Private foundations and the WHO: A recipe for disaster or the future of global health?

A few weeks ago I read an article about how the Bill and Melinda Gates Foundation helped fund Ebola-related activities during the 2014 Ebola outbreak, and I wondered why in the world they had to help in the first place. So I wanted to further explore the limitations of the WHO’s current funding mechanism, and explain how the Gates Foundation stepped in to help during the extraordinary circumstance of the 2014 Ebola outbreak.

But then I started thinking, with the way humanity is encroaching on undeveloped land and coming into contact with previously unknown pathogens, will the 2014 Ebola outbreak really be that extraordinary? And if these major outbreaks of previously unknown pathogens become our “new normal”, how is the world going to handle this, or are we just going to hope the Bill Gates’ of the world keep starting global health related foundations and can throw money at these outbreaks?

Photo of WHO Director General Margaret Chan on stage at the WHO. Courtesy NPR.

Photo of WHO Director General Margaret Chan. Courtesy NPR.

First, let’s explore a little about the WHO and how it’s funded. The World Health Organization is a specialized agency of the United Nations, which is an intergovernmental agency created to bring the world’s nations together to work on things such as international peace and security and international cooperation. Now the UN has various programmes, funds and agencies, such as UNAIDS, World Bank, World Trade Organization (WTO), International Monetary Fund (IMF), World Food Programme (WFP), United Nations Children’s Fund (UNICEF), etc. and all of these programmes, funds and agencies all have their own leadership, membership and budget.

The WHO is funded through both assessed and voluntary contributions. Assessed contributions are the dues countries pay to be members and the amount is relative to the country’s population and wealth. So any global economic depression naturally shrinks the amount of money Member States owe, and subsequently shrinks the WHO’s available budget. Voluntary contributions are those contributions that come from Member States (in addition to the assessed contributions they already pay) or from other non-governmental organizations. Voluntary contributions can be flexible or marked for a specific purpose. In recent years voluntary contributions have accounted for more than three-quarters of the WHO’s financing overall, and most of the voluntary funding is specified and not flexible. So what this means is that the WHO is basically operating on the generosity of Member States and other organizations, all of whom could reduce or eliminate their voluntary financial support at any time, and even if they don’t reduce or eliminate their voluntary support, the WHO can’t use most of that money for emergencies as it’s already marked for another purpose.

Now you can understand how the WHO, in its current structure, really can’t quickly respond to outbreaks or other issues. If all your money is already specified for other purposes, you can’t  rob Peter to pay Paul as we say in the States, which means that you can’t take money from one area to pay for another. If you’re even remotely interested in the details of WHO funding (it is sort of interesting to see where the money all goes) check out their interactive site here.

Second, let’s talk about what happened during the 2014 Ebola outbreak. As The World Post (a division of the Huffington Post) reported, Dr. Frieden (former director of the CDC) went to West Africa and saw firsthand how quickly this was going to get out of hand. He emailed his contact at the Gates Foundation and through some pleading he was able to convince them to move some additional money, beyond the couple million they had already put towards Ebola, into the CDC Foundation so the CDC could use the funds to fight Ebola. The Gates Foundation did better than that, they donated money not only to the CDC Foundation but also to WHO, UNICEF, and various non-governmental agencies operating in the area. Now you might think, “Well yeah, the Gates Foundation has a bunch of money, why shouldn’t they contribute to these major global health events”. And you’d be right. But I should also mention that the Gates Foundation, at the time of this article, contributes 18.09% of the WHO budget, which is more than the United States which is the next highest contributor. At the time of the Ebola outbreak, they were the second highest contributor, behind the United States.

Photo of the Gates Foundation exterior. Courtesy of Tom Paulson/Humanosphere.

The Gates Foundation. Courtesy of Tom Paulson/Humanosphere.

This brings us back to my original point. If the WHO isn’t funded in a manner that allows them to respond quickly to the inevitable emerging outbreaks, should we rely on private foundations to fill the gap? Or is this too risky? And if the purpose of the WHO is to place the responsibility for global health onto the world’s governments, why aren’t they doing more to ensure the WHO is properly funded? While the WHO isn’t in the position to demand more of it’s voluntary donors, as they could easily take their money elsewhere, what responsibility do we have as global health leaders to ensure that our monetary donations to organizations allow for flexible spending?

Events like the 2014 Ebola outbreak will continue to happen, probably with increasing frequency. So the main question becomes, will we change the way we fund the responses to these outbreaks, or we will continue to hope for someone else to step in and save the day. For the sake of humanity, I hope we change our ways.

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