On Monday, President Trump issued a 30-day warning to the World Health Organization: Shape up or lose U.S. funding. In a May 18 letter to the WHO, Trump argued the organization “has been curiously insistent on praising China,” and failed to alert the world about the covid-19 danger in a timely manner.

Both Bill and Melinda Gates criticized Trump’s announcement last month about freezing U.S. funding to the WHO — and in recent weeks, Bill Gates encouraged more than 200 billionaires who have signed onto Gates’s Giving Pledge to coordinate their efforts on the covid-19 response.

Global health policy faces two challenges — a possible U.S. withdrawal from the WHO, and a likely increase in the need for philanthropy as the United States pulls back. Here’s what those changes are likely to mean.

The U.S. is losing influence

WHO funding is one example of how the U.S. provides “global public goods” as part of its leadership. In the U.S., global health security traditionally has been a bipartisan priority. Here’s an example: the U.S. partnership with the WHO on the Global Health Security Agenda expands the reach of U.S. foreign policy. The U.S. allocates only 5 percent of its global health budget to health security, but leverages this investment through the broader WHO effort. Beyond preventing the spread of disease, this has important security implications — inadequate health care elsewhere in the world makes countries vulnerable to instability and violence, particularly in the event of outbreaks.

To understand the consequences of the U.S. threat to withdraw funding, I drew on a recent TRIP Snap Poll conducted between April 27 and May 4, capturing attitudes and opinions of more than 900 U.S. international relations experts.

Over 90 percent of TRIP survey respondents anticipate foreign leaders would view the U.S. as either “less likely” or “much less likely” to provide global public goods after the covid-19 pandemic. In addition, respondents expect sharp declines in global perceptions of the U.S. as a “state that honors its international commitments” and a “state that is widely respected in the international system.”

These views may reflect dismay at Trump’s attacks on the WHO, alongside restrictions the U.S. government has placed on its foreign aid to prevent other countries from buying up needed personal protective equipment for health-care workers. And freezing WHO funding would curtail the global response to a pandemic that has not yet peaked in many African countries and other areas of the world that are particularly vulnerable to covid-19 because of weak health systems and mass displacement.

The TRIP survey asked international relations experts to rate the U.S. role in coordinating the international response to the current pandemic. A very small minority of respondents say the U.S. has been somewhat effective or very effective — while 80.3 percent of survey respondents say the U.S. has not been effective at all.

How philanthropy is becoming more important in global health

Suspending WHO funding will limit the WHO’s activities — and U.S. influence over global health. But if the United States withdraws funds, it will create a void that other types of donors are likely to fill.

My research shows how philanthropy and private foundations are already shaping global health policy — and becoming more important during health crises. When powerful countries like the United States and United Kingdom curtailed WHO funding in the early 1980s, the organization’s budget began to shift away from assessed (mandatory) country dues. Instead, WHO relied more and more on voluntary contributions from both countries as well as non-country donors.

Voluntary contributions make up around 80 percent of the WHO’s budget, which totals $6.27 billion for 2018-2019. These funds are heavily earmarked — meaning the WHO has limited flexible funding to shift rapidly in response to a sudden outbreak. The United States is the WHO’s largest donor, providing around 15 percent of its total budget. The second-largest donor, the Bill and Melinda Gates Foundation, accounts for around 9 percent.

The WHO remains an important hub in an increasingly complex global health policy architecture. But in addition to international organizations, this architecture involves public-private partnerships such as GAVI and the Global Fund, providing ways for philanthropic organizations to exert influence.

Countries remain decisive players when it comes to issuing travel and trade restrictions during crises where health and national security intersect. Yet U.S. abdication of leadership on health security issues more broadly may create space for greater private sector engagement in the future.

Private philanthropy — about 20 percent of overall development assistance for health — is likely to play a more important role than ever before. Private gifts during emergencies were historically rare before the 2013-2016 Ebola response. Data from Candid, a nonprofit tracking private giving, shows donations related to covid-19 since January have skyrocketed to $10.4 billion — representing more than 3,400 grants from 677 funders. By comparison, since the 2002 SARS outbreak, donors contributed a total of just $7.2 billion to assist in the response to other global health emergencies during the past 18 years.

More money to fight covid-19 sounds like a good thing — but the expansion of philanthropy is more controversial than one might think. Some scholars say that while donors may be well intentioned, their interactions with global health institutions give a small group of wealthy individuals considerable political influence — but little democratic accountability.

More generally, private giving during a global health crisis is unlikely to address the systemic problems of strengthening health systems around the world to protect against devastating consequences from future crises — including pandemics. Bill Gates, for instance, has gone on record stating that philanthropic efforts cannot fill the roles of donor countries. Gates — who plans to give away his entire fortune — may seem an unlikely prophet of the limits of philanthropy, but his skepticism suggests that as philanthropists displace the work of donor governments, they are discovering that they can’t do nearly everything that countries and the WHO can do.

Summer Marion is a PhD candidate in political science at Northeastern University and visiting researcher at Harvard Humanitarian Initiative. She researches international cooperation, health politics, and philanthropy. Follow her on Twitter at @summermarion.

Read more: