China’s assessed contribution to the World Health Organization (WHO) would increase by more than $50 million – from $87.586 million in 2025 to $137.828 million in 2026 if WHO member states approve another 20% step-wise contribution from all countries at the May World Health Assembly (WHA). 

That would be even larger than the US contribution of $130 million for 2025. For 2026, the US assessment would increase at a much smaller rate than China’s, amounting to 155.572 million, were it to remain in the organization.  

The hike in China’s fees stems from an updated scale of assessment that distributes budget cost more fairly and proportionately amongst all 194 member states, in line with their GDP. 

The data was disclosed in documents published Monday morning ahead of the seventh day of WHO Executive Board discussions. 

Along with the proposed step-wise increase in all member state fees, China’s dues are being recalculated at a higher rate, in line with a new UN global assessment scale. The scale is largely based on GDP, while adjusting for debt burden, per capita income, and development status. The new UN formula translates into a proportionately larger share for Beijing of the WHO assessment.   

“China moves up as the scale of assessment is based on GDP,” one member state delegate told Health Policy Watch.

Effectively, the new scale would charge China for 20% of the entire amount to be paid by all 194 member states to WHO, as compared to 15% in 2025.  Meanwhile, the US share would remain steady at 22%. While there are minor adjustments up or down in assessment rates for some other member states none are as large China’s.  Some countries, like Brazil, would see a big decline. 

US President Donald Trump has long complained that China’s payments to WHO were out of sync with its economic prowess and population, citing that as one reason from withdrawing from the organisation just after his inauguration in January 2020.  Along with its assessed contributions to WHO, the US has traditionally paid hundreds of millions in donations. 

China still baulking at member state increase 

Altogether, WHO would receive some $537.4 million in 2026 from the planned 20% increase in assessed contributions by countries  – even without the United States participation. If the US were ever to remain in the organisation, WHO’s total budget from assessed contributions to be about  $692.9 million, according to the data published Monday. 

That is still only 22% – 28% of the $2.45 billion budget for 2026 that has been tabled this month’s EB meeting.  But increasing those assessments is regarded as an increasingly vital move to stave off a bigger WHO financial crisis.  And the total 2026-27 biennium budget of $2.9 billion has already been slashed by $400 million in anticipation of the US withdrawal. 

Speaking at Monday’s board meeting, China was one of only two states that once again expressed opposition to the 20% increase in assessed contributions for 2026, which had been agreed to in principle in 2022 as part of a step-wise plan to increased member state contributions to WHO to 50% of its budget by the end of the decade. 

“At present, the global economic recovery remains sluggish, and both Member States and international organisations are excessing caution in increasing their budgets. Against this backdrop, various parties, including China, agreed to a 20% increase in AC for 2024 to 2025 demonstrating great support for the organisation. Regarding the secretary’s proposal for further 20% increase in the EAC for 2026 and 2027 China has previously stated its position,” stated the delegate from Beijing.

However, in the day’s debate, Beijing was largely alone. 

A long list of African, as well as European, member states expressed support for the next of stepwise increase in assessed contributions in 2026. 

“We … wish to join others in supporting the 20% increase in the assessed contributions, which we think is even more important now that it drives our intention in our work towards sustainably financed who providing more support and better support for countries,” said Ethiopia, echoing a statement made by Senegal on behalf of the 47 member states of WHO’s African region.

Member states question pay raise for senior management 

Member states also questioned a proposal by the WHO administration to raise the pay rates of professional and senior staff by 9.5%, particularly in a period of austerity.

That means that the gross salary of the organisation’s 10 assistant director generals as well as directors in five WHO regions would be $216,655 per year in 2025, according to the new scale, as compared to about $198,000 previously.  

WHO’s Deputy Director-General, Mike Ryan, who also heads WHO’s emergency operations,  would receive a gross salary of US$ 235,064 per annum in 2025. And the gross salary of the director-general, Dr Tedros Adhanom Ghebreyesus, would be US$ 293,003 a year. 

Responding to EB member concerns, Tedros told the board that the increase had been proposed by the International Civil Service Commission of the United Nations to bring Geneva salaries in line with those of other UN agencies.  

However, the increase in base pay would be offset by a reduction in the “post adjustment” rate that WHO staff receive, leading to a net “no -gain, no loss” outcome in terms of their net pay, he stressed.  

Right now, post adjustment rates for Geneva’s professional staff, for instance, amount to a whopping 80% over WHO’s basic pay rate – due to the high cost of living in Switzerland.  Even so, it remained unclear if the “no-gain no/loss principle” would really apply to senior staff in WHO regions, where the cost of living, and thus post adjustment rates are much lower to begin with. 

WHO did not respond to enquiries from Health Policy Watch regarding the issue. 

Member states call for more transparency by WHO administration

In Monday’s debate, however, several member states stressed that the WHO administration still needs to be more transparent regarding disclosures regarding staff costs, in terms of the organisational budget overall.  

Notably, in the hundreds of pages of WHO  documents before the Executive Board, there is no breakdown of average and aggregate costs to the organisation of staff, with respect to professional and administrative staff at different salary grades. 

And in the proposal to raise the pay of the DG and ADGs, it was unclear if the “net pay rates” cited, which were about 26% lower than the gross pay scales, really reflect all of the perks that senior staff enjoy.

Those would include post adjustments, [even at a reduced rate], as well as educational grants, dependency allowances, and other housing benefits. WHO professional staff also enjoy tax free status in Geneva and their home countries – with the exception of the United States where the organisation pays taxes on behalf of WHO professional staff. 

WHO did not reply to repeated Health Policy Watch requests for further budget details.    

Most WHA decisions and resolutions approved conditionally  

In other business, the executive board conditionally approved over a dozen new or expanded WHO initiatives on universal health coverage, environmental health, communicable and non-communicable diseases, for consideration at the May World Health Assembly. The green-lighted initiatives also included a new global strategy on women, children’s and adolescent health, as well as a strategy on the health care workforce.

But they added stipulation that resolutions requiring WHO to undertake new or expanded programme of activities at significant cost would be reviewed and prioritised prior to the WHA to see which should indeed be approved in May, or alternatively, amended or delayed.    

The conditions, initially proposed by Norway, would have implementation “subject to the operationalisation of the Programme budget 2026–2027 once approved””- with a consultation process leading up to the WHA to prioritise the most important activities. 

Amongst the measures considered, however, several were also delayed. The Board deferred to the full Assembly any decision on an initiative by Pacific Island states to update WHO’s guidance on nuclear weapons – due to Russian opposition. (See related story).

The Board also agreed to continue negotiations between now and the WHA over a draft strategy on Traditional Medicine as well as a new global strategy for climate change and health – which was presented to member states at the EB as an “initial draft” for feedback and negotiation over the course of the coming three months. 

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