It has been a very interesting experience to document and witness fundamental shifts in global health during these times. But we must confess that the speed and the direction of these changes are increasingly getting complex.
Our job is to simplify this for you. We are supported by experts, officials and others, who help us understand and report on the significance of these changes in global health.
Take for instance, WHO commissioning the International Chamber of Commerce for a study titled The Economic Case for Global Vaccinations: An Epidemiological Model with International Production Networks. At the peak of the inequities in vaccines access during this pandemic, we have not fully understood why WHO would rely on a private actor to frame the response to this pandemic in economic terms. It appears to be a desperate attempt to raise funding of vaccines for the developing world, just so that economic recovery can be faster in the developed world. The house view is that there is something wrong with this picture. The lines are drawn and WHO’s position on this seems to be unambiguous.
One could argue that it is all about the money. To understand the pressures on WHO financing, today we bring you an interview with Björn Kümmel, Vice Chair, WHO Executive Board.
We are also happy to announce that we are collaborating with Health Policy Watch. Under this arrangement, we will be sharing such interviews to reach a wider audience and grow our community.
Look out for our analyses of the week on Friday.
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I. THE GENEVA HEALTH FILES INTERVIEW:
Björn Kümmel, Vice Chair, WHO Executive Board
Discussions on WHO’s state of financing were addressed by member states during the on-going Executive Board meeting. As we reported last week, WHO is keen on defining independence and sustainability of its financing to be better prepared to address emergencies in the future.
We spoke to Björn Kümmel, Deputy Head of Unit, Global Health, German Federal Ministry of Health and Vice Chair of the WHO Executive Board, who has been consistently raising crucial questions on the organization’s finances. He was also a part of the consultations on the Open-ended Intergovernmental Working Group on Sustainable Financing at the EB last week.
Björn Kümmel, Deputy Head of Unit, Global Health, German Federal Ministry of Health and Vice Chair of the WHO Executive Board
Image credit: C Black, WHO [Archived image prior to the COVID-19 pandemic]
Q1 [GHF]: Germany has emphasized the importance of assessed contributions for improving the finances of WHO. Can you please share your reasoning behind an increase in assessed contributions for all member states?
[BK] Strengthening of the World Health Organization (WHO) is a key priority for the German Federal Government. In the new Global Health Strategy of the German Federal Government, which has been adopted by the Cabinet of Ministers last October, there is a clear focus on enabling WHO to play its mandated role as the leading and coordinating authority in global health.
The WHO’s budget has grown over the past decades. However, the assessed contributions have remained practically stable since the year 2000. Today, WHO’s overall budget volume foresees roughly 5 billion USD for two years. While in past history, the entirety of the membership fee, the assessed contributions was the main part of WHO’s budget, since 2000, the voluntary contributions have outgrown the assessed contributions.
It is essential to realize, that today, the vast majority of financial resources (currently roughly 83 %) are contributed on a voluntary and largely unpredictable basis. These funds are provided and steered by a very limited number of generous individual donors on a purely voluntary basis. These donors decide, for which concrete goals WHO may use the funding, and they are free to withdraw the funding as they please. This financial dependency on a very limited number of key donors is seen as one of the key risks for WHO as this leads also to political dependency. Some argue that WHO is often used by donors like an implementing agency, implementing the goals that are a priority for the generous donors.
With only 17 % purely predictable and flexible sustainable finances (assessed contributions), it is practically impossible for WHO to play its envisaged role as a guardian of global health. Through the COVID-19 pandemic it has become obvious: The expectations of the 194 Member States vis-à-vis WHO by far outweigh WHO’s de facto abilities. And while in the WHO governing bodies, Member States keep on adding concrete tasks for WHO, not only but including through adopting World Health Assembly Resolutions that have wide financial implications, within the past decades, the WHO Member States have failed to properly address the key challenge of sustainable financing for WHO. One lesson that will most likely be pointed out in the current lessons-learnt-processes that assess the reaction towards the COVID-19 pandemic will be: This financing challenge needs to be tackled if WHO should in the future continue to be expected to lead and coordinate the international prevention, detection and response to pandemics.
Q2. [GHF]: . Based on the deliberations at the EB, what is your assessment of WHO's proposal for sustainable financing?
[BK] Through its resumed session in November 2020, the World Health Assembly has asked the WHO Secretariat to prepare a paper on sustainable financing for discussion at the Board`s meeting in January. The Secretariat’s report (EB148/26) provides a clear picture about the different sources of financing for WHO with regards to the question whether this financing is sustainable or not. The Secretariat proposed to set up a Member State working group to assess the situation with regards to the sustainability of financing for WHO. Based on this assessment, the working group is supposed to discuss and explore options in order to address this challenge. However, it is clear, that it is not the role of the working group to take final decisions. These would have to be taken by the entire membership of WHO, all 194 Member States together.
The proposed process is promising as it may help to address one of the key structural challenges that has been hindering WHO to fulfil its mandate. During the yearly meetings of the Executive Board in January, the implementation of the current Programme Budget is being discussed. In the relevant discussions, all Member States complain about the fact, that the different programme areas of the WHO are unevenly financed with many so called “pockets of poverty”. These are predominant throughout all WHO’s programme areas and have severe implications for WHO’s day to day work.
It is important to understand: When WHO’s programme budget is being approved by the 194 Member States, it is a largely unfunded budget. The only financing source that is purely certain is the 17 % share of the assessed contributions and some already secured grant agreements by voluntary donors. Therefore, WHO has to raise the vast majority of the needed finances after the approval of the programme budget.
This has led to the fact, that many departments need to spend major parts of their work on fund-raising efforts to make sure that envisaged activities are enabled and staff positions can be paid for. Since the vast majority of WHO’s funding is unpredictable and non-sustainable, many WHO staff members do not work on a long-term basis but even based on contracts covering shorter periods than half a year. In addition, this situation has led to a major increase of the use of “non-staff” contracts, in particular consultants and other agreements that are perceived to be more flexible and cover shorter periods of time. Obviously, this financial reality is hardly reconcilable with the need to ensure the best talent in public and global health in order to be able to lead global health by excellence. Attracting and retaining the needed talents will be a growing challenge due to the human resources consequences of the current financing model of WHO.
The discussion that will evolve based on the Secretariat’s report on sustainable financing and the future work of the working group is of highest importance to make all WHO Member States and the broader public health community aware of this financing challenge. We hope that the different ways that have been tried in the past years to ease this challenge will be assessed including why these options have failed to properly address the given challenge. It would be a great step forward, if, through this process, the WHO’s governing bodies would devote adequate focus on potential future options for long-term solutions.
It is clear, that this will be a lengthy and very complex endeavour. However, the COVID-19 crisis may serve for a new political understanding among the entire membership of WHO, that more sustainable investments are needed to enable WHO to fulfil its mandated role.
Q3. [GHF]: What steps have been taken, or will be taken, in the near future to revitalise the role of the governing bodies?
[BK] Germany has been a member of the Executive Board for the past three years. From the start, we shared the view that the role of the governing bodies and in particular the Executive Board indeed needs to be revitalized. The Executive Board has been criticized not to allow for adequate interaction between its members and sometimes not being able to more flexibly shift the focus of its deliberations on the most pressing and decisive questions. It is a fact, that the Executive Board has become to some extent a small World Health Assembly.
While this transparency is a great merit as it allows for full inclusiveness and at least theoretically ensures that the Assembly is well prepared through a consensual process, some argue that this setting sometimes limits the interaction in between the original members of the Executive Board. This leads to reading out only prepared statements and thus reduces the role of the Executive Board to serve as an exclusive steering board.
During the COVID-19 pandemic, some EB members have raised their concern, that the EB has not played its mandated role to provide oversight and guide the work of the Secretariat throughout the pandemic. In order to reflect on this and more generally the role that the Executive Board sees for itself, a retreat of the Executive Board has been proposed. Taking into account the limitations for such a retreat during the ongoing pandemic, members of the Executive Board have called for such a retreat at the earliest possible timing.
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II. WHAT WE FOUND INTERESTING
Pfizer pushes for tax breaks in 2021 federal budget: The Globe and Mail
Make no mistake, this will be the beginning of a trend.
Fauci on What Working for Trump Was Really Like: New York Times
For scientists and public servants worldwide. What an inspiration Dr Fauci. This is what standing up to authority looks like, even if you are 80 years old.
Gavi Supply Forecasts: Gavi
To an extent is provides some clarity on what the way forward for The COVAX Facility looks like. Gavi says this will be updated regularly. Vaccines supply projections divided into different regions of the WHO.
“According to our forecasting and assuming funding availability, we expect as many as ~1.8 billion doses to be available to the 92 economies of the Gavi COVAX Advance Market Commitment (AMC) in 2021, corresponding to ~27% coverage of AMC populations.”
It also points out caveats that could determine supply considerations:
“There are many uncertainties affecting the supply of COVID-19 vaccines in 2021, not least around manufacturing capacity, regulation, funding availability, final contract terms and the readiness of countries themselves to begin their national COVID-19 vaccination programmes…”
FROM THE JOURNALS / REPORTS:
“This information note explores how trade policy can play its part in ensuring the rapid roll-out of vaccine against COVID-19. This document has been prepared under the WTO Secretariat’s own responsibility as a factual overview and is without prejudice to the positions of WTO members or to their rights and obligations under the WTO.”
A very useful document with clear infographics on what vaccines logistics looks like.
Political economy of covid-19: extractive, regressive, competitive – The British Medical Journal, by Jeese B Bump and colleagues
“…To examine these patterns of covid-19 more closely is to ask about the political economy of the disease, which refers to the distribution of the effects of covid-19, the behaviour of nations, and the power relationships that these factors reflect. Overall, we interpret the broad patterns in the regressive distribution of disease and the competitive scramble for vaccines and supplies to indicate that the political economy of covid-19 is the political economy of extraction, following longstanding patterns of exploitation…”
III. WHAT WE ARE WATCHING
Vaccines mix up
The regulatory implications for vaccines for the pandemic and how authorities are playing catch-up with companies.
WTO TRIPS Council: Waiver proposal discussions this week
Proponents of the waiver proposal are working with smaller groups of countries to explore common ground to reach a consensus on the proposal.
IV. TWEET OF THE WEEK
An elegant solution on meeting health financing needs presented by this global health advocate: Mariska Meurs, Wemos
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