A grim picture is emerging of people running out of food, countries running out of medicine and hospitals closing as a result of the shock slashing of global health budgets by the United States, according to multiple World Health Organization (WHO) staff addressing a media briefing on Monday.

Meanwhile, the WHO is mulling “terrible choices” as it tries to trim 25% of its budget in the wake of the US withdrawal from the body.

Malaria: Additional 15 million cases this year?

“There are now severe disruptions to the supply of malaria diagnostics, medicines and insecticide-treated bed nets due to stockouts, delayed delivery or lack of funding,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus, reporting on the early impact of the US Agency for International Development (USAID) funding cuts.

Over the last 20 years, the US has been the largest bilateral malaria control donor, helping to prevent an estimated 2.2 billion cases and 12.7 million deaths.

“If disruptions continue, we could see an additional 15 million cases of malaria and 107,000 deaths this year alone, reversing 15 years of progress,” said Tedros.

HIV: Imminent disruption to ARV supplies

“It’s a similar story with HIV,” said Tedros. “The suspension of most funding to PEPFAR, the President’s Emergency Plan for AIDS Relief, caused an immediate stop to services for HIV treatment, testing and prevention in more than 50 countries. 

“Eight countries now have substantial disruptions to antiretroviral (ARV) therapy and will run out of medicines in the coming months. Disruptions to HIV programmes could undo 20 years of progress, leading to more than 10 million additional cases of HIV and three million HIV-related deaths, more than triple the number of deaths last year.”

The eight countries in the most immediate danger of running out of ARVs are Haiti, Kenya, Lesotho, South Sudan, Burkina Faso, Mali, Nigeria and Ukraine.

Dr Meg Doherty, WHO’s head of HIV, hepatitis and STIs, said there have already been reports of deaths of mothers and babies in settings such as South Sudan who were unable to get ARVs. In other settings, overdose deaths among injecting drug users soared within a week of opioid substitution therapy being stopped, a complementary therapy designed to reduce risks of acquring HIV infection from contaminated needles. 

“We are just going to need time to be able to get the data in, but we are seeing effects on the ground right now,” said Doherty.

‘Crippling breakdowns’ in TB response

“On tuberculosis, 27 countries in Africa and Asia are facing crippling breakdowns in their response, with shortages of human resources, disruptions to diagnosis and treatment, data and surveillance systems collapsing and vital community engagement work deteriorating,” said Tedros.

“Nine countries have reported failing procurement and supply chains for TB drugs,  jeopardising the lives of people with TB.”

Over the past 20 years, US support for TB services has saved almost 80 million lives. 

WHO Director of TB Dr Tereza Kasaeva, said that during COVID-19, there were 700,000 additional TB deaths as a result of service disruptions, and this was a grim indication of what to expect.

“When [service] disruptions last more than three months, even a 20% drop in [diagnosis] will lead to a significant increase in TB deaths,” said Kasaeva.

Threat to immunisation

WHO’s global measles and rubella network of more than 700 laboratories, funded solely by the US, faces “imminent shutdown”, said Tedros. 

“This comes at the worst possible time when measles is making a comeback. Last year, there were 57 live or disruptive measles outbreaks, and that number has been increasing for the past three years.”

WHO head of immunisation Dr Kate O’Brien described the cuts to immunisation programmes as “life-threatening”, although the results may only become clear in the years to come.

“We estimate that there will be hundreds of thousands of additional deaths as a result of the actions to compromise the vaccine programmes in place now, and many hundreds of thousands more as a result of the failure to deploy and introduce vaccines that are ready to go and to protect communities around the world, including the malaria vaccine,” said O’Brien.

Collapsed humanitarian response

“Almost 24 million people living inside crisis are at risk of not being able to access essential health services,” said Tedros.

“More than 2,600 health facilities in 12 humanitarian crises have already suspended services at least partially, or will do very soon.”

 In Afghanistan, funding shortages could force the closure of 80% of WHO-supported essential health care services. By the first week of March, 167 health facilities had already closed, denying lifesaving medical care to 1.6 million people across 25 provinces.

“Without urgent intervention, over 220 more facilities could close by June 2025, leaving an additional 1.8 million Afghans without access to primary health care,” said the WHO in a statement on Monday.

“In Cox Bazar in Bangladesh, the largest refugee camp in the world, diagnosis and treatment of hepatitis C has been disrupted, and disease surveillance, primary and secondary health care, laboratory services, procurement of supplies and salaries of health workers,” said Tedros.

Teresa Zakaria, WHO head of humanitarian relief, said that over 300 million people in 72 countries “require urgent humanitarian assistance to remain alive”. 

With data from only 12 countries, 23.8 million people are “directly affected by reduced health services” and “without urgent life saving health services, all of these individuals will be at risk of dying”. 

In these 12 countries, over 2,600 health facilities have been impacted and 900 hospitals in and over 1200 primary healthcare facilities are at risk of closing. 

It’s very early in our determination and quantification of the entire impact, but already we’re seeing how bad the situation is,” said Zakaria.

‘Terrible choices’ with WHO restructuring

WHO executive director of health emergencies, Dr Mike Ryan, is also chairing the WHO’s prioritisation committee to determine how to reduce costs while maintaining essential programmes.  

“We’re severely containing our costs to $4.9 billion over the next two years,” said Ryan, adding that a re-prioritised budget will be presented to the World Health Assembly in May.

The health emergencies budget needs to be cut from $1.2 billion for two years to around $872 million.

“That will result in a 25% contraction of the emergencies programme,” said Ryan. “What do you want to stop doing? Do you want to stop doing Ebola? Do you want to stop doing emergency medical teams responding to major disasters in the world? Would you like to stop intelligence gathering so that we know what the next epidemic or pandemic will be? There are some terrible choices to be made.”

All departments are “making similar terrible choices we would never have wanted to make,” said Ryan. 

“But we will ensure that this organisation moves into the future. We will be smaller, but we will be efficient as ever, and we will be stronger, and we will be ready to to to grow again when the time is right.”

To meet the crisis, WHO has already frozen new staff hires, laid off temporary staff, and offered early retirement packages to employees over the age of 55. But it has not responded to the Health Policy Watch report on the dramatic rise in numbers of consultants and expansion of senior WHO Directors, and particularly those at the top  (D2) level, which occurred since Tedros took over as Director General in 2017 – with corresponding costs increases.

EXCLUSIVE: Number of WHO Senior Directors Nearly Doubled since 2017, Costs Approach $100 million

US responsible for ‘orderly and humane withdrawal’

“The US administration has been extremely generous over many years, and of course, it’s within its rights to decide what it supports and to what extent,” said Tedros.

“But the US also has a responsibility to ensure that if it withdraws direct funding for countries, it is done in an orderly and humane way, with alternative sources of funding. 

“We ask the US to reconsider its support and help, which not only saves lives around the world, it also makes the US safer by preventing outbreaks from spreading internationally,” he added.

Meanwhile, Ryan said that he mourns the loss of his US colleagues, “not for the dollars, but for the loss of contact”. 

“I’ve worked in this space for 30 years. We speak every day with colleagues in the United States, with institutions around the United States. They are the core of global public health. They are the heroes of disease control.”