Member States differ on response to US withdrawal from WHO

WHO logo. Wikimedia Commons.

Geneva, 10 February (Nithin Ramakrishnan) – The divergent views of WHO Member States regarding the withdrawal of the United States from the WHO has been apparent during the first few days of the ongoing 156th Session of Executive Board (EB156).

Member States are quite clearly divided on how WHO should respond to the U.S.  The difference is mainly about whether to reduce the budget to take into account the U.S. withdrawal and if yes, whether to deprioritize certain activities and how.

The EB156 is taking place at the WHO Headquarters in Geneva from 3 to 11 February 2025.

The Executive Order signed by U.S. President Donald Trump on 20 January declared the intention of the U.S. to withdraw from the Organization. According to the order, transfer of funds to WHO has been paused while U.S. government personnel working with WHO are recalled and reassigned.

During the first few days of discussion at EB156 the issue of U.S. withdrawal appeared to dominate the agenda. However, Member States differed on the impact of this withdrawal as well as how to respond to it.

WHO Director-General Tedros Adhanom Ghebreyesus in his opening remarks tried his best to respond to the U.S. by addressing the reasons cited by President Trump, and welcomed any further suggestions from the U.S. regarding the working of the WHO, which if undertaken, could facilitate a reconsideration of the U.S. withdrawal.

However, several Member States did not like this approach especially as it would then become a question of the integrity and independence of the WHO. This discontentment surfaced when Member States were asked to increase their assessed contributions by 20%.

Though none of the delegations were seen to be criticizing the U.S. for their abrupt withdrawal and the diplomatic approaches of the WHO Director-General, EB156 witnessed diverging ideas on how WHO and Member States should respond to the U.S. withdrawal.  Mainly of them softly indicated that WHO needs to amend its ways.

Questions on the Programme Budget and the Resolutions

One of the dominant key debating issues in the current EB meeting is the impact of the U.S. withdrawal on the WHO’s Programme Budget.  The total Programme budget approved for the 2024–2025 biennium is USD 6834.2 million. The level of projected income from voluntary contributions leaves a finance gap of USD 564 million still to be funded if the Programme budget 2024–2025 is to be fully implemented. According to WHO, the U.S. contribution for the 2024-2025 biennium is a total of USD 706 million: USD 264 million in assessed contributions and USD 442 million in voluntary contributions (16% of total Voluntary Contributions).

Similarly, the proposed budget for the biennium 2026-2027 initially was USD 7473.2 million for 2026–2027, marking a 9% increase relative to 2024–2025. In this the base programmes budget segment alone was proposed to be set at USD 5324.1 million, compared with USD 4968.2 million for the Programme budget 2024–2025.

However, the Programme, Budget Administration Committee (PBAC), when it recommended the programme budget to the EB156, decided to reduce the base budget for WHO’s operational activities to USD 4.9 billion from USD 5.3 billion to accommodate the withdrawal of the U.S.

[The draft Proposed programme budget 2026–2027 and a few previous budgets are presented in four segments: base programmes; emergency operations and appeals; polio eradication; and special programmes.

Base segment represents the core mandate of WHO and constitutes the largest part of the draft Proposed programme budget 2026–2027 in terms of strategic priority setting, detail, budget figures and performance assessment mechanisms. This segment will reflect overall global health priorities trends and show budget distribution by outcome across the major offices.

Emergency operations and appeals segment includes WHO’s operations in emergency and humanitarian settings, including protracted crises, as well as its response to acute events.

Polio eradication segment represents WHO’s share of the implementation of the Global Polio Eradication Initiative strategy budget.

Special programmes segment includes special programmes that have additional governance mechanisms and budget cycles that inform their annual and biennial budgets, namely the United Nations Development Programme (UNDP)/United Nations Population Fund (UNFPA)/United Nations Children’s Fund (UNICEF)/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction; the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases; and the Pandemic Influenza Preparedness Framework.]

Beyond this reduction of the budget, PBAC made several recommendations to the Secretariat thorough its report to the EB:

“… in further developing the Programme budget for consideration and approval by the Seventy-eighth World Health Assembly, that the Secretariat should:

(a) to reflect the current financial and economic constraints by decreasing the base segment of the Executive Board version of the Proposed programme budget 2026–2027 to US$ 4.9 billion, while safeguarding and prioritizing core functions, accountability and country capacities;

(b) to build this proposal on the country priorities that were recently defined jointly by Member States and the Secretariat for the duration of the Fourteenth General Programme of Work, 2025–2028;

(c) in line with the principle of realistic budgeting, to revisit the costing of the priorities at the three levels, aligned with the recent country prioritization process, while taking into account the current economic and financing context and ensuring a stronger focus on delivering measurable impact in countries;

(d) to base the Proposed programme budget 2026–2027 on a 20% increase in assessed contributions as foreseen by decision WHA75(8) (2022);

(e) to continue the path towards a sustainably financed Organization, including by building upon the progress in the WHO investment round towards predictable, flexible and sustainable funding from a broad base of donors through a resource mobilization action plan for short-term as well as mid- to longer-term funding;

(f) to present a more detailed update on the projected Programme budget 2026–2027 financing in May 2025, including potential areas at risk of funding gaps;

(g) to continuously and transparently update the Programme budget 2026–2027 digital platform with information related to budget development;

(h) to continue informal consultations with Member States throughout the further development of the Proposed programme budget.”

Apart from these recommendations, the Secretariat also issued an information document, which proposed certain recommendations with regard to going forward with the work in the coming days. It proposed that the Board could mandate the PBAC to recommend that the World Health Assembly:

(1) adopt the resolutions as proposed and ask the Secretariat to de-prioritize other activities to allow for implementation of resolutions within the defined budget envelope;

(2) postpone adoption of all resolutions by one year to 2026; or

(3) approve the resolutions but with a provision that their implementation, other than advocacy for the topic at minimal costs, should be postponed until the review of the programme budget proposed for 2026.

The reason cited for these proposals with regard to adoption of the resolution is as follows: “The reports by the Director-General contain a total of 19 resolutions and decisions, 12 of which have cost implications. Member States are proposing 20 decisions, the majority of which have cost implications…If all the resolutions and decisions were to be adopted with their respective costings, this may pose an additional strain on budget levels that have been recommended to be reduced in the biennium 2026–2027 with respect to 2024–2025 levels”.

The report of the PBAC and the proposed programme budget for 2026-207 biennium were discussed during agenda items 4 and 23.2. respectively.

20 Percent Increase in Assessed Contributions: Imminent or not

During the discussions on agenda items 4 and 23.2, most of the developed countries agreed with the recommendations, including an increase in assessed contribution by 20% (in accordance with a commitment made in 2023) and postponing resolutions and/or prioritizing other activities. Some of them (Switzerland and Norway) also strongly felt there should not be disruption of ongoing activities, and hence limiting adoption of new resolutions is the way forward to balance the situation.

While several developing countries also agree with a 20% increase in the assessed contribution, they do not want to delay the adoption of the resolutions. The European Union member states however stated that increase in assessed contributions “will be subject to the implementation of reforms recommended by the Working Group on Sustainable Financing by the WHO”.

According to them, there is a 2023 agreement, within which Member States agreed to hike the assessed contribution by 50 percent by the year 2030, in a phased manner. The WHO Secretariat has undertaken to reform its functioning as a condition to receive this funding from Member States and the WHO needs to show progress in implementation of reforms.

A developing country delegate told Third World Network that “it is just a postering; the WHO Director-General has clearly stated in his opening remarks that more than 85 of 97 reforms suggested are already done. Nobody seems to have a problem with the statement”.

Further, countries like China and India questioned the sudden call for a 20% increase in the assessed contributions because of the U.S. withdrawal.

China said, “Member states agreed only to a 20% increase in assessed contributions for the 2024-2025 biennium, no consensus was there regarding assessed contribution increase for future years. China believes that the Secretariat as of now should further study the feasibility of a 20% increase and avoid rushing into decisions. Member States need more time to discuss, according to China, adding that it hopes “the Secretariat will present multiple scenarios with varying levels of increase [for example, 5%, 10%, and 15% increase] allowing Member States to discuss and make a decision”.

China was particularly concerned because the proposal to increase 20% came suddenly and is vague. China’s assessed contributions to UN organisations has been recently changed to an additional 20% of the current levels. China worries that the WHO Secretariat might ask for an additional 20% increase, and it could burden China with a disproportionate contribution.

India, Malaysia, Bangladesh and several other developing countries also joined China’s call for multiple financial scenarios.

India said that it understands the financial challenges arising from the U.S. decision to withdraw from the WHO. India however added, “In considering this change, however, we believe that the quick fix should not be to plug the resulting deficit in financing through the increase of ACs of other donors. We need to understand that when member countries agreed to increase AC by 20% for FY 2024-2025 and agreed to consider further proposals for increases, it was not meant to make up for losses for the withdrawal of the largest donor”.

Concerns regarding Priorities

There is a clear difference between the priorities of Member States, though everyone emphasizes preserving and sustaining WHO’s core functions. This difference in priorities can only be noticed if the statements by the Member States made across various agenda items are examined together. For countries like Germany, and other E.U. Countries, Canada, Australia etc. there are high priorities in the cross-sectoral issues such as climate change and health, whereas for countries like the Russian Federation such a cross-sectoral issue is not really a core public health function.

For instance, Norway, who was sceptical of the financial implication of the resolutions proposed by the Member States, expressed no such scepticism when it came to the question of adoption of a draft global action plan on climate change and health under agenda item 22.

The Russian Federation said during the programme budget discussion under agenda item 23.2: “It is necessary to also review the program work priorities over the next biennium. We expect to obtain from the secretariat, in the near future, specific proposals which would not go beyond the current mandate of the organization.” Russia also called “to carry out realistic budgeting” and enable “appropriate planning of the organization’s resources and appropriate accounting, in collaboration with member states”.

Previously in the opening session, during the discussion on agenda item 2 on the report of the Director-General, the Russian Federation had raised concerns regarding the WHO’s work on climate change and health.

Malaysia in their statement on programme budget very clearly alluded to the issue of prioritization: “The issue is not just the expected budget size but rather the misalignment of financing, particularly regarding voluntary earmarked funds that may not align with priorities at the country level. We request WHO to provide a mapping of the earmarked voluntary funds against country priorities and for us to have a clearer understanding of the constraints that WHO is facing … We recommend WHO should focus on core public health functions such as primary health care service, universal healthcare and minimize burden of actions which are primarily covered by other international organizations. Importance should also be given to human health and should be human-centred …”

Zambia who aligned with the Africa Group additionally sought to provide a basis for prioritization work: “We commend other Member States and the WHO Secretariat for collectively working together on revising the initially proposed budget to USD 4.9 billion in view of the current financial and economic context. The document EB152/27 on the 2026-2027 programme and budget, is based on  three main objectives: (1) to promote, provide and protect Health, while strengthening the global health system and WHO’s work; (2) to direct resources where there needed most and can make the greatest difference; and (3) for the program and budget to be guided by the principles equity ensuring that no one is left behind, to continue to advocate for universal health coverage and the right to health for all and to continue striving to reduce health disparities and to improve access to essential health services. The three objectives remain relevant even in this difficult moment and should therefore form the basis for the prioritization process. We therefore need to continue strengthening sustainable financing of the WHO which will ensure that the organization has the flexible and predictable funding it requires to ensure impact where it is needed the most”.

Brazil also called for more transparency and said they are concerned to see that the major proportion of the WHO Budget continues to be funded by earmarked voluntary contributions. They therefore said: “We firmly believe in the need to assure complete disclosure of information on WHO’s expenditures and which projects and initiatives are privileged in order to ensure at most transparency that is now more than ever not only indispensable, but also customarily adopted by the UN Agencies”.

Resolutions stalled across agenda items: Making it appear like a Big Crisis?

Although WHO resolutions are adopted by the World Health Assembly (WHA) and any Member State can propose such resolutions during the Assembly, the practice in WHO has been that the EB takes note of the resolutions proposed by the Member States, and then forward the same to the WHA, with a recommendation to consider adoption.  There are around 20 such resolutions waiting to be recommended to the WHA by EB156.

However, Norway and Switzerland as mentioned above have opposed the EB from recommending WHA, the adoption of the draft resolutions proposed this year.

Norway, although committed to increasing assessed contributions, stated: “On resolutions, we welcome the information document on the costing of the resolutions. We acknowledge that prioritization is always difficult, but this is not business as usual. It is important that we as Member States consider what we can do to elevate the burden on the organization. We prefer option 3 as proposed. As you may be aware Norway has its own resolution on the table this year and we are ready to put our own resolution on hold”.

Switzerland, while reasserting that WHO and Member States can count on them for increasing accessed contributions and supporting public health, stated: “Given the decision that will need to be taken at the WHA in May it will be crucial that the WHO can demonstrate the first results of these economic measures and prioritization measures in terms of staffing and activities. As is mentioned by a number of member states in PBAC and now, it is necessary to respect the principle established for a realistic budgeting and in this context, we reiterate our appeal to Member States to restrict the new requests to the organization through new resolutions. Any new request needs to be taken into account in the prioritization exercise and to that end the overall view that has been made available by the Secretariat is very useful.”

The E.U. on the other hand responded differently: “Due to budget constraints, we consider it premature to cosponsor any resolution at this stage. The EU has paused co-sponsorships while awaiting the revised 2026-2027 Programme Budget. We request an updated cost overview of all resolutions, considering the available financing under the revised budget proposal, to guide our future sponsorship decisions”.

However, several other countries who spoke to Third World Network explained that the proposal by Norway, Switzerland and their allies is unreasonable. There is no need to postpone or avoid adoption of resolutions. UN agencies always work only to the best endeavour efforts, in accordance with resources available. “It serves only the purpose of sending the wrong message. The world is watching,” said a delegate from a small developing country.

“Unless their intent is to make the issue appear like a big crisis before the world, rushing to postpone adoption of the resolutions is really counterproductive,” another delegate said.

During agenda item 6 on Universal Health Coverage, the President of the EB proposed to adopt the draft decisions recommending adoption of certain resolutions by WHA, under a condition that the Board may revisit the recommendations after the discussion on the current financial situation. This was not acceptable to Switzerland. Following this the EB156 decided to postpone discussions relating to the adoption of draft decisions that recommend adoption of resolutions by WHA.

The Secretariat was then called on to provide an information document on the costing of draft resolutions and decisions proposed during informal sessions.

Meanwhile Bangladesh and China also pointed out that there is not really a crisis. There are challenges, but that can be managed through various ways. Bangladesh said: “At this critical juncture, flexible funds from the donors would be vital in addressing the financing gap in the base budget … During the PBAC meeting, it was well manifested that the financing gap in the budget can be managed if a small portion of the earmarked funds from the voluntary contributions are set aside as flexible funds. This would help continue the critical functions of WHO in a predictable manner”.

China said it is prepared to collaborate with the Secretariat and Member States to develop a feasible plan that effectively improves WHO’s financial status. It also pointed out certain cases in the 2024-2025 biennium, where the WHO was performing better in mobilizing funds.

Another Member State told Third World Network, “This is not a crisis WHO or other international organisations have never met. There is nothing new about the problems in the WHO. It just exposed the vulnerabilities Member States were aware of for a very long time. The current impasse is about potential donors waiting to make a decision as WHO (Secretariat) and some of the Member States continue to woo the U.S. They want to avoid a situation where they pay more, and afterwards WHO yields to President Trump and starts to follow his priorities”.

The Norwegian White Paper and Response

Two informal meetings were conducted, one on 5 February and the second on 8 February, Saturday on the issue of WHO’s financial status and its impact on the resolutions. During the second informal meeting a White Paper by Norway was circulated which contained a draft decision for the EB.

Member States are expected to reach a decision by 11 February.

The White Paper reads:

“The Executive Board, having considered the report by the Director-General and the debate at its 156th session and on the understanding that the adoption of the decisions recommending resolutions and decisions for adoption by the Seventy-eighth Health Assembly does not entail a Programme budget increase or allocation of additional resources, decides:

(1) to consider the implications of resolutions and decisions recommended by the 156th session of the Executive Board for adoption by the Seventy-eighth Health Assembly in the prioritization process as part of the development of the Programme Budget 2026/2027, in line with the guidance to the Secretariat by the Programme Budget and Administration Committee at its 41st session, as set out in document EB156/4, paragraphs 23 (a), 23 (b), 23 (c) and 23 (h);

(2) to subject the implementation of the resolutions and decisions recommended by the 156th session of the Executive Board for adoption by the Seventy-eighth Health Assembly to the operationalization of the Programme budget 2026–2027 once approved, while still allowing their use for advocacy, awareness, and continuation of ongoing activities;

(3) to request the Director-General to inform Member States of the outcome of the prioritization and operationalization processes, including with respect to the resolutions and decisions recommended by the 156th session of the Executive Board for adoption by the Seventy-eight Health Assembly.”

Thus, the Norwegian proposal is to subject the implementation of the resolutions and decisions recommended by EB156 to the operationalization of the Programme Budget. At the same time, it would mean the WHO Secretariat takes control of the prioritization and operationalization process, although Member States might be involved at the country level priority setting.  This is because in sub paragraph 3, the Director-General is mandated only to inform Member States on the outcomes of prioritization and operationalization. Member States are also concerned with language in the chapeau which proposes that the adoption of the resolutions does not entail programme budget increase.

Countries like the Philippines, Brazil, South Africa, Mexico, Namibia, Peru, Indonesia, Malaysia, Bangladesh responded to the Norwegian proposal by explaining that the proposal is treating this year’s proposed resolutions as a separate category within activities and expenditures of the WHO and this would pre-judge the prioritization process as such.

The Philippines on behalf of these countries stated: “Targeting this year’s resolutions for “deprioritization” because of their misfortune of being the most recent reflections of Member States’ aspirations does not appear to be logical. Any financial prioritization exercise must take into account all aspects of the Organization’s expenditures and shall be guided by the Organization’s overall goals.”

They also raised certain other aspects and questions to be considered while discussing the White Paper:

(a) Resolutions are negotiated directly by Member States and are reflections of what Member States consider as important. Its operationalization of democracy and equity in WHO.

(b) The costing for each resolution is prepared separately by the Secretariat. Member States are not directly involved in this process. The costing, unlike the resolution itself, is not a Member State document. The world of costing is entrusted to Secretariat on the basis of trust that the secretariat would do their best based on available resources

(c) Whether the resolutions are based on Secretariat-prepared costings fully funded in the last 5 or 10 years? Or whether the resolutions to the extent possible based on available resources?

Malaysia, meanwhile, on behalf of the other Member States mentioned above called for three actions: First, to recommend resolutions for adoption by the WHA.  Second, to recommend monitoring and review of the progress of the work mandated to WHO Secretariat under these resolutions in the light of financial challenges faced by the WHO and the prospects of overcoming such challenges. Finally, to recommend WHA to set up a Member State-led process to assist WHO Secretariat in performing their work with optimal resource allocation, in accordance with Member States priorities, in case the financial challenges persist.

Malaysia and others were of the opinion that resolutions play several functions including normative enrichment, agenda setting, recognizing common trends, concerns and objectives and not all aspects have costing implications. Further they were of the view that the proposed budget is always aspirational and the adoption of resolutions, strategies and plans of action in advance could signal future resource mobilization strategies and efforts.

Malaysia further stated that “the financial situation is exposing the vulnerabilities of the organisation in relying on voluntary earmarked funds to carry out the major bulk of its works. For several years this vulnerability has been highlighted by developing countries… WHO might have to focus more on core public health functions and reduce the number of platforms duplicating the efforts on the same issue, especially when it comes to areas beyond core public health functions”.

They also pointed out, however, the issue of prioritisation etc. are not matters that are to be decided imminently by EB156. More time and efforts need to be invested with regard to programme budgeting and resource mobilization and at the later stage, if it becomes clear that financial challenges will remain unresolved, Member States can come together to assist the WHO Secretariat on how to go about future work.

A big developing country said, “it’s hardly a week or two since the U.S. announced its intention to withdraw from WHO. The U.S. delegation is still present and participating in the EB meetings. It is too early to talk about prioritization and make adjustments to the next biennium’s budget.”

- Third World Network