Responding to health emergencies is at the heart of the work of the World Health Organization (WHO), which assisted almost 90 million people with humanitarian health support in the first nine months of 2024.

But the loss of United States funding, which has included the immediate freezing of funds already committed, means that this essential work will need to be cut back by as much as 25%.

There were 45 graded emergencies affecting 87 countries, and 18 required major support, according to the WHO Director General’s report on health emergencies to the Executive Board.

Dr Mike Ryan, Executive Director of WHO’s Health Emergencies Programme, joined the EB on Zoom from Uganda where he is assisting the country to respond to an outbreak of Ebola.

“The immediate response here in WHO was to use our Emergency Response Framework, to realign the functions at the country office to deploy an incident manager and core staff from the Afro rapid response mechanism, to send specialist expertise in from both the regional and from the HQ level,” explained Ryan.

“Dr Tedros immediately issued contingency funds of $1 million to support the response, and that allowed that response to start up very quickly,” added Ryan, who explained that the WHO has worked with the Ugandan government for the past year to prepare for such an emergency.

“It took less than one day to sequence the virus, and it was immediately published for the global community. An incredible achievement by public health laboratories here in Uganda,” added Ryan.

Uganda’s Ministry of Health, WHO and other partners also launched the first-ever clinical efficacy trial for a vaccine for Ebola Sudan virus in that country this week.

Immediate impact of US aid cut

But the US funds around 20% of the WHO’s emergency appeal and acute response side, and about 25% of its core programme, Scott Pendergast, Director for Strategy, Financing, and Partnerships for the WHO Health Emergencies Programme, told the EB.

“We’re also having to deal with the immediate withdrawal, the instruction of the US to stop any spending against the existing awards we have. This is putting a major challenge on our teams on the ground in terms of how to reduce operations or meet the obligations that we have now that we no longer have access to that financing,” Pendergast added.

The WHO’s health emergency appeal is only 65% funded for 2025, while there is only $22 million in the contingency fund for rapid action in health emergencies, he explained.

“More than 80% of the financing for the emergency programme is going to the country level,” said Pendergast. But the department was working with regions on the “new reality” of potentially having to cut a quarter of its budget and a report on how this will be done will be available next month.

Switzerland noted that some emergency relief programmes “are currently under immediate operational risk”. 

“For example, numerous CDC deployments from the United States no longer appeared at work since last Monday. These are specialized experts who played key roles in functions such as immunization, surveillance and the preparation against the pandemics in many countries. Contracts for contractors and suppliers are frozen. Therefore expertise is already starting to leave the organization and offices are starting to cut back on staff.” 

Budget cut comes amid growing need

The loss of US funding comes at a time of increased health emergencies, fuelled by rising conflict and climate-related health emergencies. In the African Region alone, 56% of all public health emergencies between 2001 and 2021 were climate-related.

Over several hours on Wednesday, member states at the EB expressed gratitude to WHO teams for assistance in a wide variety of situations.

Lebanon, speaking for the Eastern Mediterranean region, described 2024 as being “marked by violence, death, disease, destruction and displacement”. 

“It is sobering to note that over one-third of all health emergencies responded to by WHO last year occurred in our region. Outbreaks of measles, cholera, dengue and other diseases escalated, fueled by conflict, fragility, disrupted surveillance and control systems and effects of climate change,” Lebanon noted.

“The most devastating humanitarian crisis unfolded in the occupied Palestinian territory,  Sudan and Lebanon.

“Wars and armed conflicts do not only shatter buildings and destroy lives. They can leave people mentally and emotionally scarred, sometimes for a lifetime.”

Togo, speaking for the Africa region, described how the WHO African region has “actively intervened in 17 emergencies, with 14 extreme emergencies, four of which were at level three, requiring the highest level of support, and three prolonged emergencies”.

WHO assistance included training health workers, establishing health emergency operations centres, and providing medicines, vaccines and diagnostics “in considerable quantities to help countries in crisis”.

Attacks on health workers

“By 30 September 2024, 1080 attacks on healthcare workers and facilities had been reported through the WHO surveillance system, in 13 countries/ territories – resulting in 554 deaths and 923 injuries among staff and patients,” according to the DG’s report.

The occupied Palestinian territory, including east Jerusalem, accounted for the highest number of incidents (505), followed by Ukraine (320).

 “Attacks on health care have become an unacceptable norm in these conflicts,” Lebanon noted.

“These assaults undermine the very essence of humanity. In Gaza, aid workers describe the war as the most brutal and severe crisis they have ever faced. In Sudan, violence has displaced more people than any recent emergency. Over half of the population now needs urgent humanitarian assistance.”

Questions for Secretariat

Switzerland asked how the WHO Secretariat can “protect the critical work in all these areas, as well as other essential work”, but pledged to support the WHO,

Meanwhile, Germany urged WHO and member states to “do whatever it takes to secure flexible and sustainable funding for these now severely underfunded functions”.

“We would also appreciate more information by the Secretariat on the immediate measures taken by who to address this gap,” said Germany.

“Let us not forget that it is in our collective and national interest to maintain and prioritize work and health emergencies. Filling funding gaps and funding the initial response is particularly crucial, and the contingency fund for emergencies has an important role to play,” added Germany, urging all countries to increase their commitments to the fund. 

While Brazil acknowledged the WHO’s efforts in strengthening surveillance preparedness and response, it urged the WHO to “fulfil the estimated $55.5 million needed to bolster global response capabilities”.

Meanwhile, Namibia urged the WHO Secretariat “to collaborate with relevant stakeholders, including the World Bank and IMF, to support developing countries in addressing their international debt burdens, which have colonial underpinnings.

“Facilitating debt restructuring reforms is crucial for improving the fiscal space of African nations, enabling them to allocate more resources toward domestic health investments. 

By doing so, we believe the Secretariat can help build a more robust financial foundation for member states, facilitating improved health outcomes and stronger resilience against future health emergencies.”

In response, Director General Dr Tedros Adhanom Ghebreyesus told member states that the WHO’s operational arm, “will stay and will be very important”.

“There is no way that we can leave the community behind and go, and in some places, our colleagues paid the ultimate sacrifice. So I hope you will understand that, when we talk about financing, prioritization and balancing, it’s not just norms and standards. We have the operational arm that we develop, and that cannot be starved because the people we serve need it.”

“We need to continue to mobilize resources, and we need to also be careful about expenditure, meaning we need to do efficiency gains, meaning, tighten our belts,” added Tedros.

He appealed to member states: “We have the assessed contribution. If you agree on that 20% that means a lot. We have the investment round. For countries who haven’t contributed to that, if you can contribute, that will help us in balancing.

“And we have the WHO Foundation. If your private sectors could be convinced, if you can convince them, and then we have some resources through that. I think that will really keep the balance.”

Image Credits: WHO, WHO .