The United States’ dismantling of its vast network of global health aid and assistance programmes constitutes “greatest disruption to global health finance in memory” and it is “sowing chaos in public health”, that threatens to roll back decades of progress on infectious and neglected diseases of poverty that affect billions of people, said WHO’s Director General Dr Tedros Adhanom Ghebreyesus on Thursday. 

But Tedros still expressed hopes that the WHO’s biggest donor might eventually rejoin – asserting boldly that the global health agency had already fulfilled key demands made by US President Donald Trump when he withdrew from the organization in January.  

“We still believe the US will reconsider and join. Because for me, the US withdrawal is not about losing money. … More important for me is its impact on the partnership. US leadership is important. US partnership is important. No country should be out of WHO because it [countries] benefit.…. The decision is lose, lose. The US loses, and the rest of the world, we know for sure, loses.”

The WHO Director General’s comments at a two hour-long briefing with Geneva’s UN press constituted his most significant statement on WHO’s budget crisis, restructuring, and the troubled US relationship since Trump’s inauguration. 

In a related development, an internal UN task force memo has suggested merging another financially troubled Geneva agency, UNAIDS, into the WHO, as well as merging WHO’s emergency operations with those of other agencies delivering emergency relief, including the World Food Programme, UNICEF and the UN Refugee Agency (UNHCR) into a single humanitarian entity, Reuters reported. Asked for comment by Health Policy Watch, a WHO spokesperson declined, saying it was was a UN document.

Pushes back against Trump – saying reforms are happening

On the campaign trail, prior to being elected, Trump repeatedly blasted the organization as a “corrupt globalist scam, paid for by the United States but owned and controlled by China.” 

The World Health Organization has become nothing more than a corrupt globalist scam paid for by the United States but OWNED and controlled by China. When the China Virus reached our shores three years ago, the World Health Organization disgracefully covered the tracks of the… pic.twitter.com/AZydUGTbxo

— Donald J. Trump Posts From His Truth Social (@TrumpDailyPosts) October 18, 2023

At the Geneva briefing, Tedros pushed back saying that most of the reforms that the Trump had cited in his Executive order issued shortly after his inauguration were already being made by the agency.  

At the same time, Tedros referred to the “catastrophic” health and hunger crisis in war-torn Gaza; a major cholera outbreak in Angola; and gang violence in Haiti as examples of public health threats faced by WHO – and the world. On a brighter note, he expressed optimism that WHO member states would finally approve a pandemic treaty in the upcoming World Health Assembly, 19-27 May, after negotiators, working around the clock, finally reached an accord last month.      

Countries Say YES to Pandemic Agreement

Trump’s reasons for leaving WHO are now ‘good reasons to stay’

Legally, the US withdrawal would take effect in January 2026, but WHO officials admit that along with the lost of voluntary funds, they also haven’t any of the $260 million in US assessed contribution for 2024-2025. Those losses, along with other laggard member state payments, has contributed to a $600 million budget shortfall for 2025. The agency faces a whopping $1.9 billion deficit for 2026-2027. 

“As far as we know, there were four issues mentioned in the Executive order” issued by Donald Trump to withdraw from the Organization,” Tedros said.  

“One is [organizational] reform, second is [US] payments, third is COVID management and fourth is independence. 

“And all four are good reasons for the US to stay,” he added, saying that the agency had undertaken more than 94 reform initiatives; WHO  is gradually  increasing all member states’ required contributions so that ultimately the United States would be able to “pay less” overall. 

In terms of COVID management, Tedros argued that the pandemic agreement would improve the world’s and WHO’s response to a future crisis without sacrificing national sovereignty- although the US has said that they will not participate in the accord. 

“And there are even many Americans in Congress who say that the accountability and transparency of the organization has improved,” Tedros maintained.  But the problem, he added, is “wrong information, and other people running around and blaming the organization.”

Praises past collaborations

The Director General also praised WHO’s longstanding partnership with the United States – saying: “Of course, donor countries can spend money where they want – and we are grateful to those that have for decades funded health systems globally – but instead of an orderly decline, the abrupt cuts to overseas development aid and a challenging economic and trade environment are sewing chaos in public health.

“For example, advances in tackling Neglected Tropical Diseases, which affect over one billion people and disproportionately impact the poorest and most marginalized communities, are at real risk of backsliding,” Tedros said.

“Thanks to the huge efforts of the US government, more than three billion treatments have been delivered to 1.7 billion people in 26 countries over the past two decades.

“The combination of $1.4 billion from the United States, generous pharmaceutical donations, private sector innovation and (largely public sector) health workers, has helped stop transmission of lymphatic filariasis, river blindness, schistosomiasis, intestinal worms and trachoma in 14 countries.

“However, the abrupt cuts and withdrawal of US funding, on top of other donor countries cutting investments to NTDs, have led to treatment campaigns for more than 140 million people being paused, and research on new medical tools being cut.

“But it doesn’t have to be this way, and we urge governments to not turn their backs on the poorest and most marginalized and undermine decades of progress,” he said, pointing out that, “diseases continue to be born, with a heating world, protracted conflict and continuing outbreaks.”

25% of 2026-27 salary costs are unmet

Just last week, WHO unveiled a new plan to staff and member states that would dramatically reduce the number of departments at headquarters from around 60 to around 33, while programme divisions at headquarters would shrink from 10 to just four. 

As for rank and file staff, some projections have held that cuts at headquarters, which faces the biggest deficit, could ultimately be in the range of 40%.

Tedros confirmed that the cutbacks would affect the Geneva headquarters’ operations most deeply, followed by rollbacks in WHO’s six regional and 152 country offices. 

While country offices should be the least affected, WHO is also planning to close country offices operating in high and upper middle income countries – which depend far less on the global health agency’s technical support, Tedros added.

But WHO’s head of Business Operations, Raul Thomas, said that officials are so far unable to make projections – until WHO management completes a “prioritization” exercise to determine more precisely what projects and programmes should be cancelled, which should remain – as well as what teams or initiatives might actually relocate outside of Geneva to less expensive locations.   

“The outcome of the shape of the organization will be heavily dependent on the prioritization exercise,” Thomas told journalists. “And out of that, we will then be able to determine the location of those positions that we’re going to reduce, the grades of those positions – which will heavily impact the number of positions [to be cut]. 

“What we do know is that, based on our projections, our financial projections, 25% of our salary costs for the next biennium are not met. So what that translates into in terms of number of positions and unknown at this point in time.”

At the same time, Tedros sought to put a positive light on the cutbacks, saying that in the end, it would make WHO more efficient and responsive to country needs. 

“We will make sure that this prioritization will help us to …focus the organization … to sharpen the organization and make it more focused and even more impactful.”

He made no reference at the briefing to the UN task force memo circulating, an initiative of  UN Secretary General António Guterres, which raises the possibility of even more dramatic changes – particularly regarding a possible UNAIDS merger with WHO and the merger of operational aspects of WHO’s Emergencies Department with those of other agencies.  The memo, prepared by a task force appointed in March by Guterres, was described by his Spokesperson Stéphane Dujarric as an exercise to “generate ideas and thoughts from senior officials on how to achieve the Secretary General’s vision.” 

No regrets about past years of expansion 

Tedros, meanwhile, said that he had no regrets about the expansion of staff, consultants and senior directors positions that he has overseen since taking office in July 2017. 

An earlier report by Health Policy Watch found that globally, the number of the most senior, D2, directors had nearly doubled, increasing from 39 to 75 worldwide as of July 2024. The number of non-staff affiliates also soared from roughly 3800 in 2017 to around 7600 as of July 2024, while rank and file staff increased by 17%. See related story: 

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

On the large increase in D2 directors, Tedros said that the creation of new initiatives, such as the Chief Scientists’ Office, the WHO Academy; a new Berlin-based office of Pandemic Surveillance; and a Department of Digital Technology, had warranted the creation of new high-level positions – as part of initiatives to make WHO more fit for the future. 

“These were intentional and conscious …  things that can help the organization or prepare the organization for the future. It’s on science. It’s on evidence, on data, on digital technology.”

Beyond the creation of new positions, however, Tedros acknowledged that the near doubling of D2 directors, from 39 to 75 as of July 2024, as noted in the 10 March Health Policy Watch report, was largely a function of promotions. 

“Of course, if you count them as doubling, there were directors to be promoted from D1 to D2, and the reason for that is we need to be competitive, to attract talent. … And in terms of money, by the way, it’s a very small amount,” he said.

Swollen consultants’ ranks

As for the increase in consultants as well as staff, Tedros said that the COVID pandemic, followed by two mpox public health emergencies, not to mention other outbreaks and humanitarian crises, had led to the increase in WHO’s non-staff hires.  

“It had to be done. There was no other way. And I would do it again if there was an emergency,” he said, “We went from one thing to another, we don’t regret. There was a need.””

But he contended that the agency had been “over the last two years, trying to decrease” its consultants corps. In fact, 2023 was a peak year for WHO hires of both “consultants” as well as of personnel on non-staff Special Service Agreements, according to Health Policy Watch’s analysis of the HR data from 2017-2024.

New data published just ahead of WHA shows that consultancy contracts of all kinds did finally decline in end 2024 – from approximately 6311 contracts in 2023 to 5317 as of end 2024. And the number of full time equivalents (FTE) those contracts represent shrunk from 2398 to 1717 as of end year. For Special Services Agreements, the other major type of long-term, non-staff agreement, there was a very slight decline from 5606 to 5494 contract holders. 

In either case, Tedros said that he aims to use the present crisis to put WHO on a stronger footing. 

“That’s why I say it’s an opportunity, because we wanted to make the organization especially want a better footing addressing the systemic problems related to financing, and make sure that the organization is involved.”

As for the pending appointments of just four new Assistant Director General’s out of a team of 11 senior leadership members today, Tedros said that “It will be very difficult to satisfy the various expectations.  But I’m having a session with every senior manager, we are discussing openly, and I hope the outcome of the appointments will be for the best of the organization – make the organization even better.” 

Updated 2.5.2025

Image Credits: Health Policy Watch , WHO, RTI Fights NTDs, WHO , WHO HR and EB records, 2023-2024, WHO HR Update Tables as of 31.12.2024.