NEW YORK — The Trump administration’s decision to withdraw funding from the World Health Organization could result in swift reductions in health programs, or it could drag out indefinitely without any clear action.
After weeks of threats for WHO to “reform or else,” President Donald Trump announced at the end of May that the U.S. government would cut all funding to the global health entity. Legal questions remain, as the U.S. has yet to formalize the end of their WHO relationship with official communication.
There has been no additional outreach to WHO or the United Nations secretary-general since the initial announcement, according to development experts.
“It is very unclear, the full intent of the U.S. government with regard to that announcement,” Kate Dodson, vice president for global health at the UN Foundation, told Devex late last week.
“Is this really going to happen? How much of this is bluster, and how much of this is real? I don't think it is totally clear. Some of this has been politics, just politics.”— Jen Kates, senior vice president and director of global health and HIV policy, the Kaiser Family Foundation
There are also various ways that the U.S., the top WHO donor, could make good on its promise to pull funding, global health and development experts tell Devex.
“We don’t fully understand what they are doing with the WHO. Trump has used a lot of language to describe what is happening and others in the administration have used different language, so the exact mechanism or the route by which they are trying to do this is unclear,” said Conor Savoy, executive director of the Modernizing Foreign Assistance Network.
Future — or already promised — funding might not come through
The U.S. gave $893 million to WHO from 2018-2019, of which $237 million were assessed contributions, or annual dues governments pay to remain part of the member-based organization. Polio eradication work constituted 27% of the U.S. contributions, according to WHO Spokesperson Fadéla Chaib.
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But the U.S. still owes approximately $392 million to WHO through various multiyear cooperative agreements, according to Dodson. Some of this money would carry over into WHO’s next fiscal year of 2022-2023.
Now, the worst-case scenario is that the U.S. does not pay the money it already promised WHO, Dodson explained.
“If the U.S. were to pause all of its funding, or continue to pause all of its funding, the implications and the impacts at WHO would be varied over the course of the next few years. That’s because the U.S. government and WHO have a multifaceted relationship. There is voluntary funding that flows from the U.S. CDC, USAID, and from the State Department,” Dodson said.
If the U.S. does not pay its routine dues to WHO, it would find itself in the company of Venezuela, South Sudan, and other countries that have lost their voting rights after not paying arrears.
“Governments that have had trouble paying their dues can be reinstated. It’s the same as when you owe money through credit card companies. The precedent is to correct, to make good on the arrears. But we will see what happens in this case,” said Amanda Glassman, executive vice president at the Center for Global Development.
Where the cuts could be felt
Already underfunded areas of work the U.S. has supported, like polio eradication, might feel the impact of cuts before other more financially stable programs. Those cuts would be compounded by the fact that WHO has had to stop polio programs during the pandemic.
“WHO may feel the deficit of the government not funding them soon, in some cases. Polio is one of those areas where the impact may be more acute, because the funding runs out sooner. If the U.S. chooses not to release its next disbursement on any of these multiyear cooperative agreements, that is where the burn will be felt soonest,” Dodson said.
“This is something that really has a very prompt and negative impact on not just the WHO, but the global capacity to get things done,” said Tom Frieden, president and CEO of Resolve to Save Lives, a Vital Strategies initiative that works on health epidemics. Core WHO work including assessing COVID-19 vaccine trials, providing health guidance, and supporting individual countries could all be jeopardized, he explained.
A U.S. withdrawal from the World Health Organization would elevate the Bill & Melinda Gates Foundation to top donor, prompting questions about what such influence from a single private foundation could mean.
“All of those things are at risk and having insecurity of funding has negative consequences beyond individual efforts. It means it is harder to hire staff, it is harder to enter into contracts. It is very disruptive for organizations,” Frieden continued.
Donors adopt ‘wait and see’ approach
“Menendez’s bill includes some clauses to finance the WHO and pay the assessed dues, but the question is whether those will pass given the present political situation,” Glassman said.
“I know there is some disagreement about the versions of the draft legislation that makes me think that the bills will not go through.”
The waiting period could drag on past the November presidential election, Glassman said.
“I am hopeful, but I am also realistic. It is a difficult period and we are in the pre-election period. The probability of bipartisan effort is low. I think basically everyone is waiting for the election,” Glassman said.
Even if Congress votes to authorize funding for WHO, “that doesn’t mean the administration has to spend the money,” Savoy said. Trump has ignored Congressional appropriations for Ukraine aid, for example, in the past.
“The reality is the White House has a certain amount of discretion to make decisions about this. But it doesn’t mean that a future president could not bring us back or restore the funding. It is not like Joe Biden wouldn’t bring us back to the WHO,” Savoy explained.
China, Ireland, and Finland have all recently increased their contributions to WHO. Other donors have reaffirmed their support for the global health entity, but there has not been a surge in funding to match U.S. contributions. The Bill & Melinda Gates Foundation is set to become the agency’s largest donor if the U.S. withdraws.
“It’s not like there is another big polio funder out there. There is the Gates Foundation, but given that the Global Polio Eradication Initiative has suspended its activities because of COVID, it is already going to suffer,” said Jen Kates, senior vice president and director of global health and HIV policy at the Kaiser Family Foundation.
Kates said donors are adopting a “wait and see approach.”
“Is this really going to happen? How much of this is bluster, and how much of this is real? I don't think it is totally clear. Some of this has been politics, just politics,” Kates said.