A Reformed WHO Should Make Its Case To America

By Gordon Brown - Project Syndicate | Feb 10, 2025

Despite beginning the process of withdrawing the United States from the World Health Organization, President Donald Trump has suggested that he could be convinced to reverse course. To that end, the WHO must demonstrate progress on ensuring fair burden-sharing, strengthening country offices, and avoiding mission creep.

EDINBURGH – After announcing his intention to withdraw the United States from the World Health Organization, President Donald Trump has indicated that he might be willing to reconsider. At issue is one of Trump’s favorite themes: reciprocity and fair burden-sharing. He believes that China contributes too little and exerts too much influence over the WHO.

Trump is right to point out the importance of equitable burden-sharing. In fact, the WHO has already adopted measures suggested by its member states to address this imbalance. At present, only 26% of the WHO’s approved budget comes from assessed contributions, a membership fee of sorts based largely on a country’s share of global GDP and population (United Nations Peacekeeping, the International Monetary Fund, and the World Bank also use this approach). But member states are now on a path to financing at least 50% of the WHO’s main budget in proportion to their economic and population size by 2031.

Under the current formula, America’s portion of the assessed contributions is capped at 22% even though it accounts for 26% of global GDP. China now pays 15% and that percentage will continue to rise as the country’s share of global GDP grows.

The more that the WHO is financed through assessed contributions, the more that China, India, the Gulf petrostates, and several Central European countries will be obliged to contribute, ensuring that all countries pay their fair share. Of course, owing to America’s generosity, the US government has made contributions that go beyond normal member-state dues – hence its position as the largest donor to the WHO. China, for its part, currently gives little beyond what is required, but this should also change over the coming years.

Trump is equally concerned about China’s influence on the WHO and the country’s handling of the COVID-19 pandemic. WHO Director-General Tedros Adhanom Ghebreyesus shares some of these concerns. He has repeatedly called on China to investigate and disclose what happened in Wuhan five years ago and has drawn China’s condemnation by rightly insisting that, until that occurs, all hypotheses about the virus’s origin remain on the table.

Ironically, given the torrent of falsehoods about it, the pandemic accord under negotiation at the WHO would improve international health coordination and prevent similar failures from happening again. If this proposed instrument, as well as the updated international health regulations, were to require earlier reporting, full information-sharing, and a more rapid response to health threats, we could avoid repeating past mistakes. But the US will lose all influence over these negotiations if it leaves the WHO, while the Trump administration could instead use its clout within the organization to reach an agreement that the US can accept.

Trump also wants evidence of reform at the WHO. That means decentralization, with country and regional offices gaining greater authority vis-à-vis what he sees as an overly bureaucratic Geneva headquarters. It also implies avoiding the mission creep that often arises from member-state requests and earmarked funding designed to give priority to their own projects. The WHO must demonstrate progress on both issues in a transparent manner.

In fact, all WHO member states have requested reforms – both these and others – to enhance the organization’s performance, accountability, and transparency, as a quid pro quo for agreeing to increase the percentage of assessed contributions. They want a guarantee that the money will be spent efficiently, with timely results and fully operational internal controls.

The WHO has already made important progress. Tedros has, in fact, launched an ambitious plan to transform the organization, including by bolstering and delegating more authority to country offices. Moreover, in response to the recommendations of the Agile Member States Task Group, and following the Secretariat’s complementary implementation plan on reform, the WHO has become more transparent and accountable. It has improved internal control systems and developed a process for designing and implementing program budgets that involves member states to a greater degree and improves resource allocation, monitoring, and reporting. Systems for preventing and responding to sexual abuse and misconduct have also been a priority under Tedros’s leadership.

Perhaps most critically, Tedros himself has taken the initiative to resist the natural tendency of the World Health Assembly (the WHO’s decision-making body) to vote in new priorities and work areas. This has limited countries’ practice of earmarking funding for special-interest projects that would dilute the WHO’s purpose and strength.

In this age of mass travel, increasing urbanization, industrial livestock farming, and human encroachment on wildlife habitats, the need for the WHO is stronger now than it was in the 1850s, when the first formal international health conference was held in response to a cholera outbreak. Even more vigilance – and greater cross-border cooperation – is required if we are to prevent the spread of infectious diseases.

The last half-century has shown what such collaboration can achieve: smallpox was eradicated, polio and many tropical diseases are close to being eradicated, and HIV-related deaths have fallen by nearly 70%. But progress will falter if countries decide to go it alone.

That is why, to reassure the Trump administration and other governments, like Argentina, that are threatening to leave, there is a case for bringing together a group of highly respected leaders, representing every continent, and a top-level American official. They could be asked to show how the reformed WHO would best serve the global community – both the US and the rest of the world – now and in the future. We owe it to ourselves and future generations to do everything in our power to make global health cooperation the best it can be. We must never forget the medical lessons we have learned, from cholera to COVID: no one is safe until everyone is safe.

Gordon Brown, a former prime minister of the United Kingdom, is UN Special Envoy for Global Education and Chair of Education Cannot Wait.

Copyright Project Syndicate