Funding the WHO solves.

It’s a little-known fact that the World Health Organization (WHO) lives a hand-to-mouth existence. Governments contribute most of its annual US$6-billion budget, but the WHO is allowed to spend less than 20% of this on its core mission, which is to support public health in the poorest countries and respond to emergencies around the world. Much of the rest consists of voluntary donations earmarked for projects specified by donors, such as eliminating polio or treating HIV/AIDS.

The governments of most of the WHO’s member states are now rightly saying that the agency needs more-predictable funding, as well as the flexibility to decide when and how to spend a greater proportion of its budget — during a pandemic, for example. They should consider how to move ahead with implementing this plan despite the fact that a small number of countries are opposing it.

Since the WHO was founded in 1948, its total spending power has increased nearly sixfold, when adjusted for inflation. But the majority of this money has been provided through voluntary contributions. By contrast, core funding — which comes from assessed contributions, based on a country’s wealth — has decreased in real terms. As a result, the WHO is struggling to achieve a key goal to provide universal health coverage for the most vulnerable populations.

For decades, the WHO’s leadership has tried to persuade its donors to rebalance its funding. Last week, it tried again. At least 120 countries are backing a proposal for half of all funding for the WHO to comprise assessed contributions. This would bring its funding mechanism closer to that of many other United Nations agencies. But eight countries — including, most notably, the United States, but also Brazil, Japan and Poland — are opposing the move.

The United States wants to see how the WHO can increase efficiency before it commits more funding. In 2019 (the last year for which data are available), the United States paid $419 million to the WHO, of which assessed contributions made up $119 million. One way to increase efficiency would be to relieve the agency of the need to devote so many of its resources to the priorities of individual governments.