A core group of WHO member states have agreed on a landmark move to boost their annual “assessed” contributions to the global health organization to cover 50% of its core budget needs by 2028-2029 – but contingent on internal WHO reforms to boost efficiency and transparency.  

Partly in response to the reform call, a reshuffle of WHO’s senior management is expected to be announced shortly after WHO Director General Dr Tedros Adhanom Ghebreyesus is re-elected at the 75th World Health Assembly, which meets 22-28 May. 

That reshuffle is likely to include the departure of WHO Deputy Director Dr Zsuzsanna Jakab as well as WHO Health Emergencies Executive Director, Mike Ryan who has led the agency’s pandemic response in its first two years, diplomatic sources told Health Policy Watch.  

Jakab, a Hungarian health professional born in 1951, is already well over the WHO mandatory retirement age of 65 – which can be exceptionally extended only by three years at the decision of the WHO director general. She previously was the Regional Director for WHO’s European office.

Ryan, a seasoned health emergencies professional, may leave WHO to return to his family in Ireland, sources say, noting that two-years leading a response to the COVID pandemic has taken its toll on senior staff. However, others say that Ryan’s departure also reflects Washington’s desire to see new leadership in the WHO emergencies operations – which was criticized for being unduly slow and cautious at key moments – including the WHO’s declaration of a public health emergency and WHO’s months-long resistance to acknowledging that the virus is “airborne” and required public use of face masks as well as by health personnel. 

Asked by Health Policy Watch about the pending senior management reshuffle, a WHO spokesperson was reportedly ‘checking into’ them – but would neither confirm nor deny the reports. 

Other sources said that a shakeup in the Organization’s senior leadership is to be expected anyway following Tedros’ re-election to a second term as WHO Director General, for which he is running unopposed. 

Decision on more sustainable WHO funding formula announced by Germany  

The decision on the new formula for WHO funding, by a Working Group on Sustainable Finance, was announced near midnight Wednesday, by Germany’s UN Mission in Geneva – following three days of intensive negotiations. 

It overcomes the impasse encountered in late December and early January 202, when a handful of holdback nations, including the United States, had blocked consensus over the move.   

The WG on Sustainable Financing successfully concluded with a clear aspiration to increase @WHO assessed contributions to 50% of the base budget, following up on key recommendation of the @TheIndPanel. 👏

Thanks to all member states! pic.twitter.com/kc7tXgd2hw

— Germany UN Geneva 🇩🇪🇪🇺🇺🇦 (@GermanyUNGeneva) April 27, 2022

The move is significant because member state contributions have stagnated over the past two decades to the point where they comprise only about $475 million a year – or  about 16% of WHO’s $3 billion annual budget – of which about $2.2 billion is regarded as “core.”

Large “voluntary contributions” from rich member states, including the United States, and donor organizations, led by the Bill and Melinda Gates Foundation, have played a growing role in WHO’s budget. That also gives a handful of member states and donors outsize influence in the member state body, critics have said. 

WHO’s Director General Dr Tedros Adhanom Ghebreyesys had repeatedly complained that such “voluntary donations” often made it more difficult to plan strategically, as well as making WHO vulnerable to donor whims about what they do and don’t want to finance. 

Stepwise increase conditioned on WHO reforms 

Sources told Health Policy Watch that the real breakthrough on the new finance formula came after the US shifted from being a holdback to a leader in the initiative. 

Huge thank you Bjorn for your years of leadership to make this happen. Now time for @WHO and its Member States to deliver!

— Colin McIff (@CLMcIff) April 27, 2022

The breakthrough came as the Working Group agreed to link the new funding formula  to a member-state review of WHO progress on promised internal reforms – at each step of the step-wise increase toward the goal of 50% funding by member states. 

The US had previously stressed that it wanted to ensure any new finance formula would be tied to better WHO performance, including with respect to key gaps identified during the pandemic. 

Those reforms aim to make the Organization more efficient, accountable and transparent – in line with a series of recent external reviews of WHO’s response during the pandemic crisis, including a review of WHO Emergencies functions and another, even more sweeping review of pandemic response by The Independent Panel.  

Setting better priorities improving efficiencies

“Practically speaking, it means setting better priorities, making sure that member states are well informed. financial situation, clarifying any new initiatives that need to be seen by governing bodies, ensuring that we have an agile workforce,” said one member of the Bureau, who requested anonymity. 

“Most of that is already in the mandate,” the Bureau member added, noting that in any case, approval of WHO’s biennial budget is conditioned upon member state support – but the compromise makes the conditionality more explicit.  

The source added that the sexual exploitation and harrassment scandal involving WHO Ebola response workers in the Democratic Republic of Congo, which came to light in late 2020 as a result of an investigation by The New Humanitarian and Thomson Reuters Foundation, “was a big concern for the US.

“But overall, it becomes clear that we need to set better priorities with what needs to happen with the available resources, and this is not new. 

“Obviously, some member states need to clarify to their constituencies, to their Parliaments or Congress, etc, that they are not giving carte blanche to an organization, but rather than providing the right resources, but at the end, also taking care that these resources are used the most appropriate way under the control of member states.”

The Working Group also agreed that the aspiration to reach the 50% goal in member state contributions by the 2028-29 budget biennium, could be delayed until 2030-31 as deemed appropriate at that time.   

US support led to other countries to swing behind financial reform measure 

A handful of other countries, ranging from Russia and Poland to Japan and Brazil had also been holdouts in agreement on the finance reforms. 

But once the US changed position, that opposition also melted away, other sources told Health Policy Watch.  

“The US has shown that they are back in the game. They want to be seen as a supporter of the WHO. I think that has changed in the negotiations. 

“Obviously, at the start, they were rather reluctant. Then there was a tipping point. And the US was very, very much supportive of the whole thing of the last three days that we wouldn’t have gotten to where we are without the strong support of the US.”

Indeed, Germany’s announcement was followed by supportive messages from the US Mission in Geneva – as well as Health and Human Services in Washington, DC.   

The U.S. is grateful for Germany’s leadership and thanks all those who have engaged so effectively throughout these important talks. The outcome ensures a clear path for a strengthened and sustainably financed @WHO to effectively respond to future health emergencies. https://t.co/y6x4QaUx1h

— U.S. Mission Geneva (@usmissiongeneva) April 28, 2022

Germany’s Björn Kümmel credited with sustainable finance reform’s success

Following that, Latin American states such as Brazil, as well as close US allies like Japan and Poland fell into line supporting the finance reform measure, sources said. 

And Russia, another holdout – also shifted its position to support the moves so long as they were linked to more WHO transparency.  

But it was Germany’s Björn Kümmel, deputy head of global health in the Ministry of Health, who was widely credited with saving the day on an agreement – nursing the negotiations to a successful conclusion over more than a year. 

Kummel, who in mid-December 2021 had bluntly declared that the current WHO finance structure is “fundamentally rotten” had made it an almost personal mission to leverage this highly-technical, but equally significant, institutional change.  

He also has underscored that the aggregate demand of the increased commitment from countries remains very modest – requiring only about $600 million more a year from all 194 WHA member states by 2028-2029 – or at the latest 2030-31. That would bring countries’ assessed contributions up to the desired 50% share of what is now WHO’s core annual budget of about $2.2 million a year.

And he “never gave up” said global health influencer Ilona Kickbusch, founding director of the Geneva Graduate Institute’s Global Health Centre, in a Twitter post. 

 

Big thanks to Björn Kümmel 🇩🇪who never gave up ! @WHO

— Ilona Kickbusch (@IlonaKickbusch) April 27, 2022

Achievement noteworthy in time of rising geopolitical tensions. 

The agreement is all the more noteworthy in a period in which the US, Germany and Poland are faced off squarely against Russia over the latter’s invasion of Ukraine. 

And while NATO-Russian geopolitical tensions could very well erupt somewhere on the WHA stage – and are even likely to do so somehow – for now, it appears that pitfall may have been avoided in the case of the sustainable finance accord.  

Agreement by the Working Group signals the likely smooth passage of the measure through the upcoming WHA – in line with traditional practice where most serious member state disputes are ironed out behind closed doors, and in advance of the member state assembly.  

The expected approval was signaled by comments from senior WHO officials, including Tedros himself, who said the “recommendation to increase assessed [member state] contributions to 50% will empower WHO & safeguard its unique expertise, mandate & legitimacy.”

Against the current regional and global diplomatic landscape, that is no little accomplishment, noted Olaf Wientzek, Director of Multilateral Dialogue at the Geneva-based branch of Konrad-Adenauer-Stiftung, a German foundation. 

He noted that at the UN’s New York headquarters, countries’ attention has already shifted well away from the pandemic to issues like Russia’s war in Ukraine as well as other burning regional conflicts. 

That, in turn, leaves a “closing window of opportunity” for key reforms in the health arena that were identified as so critical during the COVID pandemic – to prevent and curb the risks from future epidemics and pandemics.   

“If you look at what we are seeing now, the war between Russia and Ukraine has repercussions across the UN spectrum; there is a strong danger of reduced funding [from member states] in certain cases; and we have seen that recent contributions from donor conferences, for instance in Afghanistan, were far less that had been expected,” Wientzek observed. 

“So against all of that, having an agreement on this is a big thing.”

Image Credits: Germany's UN Mission in Geneva , Kaiser Family Foundation , WHO , WHO AFRO, WHO/P. Virot; Obama Whitehouse Archives .