In a groundbreaking decision on financing reform, the World Health Assembly (WHA) resolved on Tuesday that half of the world body’s budget will be derived from members’ fees by 2030.

That will reduce the World Health Organization’s (WHO) massive reliance on donors. But there was less enthusiasm for revising the International Health Regulations (IHR).

The Assembly adopted in full the recommendations for financing reform made by the Sustainable Financing Working Group chaired by Germany’s Björn Kümmel, which also include proposals to increase the body’s efficiency.

“When it was approved, I have to admit I had a tear in my eye,” Kümmel told Health Policy Watch on Tuesday night. “I’ve been covering WHO for ten years and I always thought the financial situation was unsustainable.”

Kümmel, deputy head of the global health division at Germany’s Ministry of Health, said he was “told that it was un-doable” when he was asked to lead the process on financing reform a year and a half ago. “This is a success of multilateralism,” he said.

Incremental increases to member states’ fees (known as assessed contributions), starting with an increase to 20% in next year’s budget, is the group’s key recommendation. 

The WHO currently derives 84% of its budget from donors and voluntary contributions, making it beholden to donor priorities and inflexible funding that is earmarked for particular projects and cannot be redirected to health emergencies.

A task group of member states will be set up to work with the WHO Secretariat to strengthen the body’s “transparency, efficiency, accountability and compliance.”

The WHO is also mandated to investigate a replenishment model for additional funds.

Member states, particularly the US, have been adamant that if they are to pay more fees, they want financing reform that leads to a more efficient WHO.

Welcoming the decision, WHO Director-General Dr Tedros Adhanom Ghebreyesus said that it  “addresses head-on the decades-long challenge WHO has faced on predictable, flexible and sustainable funding”. 

“WHO’s current financing model has been identified by many experts as posing a risk to the integrity and independence of its work,” the WHO said in a statement on Tuesday night.

“WHO’s over-reliance on voluntary contributions, with a large proportion earmarked for specific areas of work,” it said, “results in an ongoing misalignment between organizational priorities and the ability to finance them.”

As financing reform gains support, IHR reform hits opposition

However, proposals to revise the IHR did not go so smoothly at the assembly on Tuesday.

The IHR are binding laws that govern countries’ obligations to report and respond to pathogens that could result in cross-border disease outbreaks public health emergencies.

The IHR were last revised in 2005 and the Independent Panel on Pandemic Preparedness and other bodies have pointed out a number of inadequacies in the light of COVID-19.

This has led to calls for the IHR to be revised, alongside the negotiation of an international pandemic instrument or treaty to better prepare the world for future pandemics.

But on Tuesday, a group of mainly African nations pushed back on both the process and substance contained in several proposals for revising the IHR.

Among the sticking points on financing reform were issues around national sovereignty and the speed raised in proposals before delegates at the WHA.

One proposal to shorten the process for effectively reforming the IHR was put forward by Australia, Bosnia and Herzegovina, Colombia, the EU Japan, Monaco, Korea, the UK and the US – and one with more far-reaching changes was offered by the US.

While the first one is more procedural, the US proposal would strengthen the WHO’s ability to gather and share information among nations with disease outbreaks that could put global public health at risk. 

But African nations led by Botswana voiced unease, dimming hopes for the one concrete action the Assembly might be expected to take on pandemic reform. 

The US proposal suggests 13 reforms including strict timetables for reporting outbreaks and introducing language on gene sequence sharing, forming a new compliance committee to monitor nations’ implementation, and authorizing expert teams to be sent to outbreak and contamination sites.

Holistic package

Iran also objected to the US proposal’s technical measures for changing IHR Article 59, saying Tehran “deems it premature to decide to reduce the time entry into force.” 

The US proposal would shorten the timeframe for amendments to take effect to one year, down from its current two-year period. That would also limit the time that member nations have to meet, analyze and raise objections.

“The amendments need to be considered as a holistic package,” Botswana’s Moses Keetile, a deputy permanent secretary in its health ministry, said on behalf of the African delegation to the Assembly. 

A US delegate said its proposals are meant to encourage a process that is “more agile and responsive to technological” considerations, and that “it is essential that states’ parties comply” because “there is no greater duty for governments” than to look after the public health of their citizens. 

A Danish diplomat, however, expressed a preference for more “targeted amendments,” while Norway’s envoy said “much can be done without altering the regulations, and there is an urgency in doing so.”

Singapore’s Health Minister Ong Ye Kung said overall the “foundation of our response is not lockdowns but vaccinations” in responding to pandemics.

The US in January submitted its draft WHA proposal for a series of pinpoint amendments to the 17-year-old IHR.

But final agreement on any IHR amendments is now likely to be put off until 2023, with resistance growing to any attempt to “fast track” the process of amending the IHR.

The Assembly had been expected to agree only to a process for making new IHR amendments by inviting all member states to propose their own reform proposals by the end of September.

Rightwing clamour

Meanwhile, outside the WHA there has been a clamour of rightwing opposition to reforms to the IHR and to a pandemic treaty on the basis that these will cede national sovereignty to the WHO.

This has been voiced by conservative leaders including Fox News’s Tucker Carlson, US former congresswoman Michele Bachmann, and Christine Anderson, a Member of the European Parliament from the German right-wing, anti-immigrant Alternative für Deutschland.

The Biden administration is very close to handing the World Health Organization power over every aspect of your life. Imagine the civil liberties abuses of the Covid lockdowns, but permanent. https://t.co/Vcj1jBGu94 pic.twitter.com/hOSjzMUmyq

— Tucker Carlson (@TuckerCarlson) May 20, 2022

Some of the claims appear to be part of an overall disinformation campaign against the WHO by anti-vaxxers.

That was demonstrated by a petition against the IHR changes signed by a number of prominent anti-COVID-19 vaccine conspiracy theorists.

However, the WHO does not have the power to enforce or police the IHR – which was violated by a number of member states during the current pandemic.

Meanwhile, negotiations on a pandemic instrument or treaty only started this year with a proposal on its form only likely at next year’s WHA at the earliest.