Last April 7, the World Health Organization (WHO) celebrated its founding anniversary with the theme “75 Years of Improving Public Health”. The WHO constitution was ratified in 1948.
For decades, the WHO, whose establishment was discussed in the conference which created the United Nations in 1945, has been instrumental in the formulation and implementation of health policies around the world. The global health organization takes the lead in international health crises like the Ebola outbreak, Severe Acute Respiratory Syndrome (SARS) and, most recently, the COVID-19 pandemic. WHO has the main responsibility of developing and facilitating partnerships among States and different institutions to respond to and eradicate these pandemics and health emergencies.
The COVID-19 pandemic and the response to this has been the ultimate test of the global public health system shaped by WHO health policies and frameworks. Many countries, especially low and lower-middle income countries, struggled to respond and contain the spread of the virus.
The WHO is supposed to be the lead global institution for health but was lacking in terms of ensuring and implementing an adequate and appropriate COVID-19 response worldwide. Instead of leading, it passed the reins of pandemic vaccine response to influential private institutions that are among the major sources of WHO funding: the Bill and Melinda Gates Foundation, Gavi the Vaccine Alliance, and the Coalition for Epidemic Preparedness Innovations (CEPI).
These organizations formed the COVAX mechanism. COVAX was supposed to facilitate the distribution of COVID-19 vaccines globally and prioritize the needs of low and middle-income countries and high-risk groups.
The high-income countries (HICs) and Big Pharma undermined the WHO’s authority in vaccine distribution and COVID-19 response. The HICs funded the vaccine researches of their big pharmaceutical firms and prioritized their own countries once vaccines were developed. Big Pharma raked in enormous profits from the exorbitant sale of vaccine doses around the world.
Three years into the pandemic, global herd immunity is still far from being achieved. Vaccine inequity is stark and, until now, only 29.3% of people in low-income countries have received a dose of the vaccine compared to the HICs that already have herd immunity, with their respective populations even receiving booster doses.[1]
And instead of making vaccine doses accessible, COVAX was hugely underfunded and even undermined by the HICs. HICs and Big Pharma did not deliver all the vaccines that they promised, while HICs kept drawing from COVAX on top of bilateral deals with Big Pharma. It became just another instrument to benefit private institutions, rich countries, and pharmaceutical companies.
Who funds WHO?
The WHO is mandated not just to ensure international global health policy and framework but also to assist UN member states in developing a strong public health system accessible to their constituents. Currently, the WHO has 194 member states divided into six (6) regional groups. These member states are involved in decision-making and policy-building through their representatives.
The WHO had a total approved budget of US$9.4 billion for its 2020-2021 program. This budget came from the total contributions of its member states and private entities. The member states are compelled to pay yearly dues called the Assessed Contributions (AC), which are computed depending on a country’s wealth and population. But these contributions cover less than 20% of the WHO’s total budget.[2]
With only a small percentage of total funding coming from members’ dues, where does the bulk of WHO funds come from?
Most of the WHO’s current funds come from Voluntary Contributions (VC), which are additional contributions from member states or funds given by other partners such as private corporations or institutions. VC make up more than 60% of the WHO’s total funds.
VC are categorized into core voluntary contributions (CVC), thematic and strategic engagement funds, and specified voluntary contributions.
CVC are given to WHO without conditions, and the organization has full authority to use these funds in their different programs. CVC amounts to 4.1% of all VC.
Meanwhile, the thematic and strategic engagement funds are “partially flexible”. This means contributors set requirements that need to be followed for the use of funds while giving the WHO a certain degree of freedom in earmarking these. These funds are 7.9% of the total VC.
The largest percentage of VC are specified voluntary contributions, which are about 88% of the total VC. The contributors of these funds have a specified program in which they want their contributions to go and WHO can only use these according to what the contributors have stated.
In the WHO’s latest 2020-2021 Financial Flow report, the agency received a total of US$6.6 billion in VC. Of the total VC, 17.3% came from Germany, 9.3% from the Bill & Melinda Gates Foundation, 7.2% from the United States (US), 6.5% from the European Commission (EC), 6.4% from Gavi, and 6% from the United Kingdom (UK).
The breakdown of WHO funding shows that the majority of the donations it receives have conditionalities that may or may not align with the overall goal of strengthening the global health system.
Conflict of interest?
The nature of WHO funding makes the agency easier to control by HICs and big institutions who pour in huge amounts of contributions to their coffers. Since most WHO funding consists of specified voluntary contributions, the WHO is committed to following the conditions made by the contributors.
For example, one of WHO’s biggest private contributors is the Bill & Melinda Gates Foundation. As much as 64.4% of their contributions goes to Polio eradication in a planned partnership with the Global Polio Eradication Initiative. This is an initiative started in 1988 by the WHO, Rotary International, Centers for Disease Control and Prevention (CDC), UNICEF, and the Gates Foundation. Only a small portion of the foundation’s contributions goes to improving access to quality essential health services (13.4%), strengthening country capacity in data and innovation (5.9%), and improving access to essential medicines, vaccines, diagnostics and devices for primary health care (5.2%).[3]
Meanwhile, Germany, Japan, the US, the Republic of Korea, and the EC are the top member States contributing to the program budget of WHO. Funds from these countries are mostly specified voluntary contributions allotted only to their preferred program and even preferred countries.
The WHO being so tied to its contributors’ commitments becomes instrumental in hindering the advancement of genuine health programs and policies that will benefit all. The nature of WHO’s funding makes it a virtual puppet to its largest contributors and funders; this was glaring during the course of COVID-19 response.
The COVAX mechanism is one of the WHO’s flagship pandemic response programs and is in partnership with the Bill & Melinda Gates Foundation and their allied organizations like the CEPI and Gavi. Through this partnership, these private entities greatly influenced the course of the global vaccination program despite not having voting powers within the organization.
Even before the COVID-19 pandemic, these organizations already worked closely with the WHO on many of its programs such as the Polio eradication and Ebola outbreak response.
WHO and the vaccine profits
In the first year of the COVID-19 pandemic, many countries and pharmaceutical companies invested in and launched various research to develop a vaccine to protect people from being infected with the virus. The COVID-19 vaccines saw the fastest development and rollout of any vaccine in history.
When COVID-19 was first pronounced as a global pandemic, HICs and Big Pharma immediately poured huge resources into producing vaccines against the disease. HICs such as Germany, US and UK funded big pharmaceutical companies to push research and development of vaccines. Pfizer-BioNTech, AstraZeneca, and Moderna were among the companies that received public funding for COVID-19 vaccines.
The COVAX and ACT-A initiatives – both are in partnership with the Gates Foundation, CEPI, and Gavi – used and purchased vaccine doses produced by Big Pharma such as Pfizer-BioNTech, AstraZeneca, and Moderna. All these pharmaceutical companies are headquartered in HICs and received public funding during the pandemic response. The WHO’s preference for these vaccines was seen in how they were approved easier and faster than other vaccines produced.
Big Pharma generated record profits from their COVID-19-related products such as vaccines and antiviral pills. In 2021 and 2022, Pfizer made US$35 billion in net profits, while BioNTech and Moderna each made US$20 billion.[4] For its part, AstraZeneca’s COVID-19 vaccine sales reached US$4 billion in 2021.[5] These pharmaceutical companies managed to use the pandemic to gain profits many times higher than before the pandemic.
Because of their profit-oriented nature, Big Pharma sold most of their vaccine doses to HICs which purchased and hoarded more doses than what their populations needed. As a result, only a small percentage of produced vaccine doses were delivered to poor countries through COVAX. Pfizer-BioNTech has delivered less than one percent of their total supply to low-income countries, while Moderna delivered just 0.2% in 2021.[6]
Big Pharma prioritized the delivery of vaccine doses to richer countries since this is where they will gain more profits even though the people living in low-income countries are more vulnerable to COVID-19, especially with the poor quality of their health systems.
The COVAX also failed to deliver its promised two billion doses to low and lower-middle income countries by the end of 202,1 which led to higher number of deaths due to COVID-19 in poorer countries. In 2022, the organization, Oxfam, estimated that for every COVID-19 death in an HIC, there are four deaths in low or lower-middle-income countries. Oxfam also said that deaths recorded in low and lower-middle income countries are 31% higher than in high-income countries.[7]
Who leads WHO?
The WHO is supposed to be the global coordinating authority of health policies to facilitate universal attainment of the highest level of health. The organization was built to answer the people’s needs by ensuring a strong global public health system that is accessible to all.
However, the WHO is too easily influenced by powerful HICs and big private institutions in the programs they implement. The COVID-19 vaccine profits they raked in are just the most recent example of how they use the WHO as a tool for their narrow benefit.
It has been 75 years since the WHO was established, but the achievement of its objectives remains elusive. Low and lower-middle income countries still have weak health systems and remain more vulnerable to different diseases. Two billion people still have no access to medicines despite the global pharmaceutical industry having an estimated worth of US$1.5 trillion in 2022.
The WHO should take a firm stand against the takeover of the global health system by rich countries and Big Pharma. It is time for the organization to look back and truly serve its purpose of making countries work together for the highest attainment of health and for accessible health for all.
[1] https://ourworldindata.org/covid-vaccinations
[2] https://www.who.int/about/funding
[3] https://www.who.int/about/accountability/budget
[4] https://www.somo.nl/big-pharma-raked-in-usd-90-billion-in-profits-with-covid-19-vaccines/
[5] https://www.fiercepharma.com/pharma/astrazeneca-vaccine-sales-reached-4-billion-last-year-but-don-t-expect-2022-company-says
[6] The People’s Vaccine Alliance, 2021
[7] https://www.oxfam.org/en/press-releases/covid-19-death-toll-four-times-higher-lower-income-countries-rich-ones
