Nations at the 78th World Health Assembly approved a new budget and a 20% increase in annual membership fees for the World Health Organisation (WHO), handing the embattled UN health agency a crucial lifeline as it grapples with the financial bomb dropped on Geneva by the United States’ withdrawal from international institutions.

The vote marks the second consecutive 20% hike in membership dues in as many budgets, which the agency’s member states approve on a biennial basis, the last coming in 2024.

The move is part of a long-term plan to boost mandatory contributions from 16% of WHO’s core budget at the start of the decade to 50% by 2030 in order to reduce its dependence on the whims of major donors like the now-departed United States.

These membership fees provide the organization with flexible funding it can allocate according to its own priorities, unlike the voluntary contributions that typically come strictly earmarked by donors for specific programmes that have historically made up the vast majority of the WHO’s budget.

Under the new budget, assessed contributions will make up 40% of the WHO’s base program budget of $4.2 billion for the 2026-27 period. The core budget does not include emergency humanitarian appeals or polio programmes, which bring the total budget target up to $6.2 billion.

The fee increase, initially mandated in a 2022 resolution at the WHO’s executive assembly, faced an uncertain path to approval on Tuesday, with member nations engaging in tense pre-vote debates over the fairness of regional funding cuts in the new budget – which will run for two years starting in 2026 – and demands for greater transparency in expenditure tracking.

A battle of buzzwords played out during the proceedings: supporters of the fee increase championed “flexible, predictable, sustainable and agile” funding, while skeptics countered with demands for “efficiency,” “transparency,” elimination of “redundancy” and “cost-effectiveness” – signaling clearly that the WHO’s financial reprieve comes with strings and expectations attached.

WHO officials had acknowledged in the budget document they were “cognizant that such an increase will not be automatically granted” amid overlapping global crises straining national budgets worldwide.

In the end, a collective recognition of the existential financial threat facing the agency carried the budget over the line. The chamber fell silent during the vote, with no objections raised. 

“There is a crisis,” WHO Director-General Dr Tedros Adhanom Ghebreyesus declared following the vote. “But we will use this crisis as an opportunity and make sure our organisation emerges sharper and more empowered.”

Germany’s delegation, the WHO’s most important financial backer since the American departure, hailed the decision as “historic” — but not before voicing their support in song.

“I tell you what I want, what I really, really want,” the German representative sang in an awkward rendition of the Spice Girls hit befitting the oft-lively proceedings of Committee A, “and that is that we all indeed are serious about functioning and effective multilateralism.”

“The increase is the best vaccination against the highest financial risk that WHO faces,” he added, “its dependency on a very few donors, and the discrepancy between the expectations we all put on the organisation and its ability to fulfil them.”

Financial triage

The agency has been in financial triage mode since the US exit announcement in November, implementing drastic budget reductions to secure votes that earned praise from member states for its “budgetary realism.” 

Before the US departure, the 2026-27 budget required to fulfill WHO’s core mission was projected at $5.3 billion over the two year period. Following Tuesday’s vote, the target plummeted to $4.2 billion, a 22% cut that will impact the agency’s operations worldwide. 

The revised budget represents a $700 million decrease from projections presented at WHO’s January executive board meeting, but even this diminished figure approved in Geneva remains aspirational. 

While WHO secured an additional $200 million toward its 2026-27 budget Tuesday evening following major commitments of $50 million a year from China and first-time donors Mongolia and Cambodia, among others, the agency still faces a $1.5 billion funding shortfall on top of the $1.1 billion decrease from previous budget projections.

The two new donor nations join 39 additional first-time contributors to WHO, including seven low-income and 28 lower-middle and upper-middle income countries, to join the donor base. 

“With the exception of the headquarters and the European region, the allocated or proposed budget for every regional office is currently higher, even after the reduction, than the projected implementation,” explained Imre Hollo, director of strategic planning and budget at WHO.

Without additional contributions, further life-threatening program cuts loom. All of the WHO’s six regions face significant cuts heading into the 2026-27 period covered by the budget. Regional office budgets are set to fall by 14%, with the African region facing the largest total cut of $153 million year-on-year. The agency’s Geneva headquarters will lose nearly a quarter of its annual funding.

China announced it will contribute $500 million to the WHO over the next five-year period, though it was unclear whether this includes the 20% increase in its fee contributions. This will make China, for the first time, the largest fee payer in the WHO, supplanting the US as it exits.

“We can only implement the budget if we have the financing,” Hollo said, noting the “personal sacrifice” that member states will need to make should the funding target remain unmet.

More Freedom, Less Money

The WHO’s budget victory comes amid a zero-sum competition for international aid dollars, with UN agencies and humanitarian organisations worldwide scrambling to fill gaps left by America’s retreat from global commitments.

Since January, the White House has systematically dismantled USAID—historically the world’s largest humanitarian donor—while slashing support for the United Nations and WHO’s sister agencies. By March, over 80% of USAID programs had been shuttered, punching a $60 billion hole in global aid budgets.

This broader retreat from international commitments has left organisations like the UN Refugee Agency and Office for Humanitarian Affairs and non-governental humanitarian organisations scrambling for resources just as the WHO does the same, creating unprecedented competition for a dwindling pool of donor funds that no single government appears willing or able to replenish.

In the latest sign of distress, top UN officials told staff at a town hall in New York City Tuesday that the organization is considering a 20% reduction across every secretariat under the UN umbrella for 2026 — from humanitarian affairs, to human rights, peacekeeping operations, and development programs — heightening the financial crisis in the world of international institutions and those who depend on them.

Several major financial contributors to WHO, including Germany, France, and the EU delegation, pressed the agency to develop contingency plans for potential fundraising shortfalls as the UN system creaks under the weight of the US withdrawal. 

“Should the resources, the $1.65 billion, not materialise, the idea is that we will be in a position to actually scale back or ramp up,” said Raul Thomas, WHO’s Assistant Director-General for business operations who led the budget consultations with member states. “We never know – I’m the eternal optimist. Maybe we’ll get much more money than the 1.65 million. That’s the gap right now.”