The US’s empty chair at this week’s World Health Assembly in Geneva spoke volumes. It was matched by empty words from the US health and human services Secretary, Robert F Kennedy jnr, who represents an administration that is dismantling health and human services at home and abroad.
“We don’t have to suffer the limits of a moribund WHO,” he told health officials from UN member states by video link as they met in Geneva to discuss the financial headache created by the US withdrawal from the World Health Organisation. “Let’s create new institutions or revisit existing institutions that are lean, efficient, transparent and accountable, whether it’s an emergency outbreak of an infectious disease or the pervasive rot of chronic conditions that have been overtaking not just America but the whole world. We’re ready to work with you.”
The US answer to the “pervasive rot of chronic conditions” has been to pass a death sentence on millions of people now denied life-saving treatment and protection from HIV/Aids infections, TB and malaria. This follows Elon Musk’s gleeful destruction of the US Agency for International Development and the elimination of all financial support to the WHO and a plethora of other UN agencies and NGOs that provide life-sustaining support to citizens of the world’s least developed countries.
[ WHO’s treatment of Dr Mike Ryan proves to be a shocking case studyOpens in new window ]
These are countries that the outgoing WHO deputy director general, Mike Ryan, eloquently describes as being on a different tectonic plate to the rest of the world, in danger of drifting away as they struggle to meet the needs of their impoverished populations with declining levels of official development assistance.
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In a warming world, disengagement by the US and cuts in development aid by the UK, Germany, France, Italy and Spain will only add to instability in a world where already 122.6 million people have been forced to leave their homes due to conflict, climate-induced disasters or political turmoil. According to the OECD, the US spent $65 billion on development aid in 2023, making it the world’s largest donor of foreign assistance.
Bruce Aylward, the outgoing WHO assistant director general of the universal health coverage division, told The Irish Times that a recent survey of 108 WHO country offices highlighted that the cuts in development aid from the US and other donor countries were having as big an impact on health service delivery as the Covid-19 pandemic.
More than a third of WHO country offices are now reporting shortages of vaccines, medicines and health products for key diseases and conditions. Shortages of products for potentially life-saving emergency, critical and operative care are reported for 32 per cent of countries and many have been forced to lay off staff.
Diplomats and health officials listened in stony silence as Kennedy lectured them from afar on the Trump administration’s perception of the Pandemic Agreement adopted by the assembly this week, as an accord that would “lock in all the dysfunction of the WHO pandemic response”.
He maintained, without citing evidence, that the WHO “worked with China to promote the fiction that Covid originated from bats or pangolins rather than from Chinese government-sponsored research at a biolab in Wuhan”.
WHO director general Tedros Adhanom Ghebreyesus perhaps had conspiracy theorists such as Mr Kennedy in mind when he told the assembly that the Pandemic Agreement would “not infringe on national sovereignty in any way, nor give the WHO secretariat power to impose mask or vaccine mandates or lockdowns”.
Tedros lamented: “You are all aware of the torrent of mis- and disinformation that we have faced through the negotiation of this agreement. And although you have now adopted it, deception and distortion will continue.”
The WHO had long warned about the inevitable arrival of a pandemic on a similar scale to the 1918-1920 flu pandemic, which had an estimated death roll of 17-50 million. It took Covid-19 and the loss of some 20 million lives to galvanise agreement on how to prepare for the next one.
Ryan and other WHO secretariat staff worked with UN member states for 3½ years to develop the landmark accord that stands now as a rare triumph for multilateralism in an increasingly fragmented world.
The agreement is designed to ensure safe and affordable access to pandemic-related health products by making 20 per cent of the real-time production of vaccines, therapeutics and diagnostics for any pathogen causing a public health emergency available to the WHO.
Once an annex on a pathogen and benefit-sharing system is agreed at next year’s World Health Assembly, the WHO Pandemic Agreement will then be open for signature and ratification. After 60 ratifications, the agreement will enter into force and become legally binding.
By the time that happens, the WHO will be a very different organisation after completing a major redundancy programme forced by budget shortfalls now that the US has ended its support, which amounted to $1.3 billion in 2023.
Ireland and other UN member states strived this week to make up a shortfall of $1.7 billion (€1.5 billion) in a newly adopted and reduced budget of $4.2 billion for 2026/27, agreeing to a 20 per cent increase in their assessed contributions, while several countries pledged an additional $170 million.
The cash-strapped WHO faces a $500 million salary gap this year and aims to reduce its wages bill by at least 25 per cent, which puts many jobs in jeopardy among 2,600 staff at its Geneva headquarters.
The organisation has already slimmed down its senior management team from 12 to seven and plans a reduction in the number of departments from 76 to 34. Hundreds of redundancies will follow from director level to administrative assistants.
Ryan, who had planned to leave the organisation two years ago, is one of the first casualties despite being appointed to the role of deputy director general less than a year ago.
Letting go one of the world’s most renowned epidemiologists from his senior management team, along with several other experienced officials, was “a painful decision” for Tedros, who had to reconfigure his team according to the new financial reality as well as gender and geographical considerations.
The WHO is going to lose many experienced and dedicated staff in the coming months, and the global health agency will be forced to do less in the coming years, but it proved this week that its convening power among the nations of the world remains as strong as ever.
It can only dare to hope that, sometime in the future, the US will realise it needs the WHO as much as the WHO needs it.
