WHO needs healthy financing

How much is our health worth? If COVID-19 has given any guide, clearly not enough.

This stark reality has been ignored for too long—at a price the whole world can now see. Lip service, largely, was paid to warning after warning to strengthen the world’s defenses against pandemics of novel pathogens, leaving the world dreadfully ill-prepared almost two years ago for the tsunami of suffering to come.

The subsequent toll has been great and is growing: more than 5 million lives lost with numbers of deaths still rising, and countless millions more infected, and with many of those seriously ill globally unable to get the care they need in stretched hospitals.

The failure to invest in pandemic preparedness, response, and, more generally, in the health of all people has been the most glaring symptom of the world’s ailing approach to investing in global public health, and universal health coverage, for decades.

The funding problems of the World Health Organization (WHO) are not new, but rather have been playing out over decades and, in turn, manifesting themselves in several telling ways. They are symptomatic of an overall failure to invest sufficiently in global public health. This must stop now.

Over recent years, the financial and operational independence of WHO has steadily declined. Forty years ago, WHO received 80 percent of its resources in the form of “assessed contributions,” the scalable membership fees which countries pay. But today, just 16 percent of WHO’s finances are provided by governments through their membership dues, with “no strings attached.” The overwhelming remainder is provided as voluntary contributions, often with tight and sometimes restrictive conditions, and usually over two-year cycles.

As well as making long-term planning impossible, this has resulted in the progressive weakening of WHO’s ability to perform the vast and ever-growing array of tasks that all governments, and therefore their populations, demand and need. This has led, in particular, to an underfunding of both emergency preparedness and the prevention and control of noncommunicable diseases.

WHO’s funding needs have recently been highlighted by multiple independent reviews into the pandemic response, and are now under the spotlight of governments which are discussing how to make WHO better able to deliver on the mandate they have given it.

All independent experts in the COVID-19 lessons-learned process have called on the WHO’s Member States to invest in the WHO’s independence and integrity through a substantive increase in their assessed contributions.

We continue to believe that funding the WHO through a substantially higher level of assessed contributions, closer to the 80 percent share of the early 1980s is the best way forward. But we accept that the main proposal now being considered through a member state-led working group process is to increase assessed contributions from the current levels of less than 20 percent of the core budget to 50 percent, and to allow all countries time to budget and prepare, to do so incrementally, introducing the change in stages starting from 2028.

Taking this step would ensure more predictable financing for WHO’s emergency preparedness work, from laying the groundwork to protect communities from Ebola to strengthening health care systems in vulnerable settings. It would also enable WHO to invest in supporting countries to recover from COVID-19, and to address the epidemics of noncommunicable chronic diseases, like diabetes, heart disease, and cancers, as well as enabling it to plan ahead—for example, to tackle the growing health threats associated with climate change.

If COVID-19 has taught us anything, it is that the value we place on health needs to be radically reassessed. The billions needed to prevent and respond to health crises are dwarfed by the trillions in bankruptcies, job losses, and stimulus packages that emergencies like COVID-19 have cost the world economy.

The mission to deliver health for all is at the heart of everything WHO does. But delivery on this mission relies on WHO itself being in sound financial health. Committing to the more sustainable financing of WHO is to invest in a healthier and safer world for all of us. The Jakarta Post/Asia News Network

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Gordon Brown is WHO ambassador for global health financing and former prime minister of the United Kingdom. Ellen Johnson Sirleaf is co-chair of the Independent Panel for Pandemic Preparedness and Response and former president of Liberia. Helen Clark, co-chair of the Independent Panel for Pandemic Preparedness and Response and former prime minister of New Zealand; Graça Machel, cofounder of The Elders and former first lady of Mozambique and South Africa; Paul Martin, former prime minister of Canada; Felicity Harvey, co-chair of the Independent Oversight and Advisory Committee for the WHO Health Emergencies Program; and Elhadj As Sy, co-chair of the Global Preparedness Monitoring Board and former secretary general of the International Federation of the Red Cross and Red Crescent Societies, also signed the article.

The Philippine Daily Inquirer is a member of the Asia News Network, an alliance of 22 media titles in the region.

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