World Health Organization: what does it do and how does it work?

US President Donald Trump has frozen the US contribution to funding for the World Health Organization, blaming – controversially – the organization’s “China-centric” nature and criticising it for not drawing the world’s attention to the COVID-19 outbreak earlier.

The move has prompted a storm of international condemnation, including from UN Secretary-General António Guterres, who said the middle of the pandemic was “not the time” to be withholding aid from the leading public health body. But what does the WHO actually do? And why does the US funding freeze matter so much?

The World Health Organization is a specialized agency of the United Nations. It was inagurated following the second world war on 7 April 1948 – a date now celebrated as World Health Day. The organization grew out the International Sanitary Conferences, which convened between 1851 and 1938 to combat diseases such as cholera, yellow fever and bubonic plague. Its self-proclaimed mission is the “attainment by all peoples of the highest possible level of health”.

It performs a multitude of roles globally, including advocating for universal healthcare, monitoring public health risks, setting health standards and guidelines, coordinating international responses to health emergencies, fighting infectious diseases like HIV and tuberculosis, and promoting better nutrition, housing and sanitation in the name of overall well-being. Based in Geneva, Switzerland, it employs 7,000 staff across six regional offices and 150 field offices, at the head of whom stands Dr Tedros Adhanom Ghebreyesus, the former health minister of Ethiopia, who began his five-year term as Director-General in 2017.

Since its inception, the WHO has scored some notable public health successes, including the reduction of TB and measles through mass vaccination programmes and the near-eradication of polio. Its finest hour was the battle against smallpox: in 1958, when the organization launched its global initiative, 2 million were dying of the disease every year, but by 1979 the WHO was able to announce that smallpox had been eliminated – the first that humanity had completely overcome through its own efforts.

In more recent times, however, the organization has been attacked for its slow response to the West African Ebola outbreak in 2014–15, which resulted in unnecessary fatalities. An independent report commissioned by outgoing Director-General Margaret Chan claimed it was badly underfunded. But where does WHO money come from, and how much does it actually need?

WHO funding comes from a number of sources. Just over half (51%) is donated by its 194 member states, while 16% is provided by the UN, intergovernmental organizations and development banks, and 15% from philanthropic foundations. The rest is from NGOs, the private sector and academia.

In 2019, the US was the largest contributor, providing $419 million, or some 16% of its total revenue. (The second-largest contributor was the Bill and Melinda Gates Foundation at 9.8%.) Trump’s announcement arrives as the WHO appeals for an emergency injection of $675 million to fight the coronavirus; it is expected to raise the plea to $1 billion in the coming days. The decision of its biggest donor to freeze all funding for 60-90 days could hardly have come at a worse time, and it is this that has provoked controversy, with one health expert calling it a “crime against humanity”.

“The international community [should] work together in solidarity to stop this virus,” said UN chief, Guterres. “It is my belief that the World Health Organization must be supported, as it is absolutely critical to the world’s efforts to win the war against COVID-19.”

The White House decision to withdraw funding is bound to have knock-on consequences. The UK – the WHO’s third-largest donor – has stumped up an extra $65 million, but Downing Street has also edged behind Washington with a recommendation that the organization “learn lessons” from the crisis.

How true are the charges that the WHO was slow to react to early reports of coronavirus? Many note that the WHO announced a public health emergency on 30 January, almost two months before most Western nations began locking down, while Tedros warned these same nations about “alarming levels of inaction”.

In practice, it is the global south, not China, that will shoulder the burden of the US funding cuts. In developing nations the WHO does vital year-round work expanding healthcare, improving maternal health, rolling out vaccination programmes and propping up weak healthcare systems. It is these essential but unglamorous and ongoing services that are likely to feel the pinch – just as the coronavirus lockdown makes their provision much, much tougher.