Why the US withdrawal from the WHO will have greatest impact on those in the global south

Earlier this month, the Trump administration notified Congress and the United Nations that the United States was formally withdrawing from the World Health Organization (WHO).

The legislation is congressionally mandated, and the withdrawal will take effect in July 2021. The US government had initially announced the decision to halt the WHO’s funding in May, accusing the agency of withholding vital information at the beginning of the pandemic.

In the financial year of 2018 to 2019, the US government provided a total of $893m in contributions, whereby, $656m were voluntary contributions.

To understand the importance of the funding, only 20 per cent of the WHO’s budget is guaranteed and the remaining 80 per cent is comprised of contributions called ‘’regular budget funds’’ (RBFs) which are calculated in relation to each nation’s population and wealth.

The withdrawal of the US from the WHO will have myriad implications for the US as well as the less economically developed member states.

With this decision, the US would also be exempt from cross-border collaborative initiatives such as the WHO Global Influenza Surveillance and Response system (GISRS).

The GISRS is a system designed to produce real time international and regional disease monitoring, through effective collaboration and sharing of viruses, data and benefits between member states.

The Oxford University’s Jenner Institute which is leading the race for the Covid-19 vaccine gathered the genetic sequence released by China in collaboration with the GISRS before they started their clinical trials.

The US’ withdrawal means that they would be excluded from such data exchanges and this would potentially lead to mini outbreaks during flu season.

As with vaccine development and accessibility, the US withdrawal will also mean that they would be excluded from  joining the COVAX Facility, a mandated from the WHO designed to ensure rapid, fair and equitable access to Covid-19 vaccines worldwide if the most viable vaccine is produced by a member state.

The US can still secure their own agreements with vaccine manufacturers, as has been seen with the stockpiling of Remdesivir and this can make initiatives such as the COVAX Facility redundant, reducing the supply of the vaccines to poorer nations.

However, the burden of the US withdrawal will have the greatest impact on those from low- and middle-income countries in which the WHO’s work is critical in sustaining each country’s healthcare infrastructure.

The WHO has over 149 field offices with many of them are in the global south. As well as this, the agency is currently involved in around 35 emergency operations, including a cholera outbreak in Yemen, an acute watery diarrhoea (AWD) outbreak in Ethiopia and a deadly measles outbreak in Somalia.

The funding insecurity because of the US withdrawal will have a detrimental impact on the WHO’s Strategic Preparedness and Response Plan aims. Currently, under this plan the agency has shipped around 41 million medical masks and over 10 million N-95 respirators to over 138 countries as part of their vision to equip those from poorer nations.

Aside, from technical assistance this plan has also empowered community health professionals in low- and middle-income countries by providing training and evidence-based guidance on producing high quality research.

Moreover, the reliance on voluntary contributions has seen the WHO face a range of funding issues that include a discrepancy between the donor nations financial commitments, the unreliable nature of the financing, the efficacy linked to how the resources are utilised and the transparency of the funding.

These complications have hampered the institution’s ability to carry out its core functions as a central leader in global health governance worldwide. The funding constraints have also influenced the operational capacity of the agency.

In particular, the significant uncertainty and the lack of predictability of the funding has already challenged the agency’s responses to global health emergencies in the past.

The lack of financial autonomy due to a reliance on member state funding from countries like the US has meant that the agency facilitates vertical health programmes in poorer nations which are short term, fragmented and not self-sustaining.

Without the US’ funding, these initiatives will exist in silos and may also potentially come to a standstill as they require expensive resources and human capital.

The Ebola epidemic of 2014 surfaced an unprecedented attention to the WHO and its failure to deal with the spread of infectious diseases adequately.

Although this was tied mostly to the agency’s governance, an internal 2015 review highlighted the need for a contingency fund to curb further outbreaks. Therefore, further reduction in the agency’s funding capacity could diminish the legitimacy and ability to respond to global health emergencies in poorer nations.

Ultimately, the WHO is a crucial steward for global health emergencies and pivotal in maintaining standards for less economically developed countries.

It has constantly tried to set reforms to improve coordinating global health initiatives and has already launched an independent inquiry into the organisation’s global responses to the pandemic. The US government should look to add input into reforming the WHO instead of de-funding it as diseases have little respect for borders.

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