GFO Issue 464, Article Number: 3
ABSTRACT
Amid a major financial crisis triggered by the U.S. withdrawal, WHO must fundamentally reinvent itself by refocusing on core missions, diversifying funding sources, and strengthening governance. These measures are essential to protect the gains made in the fight against HIV, tuberculosis, and malaria, and to prevent a dangerous fragmentation in the global response to health emergencies.
In spring 2025, the WHO faces an unprecedented crisis following the withdrawal of the United States, its largest donor, contributing approximately 18% of the total budget. This withdrawal results in a funding loss exceeding 20%, approximately USD 600 million for the upcoming fiscal year. Consequently, the organization announces budget cuts of 21%, reducing its budget from USD 5.3 billion to USD 4.2 billion. These significant financial constraints entail substantial staff reductions, including at the Geneva headquarters, and a stringent prioritization of ongoing programs.
Amid this challenging context, the WHO also confronts a geopolitical landscape marked by heightened tensions and fragmented multilateralism, characterized by increasing national and private interests, undermining its role in international health coordination. Therefore, the crisis is not merely a financial challenge but also necessitates a profound strategic reinvention of the organization.
Critical health issues under pressure
This budgetary crisis arises when the WHO must simultaneously respond to 42 health emergencies affecting 305 million people globally, with an emergency appeal of USD 1.5 billion for the entirety of 2025. Many of these crises are linked to climate change impacts, requiring an unprecedented, coordinated response.
Additionally, vital programs fighting HIV/AIDS, tuberculosis, and malaria are directly affected by the U.S. financial withdrawal, as highlighted in several of our articles a few months ago. UNAIDS, dependent on U.S. funding for 50% of its budget, risks disruption in medical monitoring, a dramatic increase in drug-resistant tuberculosis cases, and the potential erosion of gains made over the past twenty years in HIV prevention and treatment (Figure 1). Malaria, despite notable successes including recent vaccine introductions in 18 countries, also risks significant setbacks due to the potential loss of technical coordination and ongoing financial support.
Figure 1:
The imperative of a strategic reinvention of the WHO
In the face of these challenges, it is urgent to refocus the WHO on its core normative functions: establishing international health standards, providing independent scientific expertise, global health surveillance, and intergovernmental technical coordination. This refocusing would reduce current resource dispersion, allowing the WHO to concentrate on its global health authority role while delegating more operational interventions to bilateral or humanitarian actors.
This strategy also presupposes increased transparency and improved governance, ensuring independence from private or philanthropic funding, which already constitutes a significant portion of the budget (approximately 10% via the Gates Foundation). Furthermore, it would be crucial to strengthen the role of the World Health Assembly in strategic governance, requiring greater accountability from Member States, particularly through more predictable and increased mandatory contributions.
Transforming the financial crisis into a strategic opportunity
To overcome dependence on volatile funding, the WHO must diversify and innovate its financing sources. The establishment of health taxes, the utilization of Special Drawing Rights (SDRs) for health purposes, international health insurance, or climate-health financing can contribute to securing long-term financial resources. These solutions, although ambitious, require strengthened international coordination and sustained political support.
Concurrently, a strategic readjustment is necessary: the WHO must reduce its direct operational presence in favor of a stronger coordinating role and support for national health systems. This evolution would enable better resource utilization, building local and national resilience instead of relying entirely on external interventions, which are often costly and unsustainable.
Finally, increased exploitation of digital technologies, science, and global surveillance is an absolute priority. The proven effectiveness of digital surveillance and early warning systems during the COVID-19 pandemic must be leveraged to improve global responses to future health crises.
Protecting achievements in the fight against HIV, tuberculosis, and malaria
The financial crisis directly threatens the progress made in combating HIV/AIDS, tuberculosis, and malaria. The reduction in financial support could lead to a major resurgence of cases, particularly in South Africa, where thousands of lives are at stake by 2034. The WHO must imperatively maintain technical support for national policies on prevention, testing, and treatment, as well as the essential logistical chains required to ensure the availability of critical medications.
Regarding malaria, the recent introduction of vaccines in numerous countries represents a valuable but fragile achievement. Without solid international coordination and stable financing, these successes risk being compromised, potentially reversing years of efforts and investments.
Major risks of organizational status quo
The current status quo exposes the WHO to critical risks. Prolonged budgetary paralysis would worsen its reliance on unpredictable external funding, significantly diminishing its medium-term operational capacity. A loss of scientific authority due to the dominance of private or external interests could further weaken global credibility. Similarly, retreating into short-term humanitarian management could prevent the WHO from fully exercising its strategic role as the global health coordinator.
Additionally, key areas such as pandemic preparedness, mental health, nutrition, and other major health challenges could experience increased fragmentation and a severe lack of international coherence.
Conclusion: A moment of truth for the WHO
As compellingly argued in the Blue Note by the "Santé mondiale 2030" Think Tank, the current financial crisis represents a decisive moment for the WHO's future. The organization now has a historic opportunity to fundamentally reinvent itself, becoming a strategic, effective, transparent, and sustainable institution. The outlined proposals - normative refocusing, financial diversification, increased accountability of Member States, and intensified technological innovations - offer a clear pathway for the necessary overhaul.
Today, it is indispensable that all stakeholders - Member States, financial partners, scientists, and civil society - actively support this transformation to ensure a more resilient, coherent, and united global health future.
In spring 2025, the WHO faces an unprecedented crisis following the withdrawal of the United States, its largest donor, contributing approximately 18% of the total budget. This withdrawal results in a funding loss exceeding 20%, approximately USD 600 million for the upcoming fiscal year. Consequently, the organization announces budget cuts of 21%, reducing its budget from USD 5.3 billion to USD 4.2 billion. These significant financial constraints entail substantial staff reductions, including at the Geneva headquarters, and a stringent prioritization of ongoing programs.
Amid this challenging context, the WHO also confronts a geopolitical landscape marked by heightened tensions and fragmented multilateralism, characterized by increasing national and private interests, undermining its role in international health coordination. Therefore, the crisis is not merely a financial challenge but also necessitates a profound strategic reinvention of the organization.
Critical health issues under pressure
This budgetary crisis arises when the WHO must simultaneously respond to 42 health emergencies affecting 305 million people globally, with an emergency appeal of USD 1.5 billion for the entirety of 2025. Many of these crises are linked to climate change impacts, requiring an unprecedented, coordinated response.
Additionally, vital programs fighting HIV/AIDS, tuberculosis, and malaria are directly affected by the U.S. financial withdrawal, as highlighted in several of our articles a few months ago. UNAIDS, dependent on U.S. funding for 50% of its budget, risks disruption in medical monitoring, a dramatic increase in drug-resistant tuberculosis cases, and the potential erosion of gains made over the past twenty years in HIV prevention and treatment (Figure 1). Malaria, despite notable successes including recent vaccine introductions in 18 countries, also risks significant setbacks due to the potential loss of technical coordination and ongoing financial support.
Figure 1:
The imperative of a strategic reinvention of the WHO
In the face of these challenges, it is urgent to refocus the WHO on its core normative functions: establishing international health standards, providing independent scientific expertise, global health surveillance, and intergovernmental technical coordination. This refocusing would reduce current resource dispersion, allowing the WHO to concentrate on its global health authority role while delegating more operational interventions to bilateral or humanitarian actors.
This strategy also presupposes increased transparency and improved governance, ensuring independence from private or philanthropic funding, which already constitutes a significant portion of the budget (approximately 10% via the Gates Foundation). Furthermore, it would be crucial to strengthen the role of the World Health Assembly in strategic governance, requiring greater accountability from Member States, particularly through more predictable and increased mandatory contributions.
Transforming the financial crisis into a strategic opportunity
To overcome dependence on volatile funding, the WHO must diversify and innovate its financing sources. The establishment of health taxes, the utilization of Special Drawing Rights (SDRs) for health purposes, international health insurance, or climate-health financing can contribute to securing long-term financial resources. These solutions, although ambitious, require strengthened international coordination and sustained political support.
Concurrently, a strategic readjustment is necessary: the WHO must reduce its direct operational presence in favor of a stronger coordinating role and support for national health systems. This evolution would enable better resource utilization, building local and national resilience instead of relying entirely on external interventions, which are often costly and unsustainable.
Finally, increased exploitation of digital technologies, science, and global surveillance is an absolute priority. The proven effectiveness of digital surveillance and early warning systems during the COVID-19 pandemic must be leveraged to improve global responses to future health crises.
Protecting achievements in the fight against HIV, tuberculosis, and malaria
The financial crisis directly threatens the progress made in combating HIV/AIDS, tuberculosis, and malaria. The reduction in financial support could lead to a major resurgence of cases, particularly in South Africa, where thousands of lives are at stake by 2034. The WHO must imperatively maintain technical support for national policies on prevention, testing, and treatment, as well as the essential logistical chains required to ensure the availability of critical medications.
Regarding malaria, the recent introduction of vaccines in numerous countries represents a valuable but fragile achievement. Without solid international coordination and stable financing, these successes risk being compromised, potentially reversing years of efforts and investments.
Major risks of organizational status quo
The current status quo exposes the WHO to critical risks. Prolonged budgetary paralysis would worsen its reliance on unpredictable external funding, significantly diminishing its medium-term operational capacity. A loss of scientific authority due to the dominance of private or external interests could further weaken global credibility. Similarly, retreating into short-term humanitarian management could prevent the WHO from fully exercising its strategic role as the global health coordinator.
Additionally, key areas such as pandemic preparedness, mental health, nutrition, and other major health challenges could experience increased fragmentation and a severe lack of international coherence.
Conclusion: A moment of truth for the WHO
As compellingly argued in the Blue Note by the "Santé mondiale 2030" Think Tank, the current financial crisis represents a decisive moment for the WHO's future. The organization now has a historic opportunity to fundamentally reinvent itself, becoming a strategic, effective, transparent, and sustainable institution. The outlined proposals - normative refocusing, financial diversification, increased accountability of Member States, and intensified technological innovations - offer a clear pathway for the necessary overhaul.
Today, it is indispensable that all stakeholders - Member States, financial partners, scientists, and civil society - actively support this transformation to ensure a more resilient, coherent, and united global health future.
