How much is our health worth to us? If COVID-19 has provided any guidance, clearly not enough.
This stark reality has been ignored for too long – at a price the whole world can now see.
Lip service has largely been warning after warning to bolster the world’s defenses against novel pathogen pandemics, leaving the world woefully ill-prepared for the coming tsunami of suffering nearly two years ago.
The tally that followed was large and continues to grow: more than five million dead and the death toll continues to rise, and untold millions more infected, and many of the world’s critically ill are unable to receive the care they need in overburdened hospitals.
Add to that Long COVID and unfathomable mental anguish—so many more people have been scarred in painful, diverse, and most importantly, preventable ways.
The failure to invest in pandemic preparedness, response, and more broadly in the health of all people has been the most glaring symptom of the world’s flagging approach to investing in global public health and universal health coverage for decades.
The G20 leaders’ meeting in Rome last year doubled but did not do enough to address the shortcomings in funding the work needed to protect the world from pandemics, and in particular funding the World Health Organization (WHO) to achieve its broad – and ever-growing – mandate to act as the world’s leading authority on global health.
We appreciate the recognition by world leaders that global health and the health of WHO are intertwined and that ensuring sustainable funding for WHO is not only urgent, but also a realistic and achievable goal in 2022.
WHO’s funding problems are not new, but have been unfolding for decades, again manifesting themselves in various ways. They are symptomatic of a general failure to invest adequately in global public health. This has to stop now.
In recent years, WHO’s financial and operational independence has steadily decreased. Forty years ago, WHO received 80 per cent of its resources in the form of ‘defined dues’, the scalable membership fees that countries pay. This income was predictable and untied and could be used to address a wide range of critical health issues, from WHO’s core scientific work to its role in addressing public health emergencies. The rest came in the form of voluntary contributions from various donors, from governments to foundations, earmarked for specific health areas
But today only 16 percent of WHO’s finances are provided by governments through their membership fees, “unconditionally”. Most of the remainder is provided as voluntary contributions, often with tight and sometimes restrictive terms and typically over two-year cycles.
This has not only made long-term planning impossible, but has also led to a progressive weakening of WHO’s ability to fulfill the vast and ever-expanding range of tasks that all governments, and by extension their peoples, demand and need. In particular, this has led to underfunding of both emergency preparedness and NCD prevention and control.
And it is not only the quantity of funds that the organization receives that matters, but also the quality of the resources provided, in particular how flexibly they can be used and whether the organization can expect to receive these resources. The more flexible and predictable these are, the better.
WHO’s funding needs have recently been highlighted by several independent reviews of the pandemic response and are now in the spotlight as governments discuss how to better enable WHO to fulfill its mandate.
All independent experts in the COVID-19 learning process have called on WHO Member States to invest in WHO’s independence and integrity by substantially increasing their assessed contributions.
We continue to believe that funding WHO through a much higher level of assessed contributions, closer to the 80 percent share of the early 1980s, is the best way forward. However, we accept that the main proposal, now being considered as part of a Member State-led working group process, is to increase the assessed contributions from currently less than 20 per cent of the core budget to 50 per cent and give all countries time to budget prepare to do so gradually by phasing in the change from 2028 onwards.
This move would ensure more predictable funding for WHO’s emergency preparedness work, from laying the foundations to protect communities from Ebola to strengthening health systems in vulnerable settings. It would also enable WHO to invest in helping countries recover from COVID-19 and fight the epidemics of noncommunicable chronic diseases such as diabetes, heart disease and cancer, and enable them to look ahead to plan – for example to counteract the growing health risks associated with climate change.
The need to make WHO financially viable was also emphasized by G20 leaders, who recognized that “an adequately and sustainably funded WHO” was needed to carry out the work of leading and coordinating global health.
If COVID-19 has taught us anything, it is that the value we place on health needs to be radically reassessed. The billions needed to prevent and respond to health crises are dwarfed by the trillions in bankruptcies, job losses and stimulus packages that emergencies like COVID have cost the global economy.
When countries invest in health, the dividends are great. Nations that devote resources to universal health coverage and primary health care invest in the well-being of children, adults and the elderly so they can go to school, enter the workforce and stay as healthy as possible. This investment is the foundation for more health security.
The mission of achieving health for all is at the heart of all WHO activities. However, the fulfillment of this mission depends on the WHO itself being financially healthy. Committing to more sustainable WHO funding means investing in a healthier and safer world for all of us.
dr Felicity Harvey, Co-Chair of the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme; Graça Machel, co-founder of The Elders and former First Lady of Mozambique and South Africa; Paul Martin, former Prime Minister of Canada; Ellen Johnson Sirleaf, Co-Chair of the Independent Panel for Pandemic Preparedness and Response and former President of Liberia; Elhadj As Sy, Co-Chair of the Global Preparedness Monitoring Board and former Secretary General of the International Federation of Red Cross and Red Crescent Societies are co-authors of this article.
The views expressed in this article are the authors’ own and do not necessarily reflect the editorial stance of Al Jazeera.