WHO at crossroads: Funding crisis and the future of global health

 By Dr Satish K Gupta

At the World Health Organization (WHO) Global Health Press Conference in Geneva today, the silence was more striking than the statements. Dr Tedros Adhanom Ghebreyesus, the WHO Director-General, raised grave concerns over the abrupt withdrawal of the United States funding, warning that it could lead to millions of preventable deaths and undo decades of progress in tackling infectious diseases.

Yet, when pressed about WHO’s strategy to engage global leaders to restart dialogue with the US, there was no direct answer. “To be clear, I’m not talking about the decision by the United States to withdraw from WHO. I will not comment on that today,” he said.

Such remarks from the WHO D-G raise the larger question: Does WHO have a concrete roadmap to sustain global health efforts beyond the influence of one dominant donor? Because of the USA’s withdrawal, Dr Tedros today pointed out that more than 2,600 health facilities in 12 humanitarian crises have already suspended services at least partially, or will do so very soon. But all that he could do was to “ask the US to reconsider its support for global health, which not only saves lives around the world, it also makes the U.S. safer, by preventing outbreaks from spreading internationally”.

He sought to show the benefit of health to the United States – “And because health is wealth, fighting disease around the world supports global economic growth and stability, which benefits the US”.

The fallout of US funding cuts: A crisis unfolding

For the past two decades, the United States has been the single largest donor to global health initiatives, funding programmes that have:

• Prevented 2.2 billion cases of malaria
• Saved 2 billion lives from tuberculosis
• Supported HIV/AIDS treatment in 50+ countries. Since 1974, measles vaccines have saved nearly 94 million lives, but those gains are also at risk.
• Sustained 700 laboratories monitoring measles, rubella, and emerging diseases

Now, with this financial support abruptly halted, the consequences are staggering:

• 15 million additional malaria cases and 107,000 deaths are expected in 2025, reversing 15 years of progress.
• 10 million new HIV infections and 3 million related deaths. Eight countries now have substantial disruptions to antiretroviral therapy and will run out of medicines in the coming months. Disruptions to HIV programmes could undo 20 years of progress, leading to more than 10 million additional cases of HIV and 3 million HIV-related deaths – more than triple the number of deaths last year
• Measles resurgence, with 57 large outbreaks already recorded. (And the number has been increasing for the past three years).
• Critical shortages in TB diagnostics and treatment across 27 nations in Africa and Asia

This is not a future threat—it is an active crisis! The sudden withdrawal of U.S. funding in numerous nations poses a significant risk of undoing advancements made in areas such as disease management, vaccination coverage, maternal and child health, and readiness for emergencies.

Dr Tedros pointed out that in Cox’s Bazar, Bangladesh, which is home to the largest refugee camp globally, the diagnosis and treatment of hepatitis C have faced interruptions, along with essential services like disease monitoring, primary and secondary healthcare, laboratory operations, supply procurement, and the payment of healthcare workers’ salaries.

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• Dumped by Trump, WHO explores crowdfunding
• 80% of WHO-supported facilities in Afghanistan risk shutdown
• Funding cuts endanger lives of millions of tuberculosis patients: WHO

WHO’s response: Reprioritization but no transparency

Dr. Tedros’s team stated that WHO is reviewing, reorganizing, and reprioritizing its budget to sustain critical health services. However, there are key concerns WHO has not addressed:

• What alternative funding mechanisms are being explored?
• Why has WHO not publicly committed to diplomatic negotiations with the US?
• Are other major donor countries stepping in to fill the funding gap?

All that Dr Tedros could say today was that “if the US decides not to restore direct funding to countries, we ask it to engage in dialogue with affected countries so plans can be made to transition from reliance on US funding to more sustainable solutions, without disruptions that cost lives”. He also reminded the US that over many years the US Administration had been extremely generous. “…of course, [the US] is within its rights to decide what it supports, and to what extent. But the US also has a responsibility to ensure that if it withdraws direct funding for countries, it is done in an orderly and humane way that allows them to find alternative sources of funding.

A world-class health institution cannot afford to rely on the financial whims of political powers. If WHO remains fundamentally dependent on one or two donor nations, then global health remains politically vulnerable rather than scientifically driven.

The bigger picture: A WHO overhaul is necessary

The current funding crisis exposes WHO’s long-standing structural flaws. If an organization responsible for global health is paralyzed by a single country’s financial decisions, then it needs a financial and governance overhaul.

Key steps WHO must take to remain independent and effective:

• Diversify funding sources—Engage G20 nations, private foundations, and multilateral institutions to create a more resilient financial structure.
• Crowdsourcing for public health—WHO previously mentioned crowdsourcing, but failed to clarify its plans. A global health fund backed by multiple countries could reduce reliance on any single donor.
• Transparency reforms—The U.S. justified its funding cuts by citing transparency concerns and WHO’s delayed COVID-19 response. Addressing these criticisms is crucial for regaining credibility and attracting new funding.

The critical next step: Can WHO mobilize global leadership?

The biggest question remains: Will WHO engage global heads of state to restart dialogue with the US? Diplomatic engagement is not optional—it is urgent. Without a coordinated effort, WHO risks losing its ability to function effectively, leaving millions in vulnerable countries without life-saving care.

If WHO does not take a bold stand now, it will set a dangerous precedent—one where global health is dictated by political funding decisions rather than scientific necessity. On his part, the WHO D-G acknowledged that other donors will need to step up whether or not the US funding returns. He emphasised that WHO has long called for all countries to increase domestic health spending progressively, and that is now more important than ever.

Final thought: A call for global health independence

WHO must emerge from this crisis stronger and more independent. The world cannot afford a health organization that is at the mercy of financial and political shifts.

Global health is not a regional priority, nor is it a diplomatic bargaining tool—it is a universal human right. The question is: Will WHO rise to the occasion, or will it allow financial instability to dictate the fate of global health?