What the W.H.O. Does, and How U.S. Funding Cuts Could Affect It

What the W.H.O. Does, and How U.S. Funding Cuts Could Affect It

President Trump’s decision to halt funding for the World Health Organization, depriving it of its biggest funding source, could have far-reaching effects in efforts to fight diseases and make health care more widely available across the globe.

Mr. Trump’s order centered on the organization’s response to the coronavirus pandemic, and he is far from alone in criticizing its actions and statements. Some countries have disregarded the W.H.O.’s efforts as the epidemic has spread, failing to report outbreaks or flouting international regulations.

But the W.H.O. is responsible for much more than epidemic response, and it now finds itself financially imperiled by its newfound place in the cross-hairs of American domestic politics.

Here are answers to some common questions about the organization.

Founded after World War II as part of the United Nations, the Geneva-based organization, which has about 7,000 workers spread over 150 offices worldwide, has no direct authority over member nations. Instead, it is intended to be an international leader in public health by alerting the world to threats, fighting diseases, developing policy and improving access to care.

During emergencies like the coronavirus, the W.H.O. is meant to serve as a central coordinating body — guiding containment, declaring emergencies and making recommendations — with countries sharing information to help scientists address outbreaks.

But although the W.H.O. is broadly influential, it lacks meaningful enforcement authority and is under budgetary and political pressures, especially from powerful nations like the United States and China and private funders like the Gates Foundation.

António Guterres, the secretary general of the United Nations, defended the W.H.O. in a statement on Tuesday, saying it “must be supported, as it is absolutely critical to the world’s efforts to win the war against Covid-19.”

He said it is “not the time to reduce the resources for the operations of the World Health Organization or any other humanitarian organization in the fight against the virus.”

Financing comes from participating nations and private foundations. The United States is the largest contributor, making up 14.67 percent of its budget.

Member dues make up about a quarter of the money the United States gives the W.H.O.; they are calculated relative to a nation’s wealth and population. The rest comes from voluntary contributions, which can vary in size year to year.

In 2019, the United States contributed about $553 million. The W.HO.’s biennial budget — every two years — was about $6.3 billion in 2018-2019.

Most of the money from the United States goes toward programs like polio eradication, developing vaccines and increasing access to essential health and nutrition services. Just 2.97 percent of the U.S. contribution goes toward emergency operations, and 2.33 percent is earmarked for outbreak prevention and control.

Lawrence O. Gostin, the director of the O’Neill Institute for National and Global Health Law at Georgetown University, said about 70 percent of the funding from the United States has gone to programs that it has earmarked, such those directed toward AIDS, mental health programs, cancer and heart disease prevention.

“The highest profile is on epidemic control and preparedness,” he said. “But it is actually the least important thing W.H.O. has done historically.”

The U.S. contribution is nearly twice the next-largest contribution from a nation, the United Kingdom, which funds 7.79 percent of the W.H.O. budget. The Bill and Melinda Gates Foundation pays for 9.76 percent of the budget.

The president has accused the W.H.O. of responding too slowly to the threat of the virus and not being critical enough of China. (The same accusations have been leveled at Mr. Trump, who was warned in January about a possible pandemic and who repeatedly praised the Chinese government for its handling of the virus.)

The W.H.O. has consistently advised against travel restrictions, arguing that they are ineffective, can block needed resources and are likely to cause economic harm. But Mr. Trump has frequently pointed to his decision to limit travel from China in late January as evidence he took the threat seriously.

But Mr. Trump is not alone in his criticism. Some experts have said the W.H.O. was slow to declare a public health emergency and was too trusting of the Chinese government, which initially tried to conceal the extent of the outbreak, as the country has gained influence in the organization.

Mr. Gostin said that the organization has been hobbled for structural and political reasons, and become timid as a result.

“We need to build a different one that has ample resources and always has political backing when it speaks truth to power and calls out a country for not behaving properly,” Mr. Gostin said.

“The fact that President Trump is withholding or curtailing funding is exactly the prime example of why we are in this mess,” he said. “The director general is worried that any time he puts a move wrong, they will withdraw funding or undercut the agency politically.”

Throughout January, the W.H.O. issued advisories about the dangers of the virus. From Jan. 22 on, Dr. Tedros Adhanom Ghebreyesus, the W.H.O.’s director general, held almost daily news briefings to warn the world that the virus was spreading, and that the window of opportunity to stop it was closing.

But the organization initially hesitated to declare a global health emergency even as the virus spread outside of China.

“This is an emergency in China, but it has not yet become a global health emergency,” Dr. Tedros said on Jan. 23. “It may yet become one.” On Jan. 30, the W.H.O. made the official declaration, which often prompts governments to take action. Soon afterward, the State Department warned travelers to avoid China.

For weeks, the W.H.O. issued guidance and warnings, and it officially declared the outbreak a pandemic on March 11, calling on governments to work together to battle the virus. Critics said both its declarations came too late, and that earlier decisions could have mobilized governments more quickly. While the W.H.O. is intended to coordinate the worldwide response, there has been little global solidarity, showing the limits of its power. The organization had a plan, but few countries have hewed to it.

Mr. Gostin said that in the long run, the president’s decision to cut the funding could lead to a restructuring of the W.H.O., with new international leadership, new health alliances, and greater control over its budget.

He said the United States has also been “a thorn in the side” of the W.H.O. over the years, blocking some of its efforts on access to medicines or watering down global action plans on migrants and refugees.

“I kind of view it as a forest fire that is out of control, caused by, in this case, the president of the United States, that clears the brush and allows for new growth,” he said.

But he added: “I think that President Trump in this singular act has taken a step too far.”

“This will enormously erode American influence in the world and in global health and international affairs in the midst of an epidemic of unprecendented scope,” he said. “We will lose our voice, and even our influence, even with our allies. I don’t think we get a say anymore with how this unfolds.”

Christine Hauser contributed reporting.

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