Analysts have scrutinized the WHO’s delayed response to past public health emergencies. But our research indicates that the WHO contributes substantially to global health more broadly and serves as a significant partner in U.S. health efforts, particularly in Africa. Defunding this organization would probably erode sizable, long-standing U.S. investments on health in the region.
Global health security has long been a U.S. priority
The United States contributes the most money to the WHO, because member contributions are calculated based on a country’s wealth and population size. However, the relationship between the WHO and the United States extends beyond finances.
During both the Obama and Trump administrations, the United States has partnered with the WHO to promote the Global Health Security Agenda. This is a global effort; however, the U.S. response is spearheaded by the Centers for Disease Control and Prevention’s Division of Global Health Protection and is designed to boost global health security via strong and resilient public health systems that can prevent, detect and respond to infectious disease threats worldwide.
The CDC is specifically committed to partnering with 12 African countries to combat infectious disease threats. The United States, in its 2019-2021 Global Health Strategy, also identifies the WHO as a strategic partner in strengthening the capacity for timely and effective responses to disease outbreaks. This cooperation helps stretch U.S. efforts in global health security, because only 5 percent of the U.S. global health funding is designated for global health security.
Here’s the big problem: The proposed funding withdrawal would almost certainly constrain the WHO’s ability to support pandemic responses in Africa. As Emmanuel Balogun argues in the forthcoming book, “Convergence and Agency in West Africa,” Africa and its regional organization, the African Union, rely on this support. In 2019, the WHO and the African Union signed a memorandum of understanding to promote health emergency preparedness.
In January, for instance, the WHO worked with the African Union to train health-care providers and establish coronavirus testing labs. And the WHO’s solidarity flights have provided needed supplies to African countries most hit by covid-19, the disease caused by the novel coronavirus.
CDC and WHO collaboration are central to the U.S. global security strategy. Defunding the WHO would probably harm the operational capacity for testing, contact tracing and slow down the attempts by the WHO to accelerate research and development toward the creation of a covid-19 vaccine. These activities will also be critical in the future, as experts now predict that the virus will linger worldwide until at least 2022.
These are long-term U.S. investments in global health
Over the past two decades, the United States has spent significant funds for health care in Africa, particularly for AIDS, tuberculosis, malaria and maternal and child health. One example is PEPFAR, a signature policy achievement of President George W. Bush that has supported HIV prevention and AIDS treatment programs in 50 countries since 2003. The program has received continuous bipartisan support in Congress.
As Amy S. Patterson asserts in her book, “Africa and Global Health Governance,” PEPFAR helped institutionalize a U.S. and African commitment to health on the continent. PEPFAR has collaborated closely with the WHO to deliver HIV prevention messages, ensure quality medications and design global standards for the rapid expansion of the health-care workforce. These are tasks that PEPFAR cannot do alone — but working in collaboration, as of September 2018, PEPFAR was able to provide AIDS treatment to 14.6 million people and prevent 2.4 million babies from being born with HIV. These successes depend in part on leveraged partnerships, including those with the WHO. Defunding the WHO will erode PEPFAR’s effectiveness, and undermine a program that has spent over $90 billion combating AIDS.
Maternal and child health projects slated to receive over $1 billion in U.S. funding in 2020 may also see the impact of any WHO funding cuts. The United States has worked closely with the WHO to develop guidelines and training packages for postnatal care and preterm birth. This partnership works to decrease the estimated 15,000 children and 800 women who die each day from preventable causes, over 80 percent of whom live in Africa. WHO officials express concern that a decline in U.S. funding will hamper campaigns against vaccine-preventable diseases like measles and polio.
The WHO also fills a gap on some health issues the United States has not prioritized in Africa, particularly noncommunicable diseases like diabetes, heart disease, cancer and mental health disorders. These conditions cause the majority of deaths, sickness and disability worldwide — and they also increase the risk of death from the coronavirus. And the WHO uses its technical expertise and diplomatic skills to promote health issues such as essential medicines and tobacco control legislation.
Undercutting the U.S.-WHO partnership could have unanticipated spillover effects on nonhealth programs, including the White House’s new Women’s Global Prosperity and Development Initiative, which seeks to promote entrepreneurship for 50 million women in the developing world by 2025. Studies indicate that women’s health — including access to reproductive and family planning programs — matters for their economic advancement.
What’s the message to African allies?
Experts express concern that the U.S. action signals disinterest in robust global health leadership. The action follows an already depleted U.S. diplomatic presence on the continent, and proposals to cut U.S. global health funding for 2021 by $3 billion, to 2008 levels. African leaders have voiced support for the WHO and stressed that cooperation is essential to achieving positive health outcomes. Defunding the WHO could undermine the U.S. ability to engage in global health diplomacy at just the moment when global interdependence challenges population health and economic survival.
Amy S. Patterson (@aspatter_amy) is professor of politics at University of the South, and author of “Africa and Global Health Governance: Domestic Politics and International Structures” (Johns Hopkins University Press, 2018). She studies community mobilization, citizenship and health policy priorities, with a focus on Africa.
Emmanuel Balogun (@EA_Balogun) is assistant professor of international relations at Webster University and author of “Convergence and Agency in West Africa: Region-Building in ECOWAS” (Routledge, forthcoming 2020). He studies African regional organizations, peace and security, and global health governance in West Africa.