Rema Nagarajan | TNn.
NEW DELHI: With President Donald Trump announcing that the US will be "terminating" its relationship with the World Health Organisation (WHO), the Bill and Melinda Gates Foundation (BMGF) is set to become the biggest funder of the organisation. A private foundation becoming the biggest funder, and hence the biggest influence, on a United Nations agency would be a first.
In fact, though the WHO is meant to be a body accountable to its members countries, among the top 10 donors to the organisation only four are member countries and one is the European Commission. The rest are all non-state actors or philanthropies. When the WHO was constituted, its constitution stipulated that it should primarily be financed through regular contributions from member countries, called "assessed contributions", relative to the country’s wealth and population. However, the reluctance of member countries to increase the assessed annual contributions has made it increasingly dependent on voluntary contributions from countries and non-state actors, weakening its autonomy.
Global health experts have expressed concern over the WHO becoming increasingly reliant on voluntary and earmarked contributions. Its budget, just over $5.6 billion in 2019, is less than the revenue of a big hospital in the US. More than three-quarters of the WHO’s funds are specified voluntary contributions earmarked for specific programmes like polio eradication or TB, leaving the organisation with no flexibility in spending. Thus, the agency has struggled to find funds for an adequate response to situations like the outbreak of Ebola and now the coronavirus pandemic.
"The principle that he who pays the piper calls the tune holds true here. Countries large and small built the WHO through their contributions. There is general anxiety about unaccountable billionaires, but they welcome the investment as it’s something which otherwise they would have had to pay. Not just his investment in the WHO, but also in the various global funds and organisations, it is as if Gates has colonised the global health system. No matter how well-intentioned, when you are a monopolist, you stop questioning, stop thinking," said Dr Mukesh Kapila, professor of global health and humanitarian affairs at the University of Manchester.
The authors of a paper on the financial sustainability of the WHO, including Dr Srinath Reddy of the PHFI, pointed out: "The current dominance of earmarked contributions in effect uses the WHO to channel donor priorities. Donors then benefit from the legitimacy and credibility of a democratic institution while circumventing the very processes that underpin and establish its legitimacy and credibility…" They concluded that the WHO’s heavy reliance on donors for funding major programmes significantly limited its autonomy and global leadership.