Health services worldwide have been “severely disrupted” by the United States slashing aid, and the World Health Organisation (WHO) is radically reducing its operations following the US withdrawal from the global body – but there has been no formal engagement between the WHO and the White House.

WHO Director-General Dr Tedros Adhanom Ghebreyessus revealed this at a press conference on Thursday, reporting that three-quarters of the over 100 countries had reported “severely disrupted” services, a quarter had closed health facilities and a quarter were charging patients more for services.

The US owes the WHO $260 million in membership fees for 2024-25. The Biden administration failed to pay fees last year and the US is liable for this year’s fees as it is obliged to give a year’s notice of its withdrawal form the body. 

But there has been no formal engagement between the WHO and the White House since Trump issued an executive order on 20 January withdrawing from the WHO, said Tedros.

“I hope there will be some formal engagement, or a very honest and candid dialogue for the US to come back to the World Health Organisation. It’s in the best interest of the US to stay in WHO. It’s a health security that keeps the US safe and the rest of the world safe,” he added.

Ongoing talks between the remaining 192 WHO member states on a pandemic agreement, expected to conclude this week, would “set the rules of the game” in a future pandemic to ensure that the world is safer, added WHO Deputy Director-General Dr Mike Ryan.

“The great thing about an international rules-based system is we all agree how the game is played, and we really do need to play a better game in the next pandemic, and this is the way to do it,” added Ryan.

The US has pointedly removed itself from the pandemic agreement negotiations, erroneously claiming that a pandemic agreement will infringe on its soverignty.

Prioritise the poorest

In response to the loss of US aid, countries are “revising budgets, cutting costs and strengthening fundraising and partnerships,” said Tedros, reporting on efforts by South Africa, Nigeria and Kenya to increase their domestic allocations to health.

He advised countries to prioritise their poorest citizens, protecting them from being impoverished by additional health spending, and to resist cutting public health spending, instead improving efficiency.

“Absorb as much of the impact as possible through efficiency gains in health systems, including.. improving procurement, minimising overheads, pooling purchasing of goods and services, and using health technology assessment to guide decisions on which services and products provide the biggest health gains,” Tedros advised.

Countries can also increase revenue by introducing or increasing taxes on products that harm health, including tobacco, alcohol and sugary drinks, he added.

Unpaid WHO membership fees

The WHO is in the midst of intense reprioritisation following the loss of around a quarter of its budget. It faces a gap of $2,5 billion for the 2025/27 period, according to a recent Health Policy Watch report.

Ryan, who chairs the WHO prioritisation committee, said that the pain being experienced at WHO was a “ha’penny space” in “the hierarchy of suffering”.

“However, we recognise that we’re in a situation where, with the advice and with cooperation with our member states, we need to contract the amount of money we absorb as an organisation to do the work we do,” said Ryan.

“We’re approaching that very, very responsibly in terms of cost containment, resource mobilisation” and prioritisation of activities, he said.

“We have to have a new budget on the table for the World Health Assembly [next month]… and there will have to be a new set of priorities, and obviously an organisational design that can deliver that.”

Aside from $260 million hole left by the US withdrawal, other member states owe the WHO $193 million in unpaid membership fees (called “assessed contributions”), according to a report compiled for the World Health Assembly next month.

The voting privileges of Afghanistan, Central African Republic, Comoros, Dominica, Lebanon, Sierra Leone, Somalia, South Sudan, Sudan, Venezuela and Yemen remain suspended as a result of unpaid fees.

Algeria, Bolivia, Cameroon, Grenada, Iran, Myanmar, Panama and Saint Lucia may also lose their voting rights as a result of unpaid fees for 2024 and 2025.

Gaza blockade

Tedros also condemned Israel’s “complete blockade” of Gaza since the breakdown of the ceasefire on 2 March, in which it has prevented all food and medicine from entering into Gaza.

“In the past week, 75% of UN missions within Gaza have been denied or impeded. This blockade is leaving families hungry, malnourished, without clean water, shelter and adequate health care, and increasing the risk of disease and death,” said Tedros.

During the ceasefire, WHO had been able to resupply the health system and its warehouses but those supplies “will run out in two to four weeks unless the siege is lifted”, he added.

“Some 180,000 doses of routine childhood vaccines, enough to protect 60,000 children under the age of two, have not been allowed to enter leaving newborns and young children at risk,” said Tedros.

“Since the breakdown of the ceasefire, almost 400,000 people are estimated to have been displaced again with no safe place to go, and almost 1500 people have been killed, including 500 children,” said Tedros.

“The health system is only functioning partially and is overwhelmed. Meanwhile, healthcare continues to be attacked. On the 23 March, the Israeli army attacked a medical and emergency convoy, killing 15 health and humanitarian workers.”

On Wednesday, WHO assisted in evacuating 18 patients and 29 companions to Norway, Malta, Luxembourg and Romania but “more than 10,000 other patients are still awaiting evacuation” for medical treatment.

“WHO calls for the urgent lifting of the aid blockade, the protection of healthcare and embedded humanitarian access across Gaza, the immediate resumption of daily medical evacuations, the release of hostages still detained in Gaza, and above all, a ceasefire,” Tedros concluded.

Image Credits: UNICEF/UNI501989/Al-Qattaa.