Geneva — Ahead of a crucial meeting of the World Health Organization's (WHO) Executive Board this week, an influential group of health leaders and former heads of governments are urging WHO member states - composed of members of the United Nations - to tackle the health group's long-term funding challenge.
How much is our health worth? If Covid-19 is any guide, clearly not enough.
This stark reality has been ignored for too long – at a price the whole world is now paying.
Despite warning after warning to strengthen the world's defences against pandemics from new pathogens, the world was left dreadfully ill-prepared for the tsunami of suffering to come.
The subsequent toll has been great and is growing: more than five million lives lost, with the number of deaths still rising and countless millions more infected, and with many of those seriously ill around the globe unable to get the care they need in over-stretched hospitals.
Many more people have been scarred in painful, varied, and, above all, avoidable ways, including by persistent symptoms of Long Covid and unfathomable mental anguish.
The world is paying a high price for failure to invest in global health.
The failure to invest in pandemic preparedness and response has been the most glaring symptom of the world's ailing approach to global public health and universal health coverage. Funding for WHO has been inadequate for decades. This must stop now.
The Group of 20 - the 'G20', made up of the European Union and 19 other countries - addressed the problem at a Rome summit last October. But they failed to do enough to address the lack of funding to protect the world from pandemics, and, in particular, for financing WHO to deliver on its broad – and ever-growing – mandate to act as the world's leading health authority.
We appreciate the recognition by world leaders that global health is intertwined with WHO's institutional health and that adequate and sustainable funding for WHO is not only urgently needed but is a realistic and achievable goal in 2022.
Sufficient and sustained funding for WHO is achievable this year.
Over recent years, the financial and operational independence of WHO has steadily declined. Forty years ago, WHO received 80 percent of its resources through "assessed contributions" - the scalable membership fees that member countries pay. In the past, WHO's income was predictable and untied and could be deployed to address a wide range of critical issues - from WHO's core scientific work to its role in tackling health emergencies. Other funds came from voluntary contributions by various donors, such as governments and philanthropies, earmarked for specific health areas.
But today, just 16 percent of WHO's finances are provided by governments' membership dues, without strings attached. The overwhelming remainder is provided as voluntary contributions, often with tight and sometimes restrictive conditions, and usually over two-year cycles.
As well as making long-term planning impossible, this has resulted in the progressive weakening of WHO's ability to perform the vast and ever-growing array of tasks that all governments, and therefore their populations, demand and need. This has led to underfunding of both emergency preparedness and the prevention and control of noncommunicable diseases.
The quantity, the predictability and the flexibility of funding must be improved.
WHO's funding needs have recently been highlighted by multiple independent reviews into the pandemic response. Its needs are now under the spotlight of governments that are deliberating how to make the organization better able to deliver on the mandate they have given it.
All independent experts in the Covid-19 'lessons-learned' process have called on WHO member states to invest in the health body's independence and integrity through a substantive increase in their assessed contributions.
We continue to believe that funding WHO's work through a substantially higher level of assessed contributions - closer to the 80 percent share of the early 1980s - is the best way forward. But we accept that the main proposal now being considered through a member state-led working group process is to increase assessed contributions from the current levels to 50 percent, and to allow all countries time to budget and prepare and to do so incrementally, introducing the change in stages beginning in 2028.
The billions needed to address global health needs are much less than the trillions lost to health emergencies.
Taking this step would ensure more predictable financing for WHO's emergency preparedness work, such as laying the groundwork to protect communities from Ebola and strengthening health-care systems in vulnerable settings. It would also enable WHO to invest in supporting countries to recover from Covid-19 and to address the epidemics of noncommunicable chronic diseases, such as diabetes, heart disease, and cancers. Importantly, this plan would enable WHO to plan ahead - for example, to tackle the growing health threats associated with climate change.
The need to make WHO financially fit-for-purpose was stressed by G20 Leaders, who acknowledged that "an adequately and sustainably funded WHO" is needed to lead and coordinate global health. If Covid has taught us anything, it is that the value we place on health must be radically reassessed. The billions needed to prevent and respond to health crises are dwarfed by the trillions in bankruptcies, job losses and stimulus packages that emergencies like Covid have cost the world economy.
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The economic and social rewards of investing in health are much greater than the cost of that investment.
When countries invest in health, the dividends are great. Nations that dedicate resources to universal health coverage and primary health care are investing in the wellbeing of children, adults, and older people, enabling them to attend schools, enter the workforce and stay as healthy as possible. This investment is the bedrock of greater health security.
The mission to deliver health for all is at the heart of everything WHO does. But delivery on this mission relies on WHO itself being in sound financial health. Committing to sustainable financing of WHO is to invest in a healthier and safer world for all of us.
Gordon Brown, WHO Ambassador for Global Health Financing and former Prime Minister of the United Kingdom; Helen Clark, co-chair of the Independent Panel for Pandemic Preparedness and Response and former Prime Minister of New Zealand; Dr Felicity Harvey, co-chair of the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme; Graça Machel, co-founder of The Elders and former First Lady of Mozambique and South Africa; Paul Martin, former Prime Minister of Canada; Ellen Johnson Sirleaf, co-chair of the Independent Panel for Pandemic Preparedness and Response and former President of Liberia; Elhadj As Sy, co-chair of the Global Preparedness Monitoring Board and Former Secretary General of the International Federation of the Red Cross and Red Crescent Societies.
