outlook for 2026-2027 shows it has a gap of over $1.8 billion, or roughly 43% of its targeted budget of $4.2 billion — already 21% lower than its original ambition.

Furthermore, the category of “secured funding,” as opposed to “expected funding,” includes figures based on an increase in membership dues that still needs to be approved at the 78th World Health Assembly in May. It’s also unclear how much money the agency will be able to carry forward due to significant funding shortfalls in 2025.

Projected funds include those from Gavi, the Vaccine Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria, both of which are similarly facing a challenging replenishment period.

A WHO official, speaking anonymously because they are not authorized to speak on the matter, tells me: “To add it all up and say that this is how much we have, well, we don't have that.”

One staff member initially told me that the sentiment is mixed among staff, thinking the impact of the cuts will only be those on temporary appointments. But “people of all contract types are now concerned,” the staff member says.

Read: WHO grapples with significant funding shortfall

ICYMI: Faced with $600M income gap, WHO to scale back on work, staff, budget

Der freund

On Wednesday, German federal health minister Dr. Karl Lauterbach announced €2 million for WHO, “with a view to provide additional support in the future to come,” during an event at the WHO pandemic hub in Berlin.

“Given the ongoing process of our new government formation and budget restrictions, providing new financial support is challenging. But in difficult times, every euro, every dollar counts,” Lauterbach said.

Tedros said the €2 million builds on the €240 million pledge German Chancellor Olaf Scholz made last year as part of WHO’s investment round. It is “more important than ever” especially with the U.S. decision to withdraw from WHO and reductions in development assistance from some countries.

It’s the final countdown

Will they? Won’t they?

That was the big question for weeks as the development sector debated the potential future of the U.S. Agency for International Development, after the Trump administration terminated thousands of USAID awards and laid off thousands of its staff and contractors.

But last week the Trump administration finally laid bare its plans to shutter the agency, while merging some of its programs and functions under the State Department. The proposal — which expects the reorganization by July — is being put before the U.S. Congress, which created the agency and therefore is legally entitled to abolish it.

Under the proposal, USAID’s global health programs will be managed by the State Department’s Bureau of Global Health Security and Diplomacy.

What happens to unobligated USAID funds — those appropriated by Congress but not yet specifically allocated or contracted — for global health? My colleagues Adva Saldinger and Elissa Miolene report that it will require congressional approval to change how the money is spent.

Read: Trump administration reveals its plans to Congress to 'abolish' USAID

Read more: USAID's 'final mission' email slashes agency's staff, one last time

+ Join our live panel on April 7 to discuss the proposed USAID-State Department merger. Experts will cover benefits, downsides, and challenges. Save your spot now.

The one that got away

It’s already pretty well known that many United Nations entities and multilateral institutions weren’t spared from the USAID cuts.

My colleague Miguel Antonio Tamonan dug through pages of terminated USAID awards and identified 17 multilateral agencies that will be losing nearly $4.1 billion in total. They include WHO, the Pan American Health Organization, UNICEF, UNAIDS, the U.N. Population Fund, and Gavi.

However, one major multilateral is conspicuously absent from the list — the Global Fund, which has received significant amounts of funding from the U.S. government for more than two decades. Miguel reports that USAID had committed $13.4 billion to the Global Fund from 2017 to 2027. All that money’s been obligated, but not yet paid in its entirety.

Read: Which multilaterals are hit most by USAID terminations? (Pro)

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Cuts like a knife

While Congress debates the future of USAID, they will also have to think about what to do with the many programs left hanging by terminated USAID awards.

In Africa, that includes rehab centers and clinics that offer treatment for opioid addiction and related mental health disorders. In Kenya, the funding cuts mean a halt in the operations of methadone clinics providing opioid substitution therapy that are partly funded by the U.S. President's Emergency Plan for AIDS Relief. It also disrupts the training of African medical professionals on the treatment of opioid abuse and addiction.

Furthermore, the cancellation of USAID grants that paid for the delivery of lifesaving HIV treatment has had serious repercussions in Uganda. My colleague Andrew Green visited health facilities in two different districts this week and found shortages of antiretroviral medicine in both areas.

One health center no longer has the preferred primary treatment for children with HIV. Instead, pharmacists are portioning out adult versions of the drugs and hoping that the children will be able to tolerate them.

Ugandan officials insist treatment will remain freely available — but without any assistance, it will take time for them to rebuild USAID-supported procurement and distribution systems.

Read: Amid global health funding cuts, Africa is struggling with opioid abuse

Plus: Frustration mounts as Uganda faces HIV treatment shortages

Your next job?

With so many organizations impacted by the U.S. funding cuts, many health-focused organizations have imposed hiring freezes. But several of them are still hiring apparently, including WHO and UNICEF. The Asian Development Bank, the World Bank, and the Gates Foundation also have open positions.

Read: Who’s hiring in the health sector — and what for?

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What we’re reading

The Children’s Investment Fund Foundation committed $150 million to the Global Fund, the first pledge in the fund’s new replenishment campaign. [The Global Fund]

New York University canceled a talk by the former head of Médecins Sans Frontières due to concerns that her presentation, which included slides on USAID cuts and casualties in Gaza, was “anti-governmental.” [The Guardian]

The Trump administration began mass layoffs in U.S. health agencies, including at CDC, FDA, and NIH. [Reuters]