New challenges are looming for the WHO and its partners since the Trump administration’s orders have resulted in chaos and the collapse of USAID and the Centres for Disease Control and Prevention (CDC) blackouts.
Apart from the pulverising loss of financial aid and support, the agencies will now be hamstrung in responding to disease emergency hotspots – like the mpox outbreak in the Democratic Republic of Congo – or in deciding on the composition of the next seasonal flu vaccine, said the first WHO press conference since the slew of executive orders reverberated across the global health world.
“A significant part of WHO’s response to health crises in Uganda, DRC, Gaza, Sudan and elsewhere, is supported by funding from the United States,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus, adding that US moves in other development arenas, apart from the US withdrawal, were also having a cascading series of impacts on WHO emergency response.
Suspension of funding by Pepfar had caused an immediate stop to HIV treatment, testing and prevention services in the 50 countries Pepfar supports based on bilateral agreements, he said.
Although a waiver has been granted for life-saving services, it doesn’t include prevention services for some of the most at-risk groups, reports Health Policy Watch.
“Clinics are shuttered and health workers have been put on leave,” he said. “WHO is gathering data on service disruptions and supporting countries with mitigation measures, including by filling gaps in supplies of antiretrovirals.
“But the sudden suspension of funding and disengagement of US institutions is also affecting the response to global efforts to eradicate polio and the response to mpox epidemics in Africa.”
CDC’s participation in global flu network ends
Collaborations between the CDC and WHO on seasonal influenza’s spread have also ground to an abrupt halt, said the WHO’s Maria Van Kerkhove, from the Department of Health Emergencies.
The group is preparing for a March meeting to establish the formula for the next flu vaccine, based on reporting to date.
“CDC is now not reporting influenza data through the WHO global platforms, Flunet, that they’ve been providing information for many, many years, and we have not had direct communication with CDC related to flu,” she said.
“There are national flu centres in 133 member states, who share information about circulating viruses. That information, over the course of six months a year, is utilised in making that decision about the vaccine composition for either the northern hemisphere or the southern hemisphere.”
Mpox and beyond
On the DRC outbreak of mpox, around $7.5m directly allotted by the US to the outbreak response has been lost, and regarding HIV/Aids, while limited waivers for some Pepfar-supported services have been issued, many services remain paralysed, said Meg Doherty, Director of WHO’s HIV programme.
“There are limited waivers … to allow access to life-saving treatment, including antiretroviral therapies, and mother to child transmission, but there has been confusion in countries, and certainly with the furloughed healthcare workers (who also depend on USAID support), some of the services have not been able to get started again.
“So we’re having contact with countries’ ministries, and when there are requests for other antiretrovirals, we seek support from country to country for ARV sharing.
“This is a very short-term limited approach, but over the long term, there’s going to need to be greater co-ordination, especially with other resources and some of the domestic resources now going into antiretroviral programmes.”
Trump’s ‘asks’ of WHO
With respect to the US withdrawal, Tedros noted that the agency had already responded to two key issues raised by Donald Trump in his withdrawal announcement – internal reform of the organisation and, related to that, a more equitable and reliable stream of financial support.
Regarding the historically high rate of US payments to WHO, stepwise increases in fixed financial support through all member states’ “assessed contributions” would gradually redistribute the load more evenly, Tedros added.
As part of that, the recent WHO executive board meeting had confirmed yet another 20% increase in those stepwise payments – despite opposition from China, which will be assessed at a far higher rate – and one comparable to the US – in the future.
Additionally, WHO has also launched the WHO Foundation, allowing it to receive donations from the private sector that it cannot accept directly. And it has launched its “investment round” to broaden the base of voluntary donations from philanthropies and member states.
Tedros also said he was “in the early stage” of floating the idea of a $50bn endowment fund, which could generate $1.5-$2.5bn a year in reliable income, similar to the basis on which the noted UK philanthropy, Wellcome, operates.
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Global healthcare on shaky ground as Trump’s moves take effect
PEPFAR cuts may cost 9m years of lost life in SA and Ivory Coast