China has signalled it could oppose a planned increase in national membership fees to the World Health Organization (WHO) aimed at increasing the reliability of its funding, threatening to deepen the financial crisis at the UN health agency as it faces the loss of its largest donor, the United States.

The proposed 20% increase in assessed fees for the budget year 2026-27 was debated at WHO’s Executive Board meeting on Tuesday – despite being agreed too, in principle, by member states in 2022 when the World Health Assembly (WHA) passed a resolution to increase the agency’s funding that comes from member states to half by 2030. 

The proposed  increase in member states’ national contributions is not an increase to WHO’s budget as an agency. But the shift would give WHO greater predicability in budget planning and control over its priorities. Right now, only about 22% of WHO’s budget is financed by fixed, member state fees, while the rest is reliant upon voluntary donations from member states and large charities.  

“China does not have clear information on the specific amount of assessed contribution increase or how it will be calculated for the coming year,” China’s representative told the EB, expressing the country’s unease with the plan, which was the focus of extensive debate in 2022 and 2023 before being passed by the WHA.

“It is difficult for any country to agree to such a plan under such opacity.”

The WHO aims to gradually ramp up fixed state contributions as a proportion of its overall budget, to reach the 50% mark for 2030-2031. While states in 2023 approved the first 20% increase for 2024-2025, the next stepwise hike, of another 20%, would require WHA approval this May to kick in for the next 2026-27  budget biennium.

The Chinese delegation also questioned whether the proposed 20% increase in national contributions was necessary, pressing for additional options as low as 5%.

“China believes that the secretariat, as of now, should further study the feasibility of the 20% increase in assessed contributions and avoid rushing into any decisions,” China said. “Member states need more time to discuss and China hopes the secretariat will present multiple scenarios with varying levels of increase, allowing member states to discuss and make a decision.”

The calculations underlying the step-wise increase still include the US share, as Washington remains a legal WHO member until its withdrawal takes effect in early 2026. This means that the true impact of the US exit has yet to be factored in, and without the US, an even higher step wise increase would likely be required to reach the 50% mark by 2030.

Proposal to slash next biennial budget

Chinese opposition to the plan comes at a time of unprecedented budget crunch at WHO.

In line with the current budget uncertainty, WHO’s administration also has proposed to cut its 2026-2028 budget to $4.9 billion, slashing $400 million from its planned spending and acknowledging it could not be “business as usual” following the US exit.  That proposal is contained in the budget documents before the EB, and will presumably be approved by the board later this week. 

The agency has also imposed an immediate hiring freeze and shifted to virtual meetings while limiting technical support to only the most critical missions. Behind closed doors, WHO finance director George Kyriacou warned the organization would face “a hand-to-mouth type situation” in early 2026 at current spending rates, according to recordings obtained by The Associated Press.

The US, WHO’s largest donor, has yet to pay its full fees for 2024-2025, WHO has also said. WHO’s attempts to reclaim these dues have been largely rejected, pushing the agency into deficit even before the formal withdrawal takes effect. The US was set to provide $900 million in total funding for 2024-2025, including both assessed fees and voluntary funding.

Under budget, behind schedule

The drive to boost assessed member state contributions aims to free WHO from its current constraints, where over 80% of its funding is earmarked for specific programs dictated by donor countries and organizations.

“When it is within the purview of the Secretariat, we do the right thing to make sure that funding is equitably allocated across the organization. However, when it is highly earmarked, we are actually handcuffed,” Raul Thomas, WHO Assistant Director General of Business, told the board.

But WHO Director-General Dr Tedros Adhanom Ghebreyesus warned the board that the plan to ensure that the agency can meet 50% of its budget goals by 2030-31 with assessed member state contributions is already faltering. At the current pace – assuming that the contested 20% 2026-27 increase is finally approved – the target won’t be met until 2032-33, he said.

“That [timeline] was what was agreed by our member states, by you,” Tedros told the board. “If the 2026-2027 20% is not agreed, that will push further the target to be reached by 2034-2035, almost 12 years after the agreement. Compared to the earliest target you set, it will be delayed by six years.”

The flexibility crisis is acute – just 4.1% of voluntary donations in 2022-2023, worth $320 million, came without strings attached. Tedros suggested the organization might need to seek short-term solutions, including renegotiating with existing donors to loosen restrictions on their funding.

His warnings came as several middle-income nations joined China in expressing reservations about the planned increases, despite supporting the principle of sustainable financing for WHO.

“We do need to express our concern about the burden of time in which this contribution increases going ahead that countries are facing economic difficulties, inflationary pressures and the domestic context mean that we need to take into we will struggle to deal with this increase,” Chile’s representative said.

Peru, while backing the broader goal of increasing membership fees to 50% of WHO’s budget, emphasized that the plan must “take into account the economic reality and the fiscal reality in our countries.”

China will not fill US vacuum

China’s resistance to increased WHO funding indicates it won’t fill the financial vacuum left by the U.S. withdrawal, countering, at least initially, some of the speculation that the US departure would boost Chinese influence over the global health body.

Instead, China’s approach reflects its preferred model of health diplomacy: direct bilateral engagement rather than working through multilateral institutions. This pattern became evident during the COVID-19 pandemic when China largely bypassed COVAX, the global vaccine-sharing initiative designed to ensure equitable distribution of COVID-19 vaccines, especially to lower-income countries.

Of the 239 million vaccine doses China provided globally, only about seven million – roughly 3% – went through COVAX. China instead favoured country-to-country arrangements, a stark contrast to the US and European Union, which donated 682 million and 265 million doses respectively through the COVAX mechanism.

EU stands alone 

As the world’s two largest economies step back from WHO, the financial burden is shifting to European states – and philanthropies.

WHO’s recent investment rounds have so far secured $1.7 billion in new commitments toward its $11.15 billion budget for 2025-2028 – less than half its target. European nations provided the overwhelming majority of new funding, accounting for 77.3% ($1.27 billion) raised in the blitz. 

Brazil and Saudi Arabia, despite co-hosting two different fundraising efforts, made no pledges themselves, while China contributed just $20 million. The US, constrained by Trump’s executive order, made no new commitments. Qatar made the only contribution from the Middle East region, providing $4 million – 0.2% of the total.

“We remain strongly concerned about structural funding challenges, in particular the unhealthy dependency on a very few donors,” Germany’s representative said at the board meeting. “The announced withdrawal of the United States raises serious financial concerns and will affect core and emergency response funding.”

“We wonder why one region did not contribute financially,” he added, in an apparent reference to the complete absence of wealthy Gulf states from the funding commitments. 

WHO’s revised budget of $2.45 billion a year, or $4.9 billion for the entire 2026-2028 ‘biennium’, divided among its 194 member states, would amount to approximately $12.6 million per country – a fraction of what major economies spend on healthcare.

“The EU wants to stress the relevance of continuing efforts to broaden the funding base of WHO now more than ever,” the EU representative told the board – a diplomatic call for greater contributions from China, Middle Eastern oil-producing states, emerging economies like Brazil, India and other wealthy nations.

“Now more than ever, we should be aware of the vulnerability for the work of who to be dependent on the small number of donors.”

Image Credits: Guilhem Vellut, AidData.