Replug: WHO Secures Half Its Target For Funds Amid Dire Geopolitics. More Predictable Financing, But Insufficient
Newsletter Edition #239 [The Files In-Depth]
This edition was first published on November 22, 2024. We are now sharing this timely piece again.
Hi,
It is a sign of how difficult things are likely to be for global health financing. And a sign of how disinterested some key WHO member states are, in securing the future of the institution.
This is even as multilateralism in global health is at a cusp of a significant change with not only pressures on resources, but also the underlying dynamics in the governance of the field.
In today’s edition, we bring you a quick update on WHO’s Investment Round event that took place at the G20 Leaders’ Summit in Brazil this week.
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I. STORY OF THE WEEK
WHO Secures Half Its Target For Funds Amid Dire Geopolitics. Predictable Financing, But Insufficient
WHO says it has been able to secure commitments up to half of its initial goal of raising US $7.1 billion for its next strategy. Middle income countries have stepped up in their commitments.
WHO has managed to secure funds of up to US$ 3.8 billion for the next four years on the back of pledges from some of its member states, the private sector, foundations and multilateral organizations. This amount also reflects signed funding agreements and expected funding from partnerships, senior officials said last week.
While this amount is half of the goal it set for itself, WHO says, by securing 53% of the US$ 7.1 billion funding needed to implement its strategy for 2025-2028, it has successfully increased predictability as compared to 2020, when WHO had visibility for only 17% of funding required for its previous strategy.
The current Investment Round has been designed to raise funds for WHO’s Fourteenth General Programme of Work, which is estimated to save an additional 40 million lives over the next four years.
This week, WHO’s first Investment Round event at the G20 Leaders’ Summit was lackluster with only a few additional member states pledging support, including Australia, Indonesia and Spain. Some of the biggest developing countries among others, have been conspicuous by no or limited funding. South Africa takes over the G20 Presidency next year is expected to continue supporting WHO’s efforts to improve its financing.
Some see the G20 as a lost opportunity for WHO financing. “I would have played this differently. Why is there limited engagement from the biggest emerging economies? They just talk about multilateralism without wanting to pay for it,” a developed country diplomat said.
Analysis from health financing experts show, that as per currently available information, no pledges were made from the Americas region. (The African and the Western Pacific region has had the highest participation in the Investment Round.)
G20 Leaders' Summit was chaired by the President of Brazil, H.E. Luiz Inácio Lula da Silva. The G20 Rio de Janeiro Leaders’ Declaration said: “We reiterate the central coordinating role of the World Health Organization (WHO) in the global health architecture, supported by adequate, predictable, transparent, flexible and sustainable financing. We support the conducting of the WHO Investment Round as an additional measure for financing WHO activities.” He also said at the event, "While the WHO receives $2 billion a year to try to solve health problems around the world, we have a budget of $2.4 trillion just for war. To destroy lives and the infrastructure that took years to build, rich countries invest much more than they do to save lives."
President of South Africa H.E. Cyril Ramaphosa, who will Chair the G20 Presidency in 2025, said: “We are proud to carry the baton on from Brazil and continue to spotlight the importance of WHO and the need for sustainable financing towards the goal of health for all.”
President of France, Emmanuel Macron, said: “The World Health Organization deserves our support, as our unique common, universal, compass to global health. It is the only organization technically and politically able to coordinate our global action, and edict universal norms and advice in the field of health. As part of this Investment Round, WHO is bringing to life a new Academy, open to all health practitioners around the world, to tackle one of the key investment priorities identified during the COVID crisis, which is human capacity in the health sector. In a nutshell, investing in WHO is investing in the strengthening of our response capacity to health crises and in particular to pandemics.” Geneva-based sources say that France is expected to make an announcement for a pledge later in the year in line with the domestic budgetary cycle.
On November 18th, the first day of the G20 Leaders’ Summit, WHO Director General, Tedros Adhanom Ghebreyesus said: “Over the past seven years, WHO has undergone a radical transformation to ensure we do that work as well as we can. Seven years ago, we started 51 initiatives. To support countries to achieve the health-related SDGs, we developed a new strategy based on outcomes and impact. We invested, rightly, in science, data and digital technology, believing that digital technology is the future of health care. To do that, we rely on predictable, flexible funding from a broad range of donors. The WHO Investment Round aims to mobilise US$7 billion to implement WHO’s ambitious plan to save 40 million lives over the next four years. I thank those who have pledged so far: the 18 Member States of the African Union, China, Germany, India, Malaysia, Norway, Singapore, South Africa, Türkiye and the European Union. And today Spain. And I would like to take this opportunity to thank his Excellency President Lula for hosting the WHO Investment Round.”
The Investment Round will fund the 14th General Programme of Work, which was approved by Member States at the World Health Assembly in May 2024. The funds are meant to finance a part of the base segment of WHO’s budget during 2025-2028.
Estimates for the base budget during 2025-2028 is pegged at $ 11.1 billion. (Base budget includes technical base programmes, country strengthening, strengthening accountability, polio transition, and data and innovation. It excludes Polio Eradication, Special Programmes and Emergency Operations and appeals.)
Of the $11.1 billion base budget, a funding gap of $7.1 billion has been estimated, after accounting $4.1 billion for projected assessed contributions (that reflects an increase) and program support costs. The goal has been to meet the funding gap of $7 billion by seeking flexible, unearmarked voluntary contributions from sovereign donors and non-state donors.
THE QUALITY OF FUNDING
Although the amount of funding has been disappointing, the Investment Round, WHO says, has “successfully broadened WHO’s donor base, improving its funding resilience…. This is making WHO’s funding more diversified and thus marks a milestone in the Organization’s evolution.” Of the 70 new pledges from Member States, and philanthropic and private sector donors, 39 of which are contributing voluntary funds for the first time, according to WHO.
One the biggest stories of the Investment Round is the number of middle-income WHO member states that have stepped up their efforts to the organization.
“Seven of these new donors are low-income countries and 21 are middle-income countries, representing a shift in WHO’s funding base. This shift also demonstrates broad-based recognition of the need to invest in health and in WHO,” a statement to the press said.
On the nature of funding, WHO has said that 46 donors have so far pledged more flexible funding, compared to 35 in the last four years, increasing the ability of WHO to use the funds where they are most needed.
Typically, 50% or more of WHO funding consisted of one-year commitments, that makes long-term planning and operations difficult for WHO, senior officials explained in a recent briefing.
It is not clear which donors have pledged for flexible funding. (The UK has been one of the most significant flexible funders to WHO.)
In response to our queries on the extent of flexible financing, a WHO spokesperson said, “We will only have full visibility of the degree of flexibility of funding when we sign agreements for the pledges, but it is already clear that we will see a significant increase in the degree of flexibility of WHO’s funding.
We will be providing further information on the breakdown of the funding during our governance meetings in January. China has made a pledge of $20m. We are still in discussion with the government of India on the composition of the pledge they made at the SEARO regional committee meeting. Brazil provided leadership and advocacy for the Investment Round but has not made a pledge at this time.”
In a fresh analysis published by Global Health Hub Germany, authors Rafael García and Christoph Benn, say:
“The IR attracted new commitments from 70 donors totalling US$1.7 billion (two are not included in the available data). Out of the 68 disclosed pledges, 53 were sovereign donors (78% of disclosed contributors), 11 were philanthropy and private sector entities (16%), and 4 were multilateral organisations (6%).
In terms of the disclosed pledged amounts — almost US$1.26 billion —, sovereign donors committed US$1.02 billion equalling 81% of the total. Philanthropies and the private sector contributed US$200.5 million (16%), and multilateral entities pledged US$38 million (3%).”
(The analysis was based on WHO’s commitments data on November 19, 2024)
The authors also analysed contributions from sovereign donors: “When it comes to leading economies, seven members of the G20 matched their stated commitments to global health and WHO with a pledge: Australia, China, Germany, Indonesia, South Africa, Türkiye, and the European Union. Out of the 38 members of the OECD — which represent about 60% of the world’s GDP — 14 (37% of its members) pledged: Australia, Denmark, Estonia, Finland, Germany, Greece, Ireland, Latvia, Luxembourg, Netherlands, Norway, Slovenia, Spain, and Türkiye.”
They also draw attention to another significant insight on how the smallest countries paid much more to WHO relative to their Assessed Contributions (AC). The ACs are based on a formula.
Remember that 39 of the 70 pledges came from first time contributors to voluntary funding (this is over and above their membership dues or ACs.) But only, they beat their ACs by a big margin compared to their richer and bigger counterparts. “While low-income countries’ pledges accounted for only 1% of the total, they were equivalent to 10.1 times their combined assessed contributions. In contrast, high-income sovereign donors contributed 92% of the total, though these represented 2.6 times their aggregated assessed contributions,” the experts note.
THE CHALLENGING TERRAIN OF HEALTH FINANCING
Given the geopolitical realities, WHO has had an uphill climb with the Investment Round. (Although in relative terms, financing experts note that nearly as many countries stepped up for WHO as they did for the Global Fund in its previous round of replenishment in 2022.)
There is a significant uncertainty around global health financing as a result of the incoming Trump Presidency. And this will have implications both for WHO, and the Global Fund among others. (See: Global Health Insecurity in a Second Trump Term)
Experts say the repercussions of American global health and foreign policy can be tremendous for international development including for agencies such as UNFPA, UNRWA, Green Climate Fund among others. Multiple cuts are expected for not only global health, but also climate and development and humanitarian affairs.
For WHO in particular, the U.S. is one of the largest sovereign donors representing 22% of all assessed contributions. The organization’s emergencies work is heavily dependent on the U.S., sources say.
While the election of Donald Trump was to an extent expected, what has also upset financing calculations in the composition of the U.S. Congress with the House of Representatives and Senate that now have Republican majority. This is expected to crunch possibilities for financing further, with many new members who may not have interest or experience in international development financing, sources fear.
(Experts say there have been occasions when members of Congress rallied behind global health initiatives during the previous stint of Donald Trump. This may now be more difficult.)
During his stint in office at the height of the COVID-19 pandemic in 2020, Trump had announced that the U.S. would withdraw from the WHO.
Senior WHO officials said that they have not had any signals from the new incoming administration in the U.S. for any withdrawal.
In a select briefing to reporters last week, Catharina Boehme, WHO assistant director-general for external relations and governance, said “The United States has been very clear from the get-go when we started the investment round that due to the timing of their elections, they will not be able to make a pledge in this current cycle. So, we’ve never taken that into account or into our calculations for the success of the investment round.” (Existing grant agreements with the U.S. are expected to continue)
Boehme added, “The U.S. is an important donor to WHO and any money that we would not get from the U.S. would have to be compensated for. Either that or we look for cuts and efficiencies in the organization,” she said.
At that time, with the U.S. withdrawal from WHO (reversed subsequently), Germany became a leading donor to WHO, stepping in to fill the gap in financing. Uncertainties remain with Germany’s domestic political transitions. So, WHO will need to look elsewhere sources familiar with the developments have indicated. (Germany’s situation might also have implications for both Gavi and the Global Fund in the coming months, sources say.)
Experts also do not rule out countries reneging on their commitments on assessed contributions in the future. Watch this space.
Bianca Carvalho contributed to this story
Also see:
![Global Health Insecurity in a Second Trump Term [Guest Essay]](https://substackcdn.com/image/fetch/w_1300,h_650,c_fill,f_webp,q_auto:good,fl_progressive:steep,g_auto/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F44895b0a-64ac-4e37-9449-f47604984e6e_4382x2465.jpeg)
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