From the deadly mpox outbreak in the Democratic Republic of Congo to the composition of the next seasonal flu vaccine, the collapse of USAID and the US CDC communications blackout are creating new challenges for WHO and its partners to respond in disease emergency hotspots – well beyond the direct loss of financial support.

That was the key message of the first WHO press conference since the cascade of new US executive orders send shock waves through the global health world.

“A significant part of who’s response to health emergencies in Uganda, DRC, Gaza, Sudan and elsewhere, is supported by funding from the United States. As we have said, we regret the announcement that the United States intends to withdraw from WHO, and we would welcome the opportunity to engage in constructive dialogue,” said WHO Director General Dr Tedros Adhanom Ghebreyesus.

But he stressed that US moves in other health and development arenas, unrelated to the US withdrawal, are also having a cascading series of impacts on WHO emergency response.

“For example,” he said, “the suspension of funding by PEPFAR, the President’s Emergency Plan for AIDS Relief, caused an immediate stop to HIV treatment, testing  and prevention services in the 50 countries that PEPFAR supports based on bilateral agreements. Although a waiver has been granted for life saving services, it does not include prevention services for some of the most at risk groups.

“Despite the waiver, clinics are shuttered and health workers have been put on leave,” he said. “WHO is gathering data on service disruptions and supporting countries with mitigation measures, including by filling gaps in supplies of antiretrovirals.

“The sudden suspension of us funding and the sudden disengagement of US institutions is also affecting the response to global efforts to eradicate polio and the response to mpox epidemics in Africa,” he added.

“In Myanmar, almost 60,000 people, most of them women and children, have been left with no access to life saving [health] services. And we have limited information about the spread of avian influenza among dairy cattle in the US or human cases,” he stressed.

Appeal to continue funding for most severe emergencies

While Elon Musk, head of the new Trump administration “Department of Government Efficiency” told Whie House correspondents last night that US aid to Uganda’s Ebola response was being resumed, Tedros said that’s just one trouble spot of many. He asked the US “to consider continuing its funding” on other burning crises at least until other solutions can be found

In the eastern DRC city of Goma and the surrounding North and South Kivu regions, for instance, only 1/3 of people who need health services have been able to access them, following the conquest by the M-23 rebel group of much of the region. At thes ame time, USAID supported NGOs that previously operated in the area have now seen their funds cut off.

“Pregnant women cannot reach health facilities or save delivery. And the threat of infectious diseases, including mpox and cholera, has multiplied,” Tedros said. “Hospitals and morgues are overwhelmed. Some health workers have had to flee, while others have been working around the global days. WHO remains on the ground, although insecurity is limiting our operations, anticipating an escalation of violence, we have been working since November to pre position supplies, including medicines and fuel. However, the supplies are running out, and others are running dangerously low.”

US CDC’s participation in global influenza network has ceased

Collaborations between the US Centers for Disease Control and  WHO on seasonal influenza’s spread have also ceased, said WHO’s Maria Van Kerkhove, of WHO’s Department of Health Emergencies.

The group is preparing for a March meeting to establish the formula for the next flu vaccine, based on reporting to date.

“CDC right now is not reporting influenza data through the WHO global platforms, Flunet, that they’ve been providing information for many, many years, and we have not had direct communication with CDC related to influenza,” Van Kerhove said.

“There are national influenza centers in 133 member states. They’re sharing information about circulating viruses, and all of that information over the course of the six months a year is actually utilized in making that decision about the vaccine composition for either the northern hemisphere or the southern hemisphere. So yes, there is a pause in the reporting of information from the US, as we’ve said. We hope that that resumes. We hope that that technical exchange resumes.

“We are communicating with them, but we haven’t heard anything back.”

She added that CDC has reported a handful of human cases of the more deadly H5N1 avian flu through WHO’s emergency alert networks, and with regards to animal infections “USDA has published some information online,” but the information remains spotty and partial:  “As DG has said, we welcome active technical exchange with our colleagues in the US and there are very important meetings that are taking place.”

Mpox, Ebola and beyond

As for response to the deadly DRC outbreak of mpox, some $7.5 million directly allotted by the US to the outbreak response has been lost. “But more importantly, it is the humanitarian crisis,” said Abdi Rahman Mahamud, director of WHO’s Global Alert and Response network.

“A lot of the NGO partners depend heavily on the USAID and US partners funding. But it’s more than even the funding. As we speak today in Uganda, the Global Alert and Response network (GOARN), was started by us, CDC and WHO coming together.  And through that mechanism, CDC has deployed almost 842 US experts to countries that will never have been accessed. The continuous exchange between the two sister organizations been very critical. So while we’re very happy to see us CDC experts come into the field, joining us in Tanzania and in Uganda, I think this is in a very critical, important collaboration that needs to be further strength, and it’s beyond even the financial, which has direct impact on our partners and who, but there’s technical collaboration that will be lost for both.”

WHO tries to mitigate problems caused by PEPFAR disarray

As for HIV/AIDS, while limited waivers for some PEPFAR-supported services have been issued, many services remain paralyzed, said Meg Doherty, Director of WHO’s HIV programme, at the briefing.

“Right now, there are limited waivers that have come forward to allow access to life saving treatment, including antiretroviral therapies, mother to child transmission, but there has been confusion in countries, and certainly with the furloughed healthcare workers [who also depend on USAID support], some of the services have not been able to get started again.” she said.

“So what we’ve been doing at our coordination is having contact with countries ministries, and when there are requests for other antiretrovirals, we seek support from country to country for ARV sharing. 

“This is a very short term limited approach that we did during COVID to ensure life saving medicines were available. But over the long term, there’s going to need to be greater coordination, especially with other resources and some of the domestic resources that are now going into antiretroviral programs. So this will be an evolving story, and I think each day we learn something new.”

Tedros Responds to Trump’s ‘ASKS’ of WHO

With respect to the US withdrawal, Tedros also noted that the agency had already responded to two key issues raised by President Donald Trump in his withdrawal announcement – internal reform of the organization and, related to that, a more equitable and reliable stream of financial support.

In terms of the historically high rate of US payments to WHO, stepwise increases in fixed financial support through all member states’ “assessed contributions” would gradually redistribute the load more evenly, Tedros noted. As part of that, the recent WHO Executive Board meeting had confirmed yet another 20% increase in those stepwise payments – despite opposition from China, which will be assessed at a far higher rate – and one comparable to the US –  in the future. See related story:

China’s 2026 WHO Fee Could Match US Levels Today – But Beijing Resists Planned Increase

As part of the reform, WHO has also launched the WHO Foundation, allowing it to receive donations from the private sector that it cannot accept directly. And it has launched its “investment round” to broaden the base of voluntary donations from philanthropies and member states. Tedros also said he was “in the early stage” of floating the idea of a $US 50 billion endowment fund, which could generate $1.5-2.5 billion a year in reliable income, similar to the basis on which the noted UK philanthropy, Wellcome, operates.

“If the US wants to pay less, it’s actually in line with what we’re doing as part of our reform,” Tedros said.  because we have started in 2017 the sustainable financing reform that is helping us to broaden donor base. And when this succeeds, the contribution of  traditional donors, including the US, could decline.

“Of course, it will take some years, but will but it will decline, because the burden will be shared. So if this is what the US wants, then again, cooperation and being with WHO will be the answer, meaning we’re asking exactly the same thing ‘share the burden’. And the US is saying, ‘share the burden’, so there is no difference at all.”

Image Credits: BBC/YouTube.