More Symbolic than Catastrophic: What US funding cuts might mean for the WHO

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Author: Emma Baumann, Osgoode Hall Law School

There has been much conjecture and debate about how coronavirus and a virtually worldwide lockdown will change the landscape of international law, relations, and global health policy. Especially given Trump’s April announcement, he would halt US funding to the World Health Organization (WHO).

This specialized UN Agency born in 1948 is credited with the eradication of smallpox and drastic reductions in rates of polio infection worldwide. It has coordinated responses to SARS in 2003, and Ebola more recently. Notably, as coronavirus continues to dominate headlines, the organization has just identified a new Ebola outbreak in the Democratic Republic of the Congo.

An understanding of how the WHO is funded and resource allocation in the South East Asian Region indicates this move by the US is likely more symbolic than catastrophic for WHO operations in the Region and in general. The questions that remain are less around whether the gap in funding will be filled, but rather, who will fill it and what this will mean going forward.

Funding the WHO

The WHO budget is made up of mandatory dues paid by the 194 member states as well as ad hoc funding from governments and private entities (the highest donor after the United States is the Bill and Melinda Gates Foundation). Trump’s decision to halt funding was criticized domestically and internationally. Boris Johnson, however, acknowledged the critical role of the WHO in coordinating a global response to coronavirus (the United Kingdom is the highest state donor after the United States). In contrast to Trump’s April announcement, France and Germany have doubled down on their funding commitments and the need for a coordinated response to global pandemics and global health more generally.

Leaving condemnation from other world leaders aside, the numbers suggest this is an ill-advised move, given the potential return on investment that can come from healthier populations. The proposed programme budget of the WHO for 2020-2021 suggests funding to promote healthier populations have results ranging from returns of USD 1.50 to USD 120 for every dollar invested. This makes the US move more puzzling, especially given commentators who have noted the sums involved for the US, are similar to what it costs to run a large hospital. The criticism and the numerical data leaves one to wonder the motivation of the American move and the ramifications that may follow.

A Note on the South East Asian Region

The WHO South East Asia Region (SEARO) has 11 member states – Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor-Leste. The Region has its own Coronavirus Response Plan. It identifies gaps in national laboratory capacity, available logistics (PPE, transport media and lab reagents), and infection prevention and control practices in SEARO countries. The plan also puts total resource requirements at just USD 5, 510 000 —a small fraction of the overall operating budget of the WHO.

Indicative of the utility of WHO membership during a global pandemic, since the beginning of the outbreak in March, the WHO has been assisting SEARO countries who lacked the capacity to test by shipping their samples to Thailand and India. They have also conducted webinars on matters relating to testing, case management, and infection prevention and control.

Outside of the coronavirus response strategy, the overall increases in spending by WHO in 2020-2021 towards the South East Asian Region budget is primarily due to the transition from polio eradication activities to essential health functions. This expenditure is arguably indicative of the positive results of the WHO’s polio eradication activities in the Region. Moreover, there is no indication that the lack of US funding will impact this strategy.

Looking to the Future

As travel restrictions ease in the EU (with the US notably excluded) and coronavirus cases surge in India and Bangladesh, questions about diplomacy and reviving stagnant economies mix continue to arise.  These questions are in addition to the questions about health, safety, and how to avoid a resurgence of coronavirus.

It is possible that the bang for its buck the US received as a large WHO funder—in terms of over-representation among WHO leadership, and influence over the direction of the organization—will instead be reaped by China. This would be in step with China’s strategy in recent years of aligning itself with global institutions when it suits them, pursuing global influence while pushing messier questions of human rights aside.

Trump’s announcement represents a blow to American soft power and an opportunity for more involvement by China. The US move is less catastrophic than it is symbolic of America first policy which sees monetary contribution to international organizations as a raw deal—America foots the bill. At the same time, other countries fail to contribute their fair share. Trump’s decision is interestingly reminiscent of his administration’s failure to appoint new members to the WTO Appellate Body, effectively rendering it inoperable.

While the US has submitted its official notice of withdrawal to UN Secretary-General, it remains to be seen whether the conditions for withdrawal have been met. This includes the requirements for meeting financial obligations (assessed contributions by WTO member states are due January 1, 2021). Some go so far as to question whether the US can even withdraw from WHO, as the constitution lacks provision contemplating withdrawal. However, it is unlikely that this will be a bar to withdrawal.

Even if China fails to step up, it seems likely that other countries will follow the leads of France and Germany and renew calls for a unified response and contribution of funding. Some suggest the gap left by the United States in global institutions could present a unique opportunity for collaboration through cooperative agreements among like-minded states. This comes as an opposition to the top-down international governance heavily influenced by American hegemon.

Though criticism of the WHO is likely warranted, the COVID-19 pandemic highlights the need for a coordinated strategy from an international organization, rather than fragmentation and funding cuts. The protectionist response of state governments to coronavirus has demonstrated that for the moment, a world without the WHO is less than desirable. The calls by world leaders for equitable access to treatment and vaccines certainly speak to that.

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