U.S. withdrawal from WHO: implications and response

June 10, 2020 – The Trump administration’s declared withdrawal from WHO has raised numerous questions about funding, U.S. staffing support and advisory participation, information sharing, and much more—even the legal basis of the decision itself. Despite this uncertainty, the implications for global health and the foundation’s work are considerable. What follows is an overview of what we know at this time (based on insights from the North America, Polio, Communications and MLP teams, as well as other external sources), what steps MLP recommends, and what we’re prepared to say publicly.
 
1. The timing is unclear
 
We believe relevant U.S. agencies had little input on the decision, leaving its operational and legal implementation unclear. Moreover, the WHO Constitution has no explicit withdrawal provision. On the U.S. side, Congress included such a provision in its 1948 WHO membership resolution, but—as Just Security explains in a legal backgrounder—required that the U.S. give one-year advance notice and meet all financial obligations for that year before exiting. These stipulations alone could delay a definitive withdrawal for some time, while new legislation from Congress or a different policy from the current or a successor administration might derail withdrawal altogether. Additionally, Vanity Fair reported this week that “secret negotiations” aimed at reversing the decision are underway between WHO Director-General Dr. Tedros Adhanom Ghebreyesus and U.S. Permanent Representative to the United Nations Andrew Bremberg.
 
2. The financial impact on WHO may be significant
 
The U.S. government accounts for over 20% of WHO’s assessed contributions—almost $120 million per year. Assessed contributions are required funding from all member states that are flexible and largely used to fund “core” WHO functions. Assessed contributions represented less than 20% of the WHO budget for the last biennium. The WHO budget team has only begun to explore how it might accommodate the impact of this loss. 
 
Perhaps more challenging will be the impact of lost U.S. voluntary contributions (earmarked funding) of over $325 million per year over the last two years, which will be felt by specific WHO program teams with very limited budget flexibility. The Center for Global Development (CGD) says 70% of U.S. contributions in 2019 went to AIDS, tuberculosis, malaria, polio, and a few other programs. The foundation estimates that the Global Polio Eradication Initiative (GPEI) could see about $410 million at risk between July 2020 and December 2023.

WHO program teams will need to identify replacement funds or eliminate staff positions—as team budgets largely comprise staff costs. The extent of these potential cuts is unknown. 
 
3. Operational consequences are unclear but potentially grave
 
U.S. nationals participate in WHO operations in myriad ways—from key roles on advisory committees to Centers for Disease Control and Prevention staff detailed to Geneva. The future of these arrangements, while unknown, is possibly in jeopardy. The same is true of U.S. government-hosted WHO Collaborating Centres. Information sharing—surveillance data, program performance metrics, health statistics—is similarly at risk. WHO staff expect changes in information practices to vary from one U.S. government agency to the next, which may further impair global health policy coordination. 
 
4. WHO is working closely with UNICEF and other partners
 
The COVID-19 pandemic response has resulted in new levels of cooperation among multilateral agencies. MLP has seen a degree of coordination and cooperation among UN agencies—in particular, WHO and UNICEF—never seen before. Increasingly, UNICEF is contributing to the development of WHO guidelines, several of which have been issued jointly. Several teams have inquired about the roles and responsibilities of WHO and UNICEF in issuing and implementing guidance—in general, WHO provides technical expertise in developing the guidance, while UNICEF often supports countries in adopting and implementing it. PSTs should reach out to MLP if there are questions regarding the division of labor. 
 
5. Progress continues on the ACT Accelerator
 
The Access to COVID-19 Tools (ACT) Accelerator is a collaboration launched by global health partners, including the foundation, CEPI, Gavi, Global Fund, UNITAID, Wellcome Trust, WHO, and private sector partners, to accelerate development of, production of, and access to new COVID-19 essential health technologies. Work under the ACT Accelerator has continued in recent weeks as WHO and other partners finalize the collaboration’s architecture (including an ACT Council—providing political support to the work of the partnership on resource mobilization and communications—with representatives from developed and developing country governments, civil society, WHO, the foundation, and the Wellcome Trust). In addition, the four ACT partnerships (vaccines, therapeutics, diagnostics, and health systems) have continued to prepare work plans and estimated resource requirements ahead of a June 27 global COVID-19 event co-hosted by Global Citizen and the European Commission.

WHO will play a key role in establishing norms and standards and assuring the quality of new technologies. WHO will also lead the process to establish principles for the equitable allocation of newly developed technologies.

Additional information:

 
6. The foundation stands with WHO
 
Prior to the withdrawal announcement, the foundation was the second-largest funder of WHO, behind the U.S. government. We’re working closely with WHO on COVID-19 preparedness and response efforts and will continue to use our voice to express support for WHO and its leadership.
 
The External Communications team has developed the following Q&A response to President Trump’s announcement:
 
What do you think of the President’s decision to withdraw U.S. support from the WHO?

  • Withdrawing support from the WHO is a mistake.
  • It comes at a moment when the world needs global cooperation and leadership to respond to COVID-19.
  • WHO plays a unique and essential role in global health — only the WHO has the authority and influence to coordinate public health efforts across all 194 member states of the UN.
  • I’m worried that this decision will have consequences for the long-term ability to fight diseases, including the public health community’s ability to eradicate polio.
  • The United States has long been a global leader on health and development, and it’s disappointing to see this sort of action, which runs counter to that long history.
  • Other governments and foundations like ours won’t be able to fill the funding gap left by the United States.

Additional Q&A resources about WHO are available (please note that these are for internal use only, and we recommend opening in ‘reading mode’):

 
7. MLP recommends proceeding with planned or in-process investments
 
Regarding investments to WHO, the MLP team recommends that investment owners proceed with any planned or in-process investments. Please reach out to MLP if you have questions on specific investments or would like to discuss potential implications for your work with WHO.
 
8. Internal working group on essential health services
 
The foundation is forming an internal working group to engage with WHO on reinvigorating essential services—with an early focus on re-launching campaigns—during COVID-19. If you are interested in participating in these discussions, please reach out to Violaine Mitchell.

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