President Trump announced Tuesday he would put a hold on money spent with the World Health Organization (WHO) amid criticism of the way the international institution has handled the COVID-19 pandemic. 

Trump argued against what he considers WHO’s “China-centric” policy and regretted its lack of leadership in handling global health. 

This comes after Trump has experienced worldwide and domestic criticism over the way he has reacted to the disease, of which the United States is currently the world epicenter, with more than 610 000 confirmed cases and 26 000 deaths. 

New York City alone has 8,000 deaths and despite massive testing, the spreading of COVID-19 is far from over – even the Mexican Ambassador to the United Nations in New York, Doctor Juan Ramón de la Fuente, has tested positive for COVID-19.

Trump’s criticism on multilateral institutions is not new. In October 2017, the Trump Administration announced the U.S. withdrawal from the United Nations Organization on Education, Science and Culture (UNESCO) effective on January 1, 2019. He has also been critical of the United Nations and, in general, he despises multilateralism, no matter the key role the United States played in the UN’s creation after World War II.

The United States is a key financial contributor to the United Nations System as a whole and WHO in particular. Born in 1948, the Geneva-based world health body has historically experienced financial difficulties despite major public health achievements such as the eradication of smallpox (1980), the negotiation of the Framework Convention on Tobacco Control (2003) and the approval of the International Protocol for Assessing National Surveillance and Response Capacities for the International Health Regulations (2005). 

WHO’s 194 members are responsible for providing financial support for the organization. These assessed contributions are determined by a country’s wealth and population. Yet, WHO needs more money to achieve its goals. This is why Article 57 of the WHO Constitution allows for voluntary contributions as long as these are consistent with the objectives and policies of the international institution. This explains that governmental contributions have diminished whereas private donors have become prominent players in world health policies.

The international changing environment and WHO

The world in which the World Health Organization was born doesn’t exist anymore. At the time of its birth (1948), the World Health Organization was expected to contribute to a better health for around two billion inhabitants. Infectious diseases were the major challenges at that time. Today, the world population is around eight billion people, with a longer life expectancy (76 years in 2016) where non-communicable diseases tend to prevail as threats to health. Yet infectious diseases have not gone away and lower respiratory tract infections such as influenza and different types of coronavirus have claimed the lives of thousands of people. Globalization is the scenario where new diseases can rapidly spread throughout the world, faster than the capabilities of WHO and governments to react.

For this reason, at the end of the last decade, the WHO conducted a review of its financial requirements, by considering also three challenging trends: the existence of a number of actors such as non-governmental institutions, private donors and even celebrities who have a say in world health policies; the capacity of WHO to respond to global health emergencies such as SARS, MERS, A H1N1, and Ebola; and rivalries with other UN bodies, most visible, the New York-based Security Council, which since 2011 tends to address health issues through the glasses of biosecurity concerns by major political powers.

Financing is always a cause of concern since around 20 countries and private donors provide 79 percent of the WHO’s budget, which makes it difficult for the institution to design programs that may lack financing in the future. Being so dependent on a bunch of countries and donors exposes WHO to criticism by some of them for what is perceived as lacking transparency in how the money is spent, and inefficient resource management among other considerations. 

What if the US withdraws from WHO?

Prior to threatening WHO, the Trump Administration announced last February major cuts to global health funds in its 2021 budget proposal, slashing more than $3 billion U.S. dollars in overall programs, including half of its annual funding to the World Health Organization. Thus, it seems Trump just needed an excuse to justify reductions on U.S. contributions to the international body. At that time, the COVID-19 had its epicenter in Asia but was quickly developing in Europe. The efforts of the WHO to understand the virus, the way it spreads, and the history of the disease led to a lot of surveillance put into China, where the virus was initially detected. Thus, the attention that China received by WHO was more than justified. Today, China is the country that knows most about the disease and is currently providing critical medical assistance and equipment to several countries in the world.

Right now there’s a lot of talk about the fact that the now-called COVID-19 had caused several deaths prior to the Wuhan outbreak. Taiwan has insisted that it told WHO about the disease. According to Taipei, WHO dismissed the information. If this is true, the WHO and its head, Doctor Tedros Ghebreyesus have a lot to explain. 

Yet, it is very important to maintain the fight against COVID-19 at this very moment, not only because of its rapid spreading in the U.S., the Americas and the world, but because so far no country has been able to provide leadership in dealing with the pandemic. WHO is the only institution capable of sustaining a global effort to fight a disease that has put half of the world’s population indoors, and whose figures increase day by day – as for now it has surpassed two million confirmed cases and 130,000 deaths around the globe.

A look at WHO’s goals reveals a task out of proportion when its budget is analyzed. According to its 2018 financial statement, the international body received a total of $2.74 billion in funding both in assessed and voluntary contributions. To put it in context this is the equivalent of the gross domestic product of France but destined to increase the health of the populations in 194 countries. The largest contributors to the WHO budget are the U.S., with $281 million, the U.K. ($205 million), Germany ($154 million) and Japan ($86 million). 

The World Health Organization Budget 

As suggested before, WHO has become more dependent on private donors to fulfill its goals. Thus, the Bill and Melinda Gates Foundation is the largest private donor with a massive $228 million – or the second largest contributor overall behind the U.S. China, as can be seen, contributed only $6 million. 

The United States is the key player for both assessed and voluntary contributions. In 2019 it was expected to contribute more than 400 billion U.S. dollars, or 15 percent of the WHO total budget. Yet, the U.S. was already in arrears in payments to the WHO from last year and had not yet made this year’s contribution – and apparently it won’t meet its financial commitments at least not prior to the November presidential election. If the Trump Administration decides to stop financing WH – or even withdraws from the agency – it would harm one of the most important players in health governance. It would hamper WHO from working on several programs to fight diseases. It would prevent children throughout the developing world from getting much needed vaccination. 

President Trump understands that this is probably the worst moment, amidst the COVID-19 pandemic, to scale back financing to WHO. This does not mean that WHO does not need to improve transparency or its resource management capabilities. If there’s something wrong, it must be investigated. Yet this must be seen in the context of American politics. As explained before, Trump has got a lot of criticism not only abroad but at home due to the way in which he’s been handling the outbreak. The presidential election is scheduled for November and Trump may not want the COVID-19 to become an issue at the elections. He needs a scapegoat, somebody or something to take responsibility for this. This could be WHO. Yet blaming WHO could have devastating effects on Americans and the international community. It could also destroy the diminished leadership capabilities of the U.S. in the world.

- María Cristina Rosas is Professor and Researcher at the Faculty of Political and Social Sciences of the University Nacional Autónoma de México.