The greatest challenge facing the World Health Organization’s new leader isn’t likely to be an Ebola outbreak or the growing threat of the Zika virus. It’s going to be restoring confidence in the WHO at a time of its declining influence — and doing so while scrambling to attract more funding.
Last week, the WHO elected Tedros Adhanom Ghebreyesus as its new leader, the first time an African has won the top spot at the United Nations’ public health agency.
The former health minister of Ethiopia led the country through innovative heath reforms and drove down disease rates there. He will take over from Margaret Chan on July 1 after her decade-long stint as director general of the agency.
Tedros inherits a fraught organization. Throughout the recent Ebola epidemic, the agency was universally admonished for being too slow to respond. And one of the top reasons cited for the delay is that the WHO is underfunded, understaffed, and underpowered. It’s also losing relevance as other global health players, like the Bill and Melinda Gates Foundation, have become more prominent.
But here’s the rub: The agency’s crisis is coming at a time when we need the WHO more than ever.
The WHO has a serious money problem — especially in the Trump era
The WHO’s funding is minuscule compared to the scope of the work it does. It’s typically operating with about $2 billion per year — which is about a third of the budget of the US Centers for Disease Control and Prevention. The WHO’s budget has also remained pretty flat over the years — yet it gets tasked with doing more and more, from coordinating responses to outbreaks to setting nutrition standards and reducing vaccine-preventable diseases around the world.
Today, the agency is facing the real possibility that it might lose a significant chunk of its already small budget: The WHO’s largest contributing country, the United States, may be pulling back on its support.
The WHO is supported by its 194 member states that pay membership dues in exchange for a seat at the decision-making table. This structure is part of what makes the WHO unique: Every country, no matter how rich or poor, has a say.
But these member countries only cover about 20 percent of the WHO’s budget. The rest of the agency’s funding comes from voluntary contributions made by wealthy countries (like the US and England) and other donors (most significantly, the Bill and Melinda Gates Foundation).
This year, President Donald Trump has repeatedly signaled he’s not interested in supporting international development and may even push for caps on US contributions to UN organizations. In the administration’s proposed budgets so far, public and global health funding have been cut while the president has focused on beefing up funding for the US military.
“I think it’s likely that the Trump administration will try to reduce funding to the WHO as part of a more general push to reduce its global footprint and investment in international organizations,” said Jennifer Kates, director of global health and HIV policy at the Kaiser Family Foundation.
“If the US pulls back [its funding],” she added, “there’s a vacuum in terms of that role in leadership on development funding.”
This means Tedros is coming in at a pivotal moment. “We desperately need a new director general who will be able to convince countries like the US that investing in global health and in the WHO will yield a fantastic return,” said global health researcher (and Vox contributor) Steven Hoffman. “This election was important because it’ll be up to the next director general to restore confidence in the WHO and convince people like Donald Trump to invest in them.”
In a media briefing last Wednesday, Tedros signaled that bolstering fundraising efforts for the agency will be a chief priority. Realistically, this means he’ll need to find new donors who will support the WHO, since member countries have long been asked — and have failed to — to increase their dues.
He’ll also need to consider focusing the scope of the WHO’s work — an idea that has surfaced in a number post-Ebola WHO reports.
The job won’t be easy, said Seth Berkley, the head of Gavi. “Do you dramatically prioritize and do a few things really well and with that strategy rebuild confidence and be able to get funding back to a reasonable level? Or do you continue to do everything at whatever level you can with the funding you have? It’s a real challenge.”
We really need a strong WHO
As WHO grapples with these funding and credibility problems, the world needs the agency more than ever.
We know that new disease outbreaks are around the corner and increasing in frequency. And the WHO is still the only institution that can declare a global pandemic and mobilize internationally to respond to one.
“If we got rid of WHO today, you’d have to recreate it tomorrow,” said Dr. Ashish Jha, director of the Harvard Global Health Institute. It does the work no other agency or body has the credibility or bandwidth to do. “It’s essential we have a WHO — diseases don’t know boundaries and health problems are global.”
“You can make a trade wall — but you can’t make a disease wall,” said Berkley. “It’s easy to sit in America and think WHO is irrelevant over in Geneva, and for some things it does — like helping a country in the middle of an epidemic — the US has CDC and its own instruments.” But figuring out which flu strains are going to be in the next vaccine and responding to outbreaks require the kind of global collaboration the WHO was designed for, he added.
Tedros certainly has the resume for the role. In addition to working in health, he’s also well-versed in politics as Ethiopia’s former minister of foreign affairs — and this combination of technical expertise and political experience make him an excellent candidate. But that experience may not mean much in front of an impossible task.
Clarification: A previous version of this article linked to a Kaiser report that showed the US is the WHO’s largest contributor. The most recent WHO data shows that while the US is the largest contributing country, the Gates Foundation is actually the WHO’s biggest contributor.