This morning, I want to add my support to the important deliberations of the sustainable financing working group, whom I thank for your pioneering work and endorse your plea - an unanswerable epidemiological, economic and ethical case - that the World Health Organization be fully financed to step up the lifesaving work not only of containing infectious diseases but ensuring that health is a human right available to all, irrespective of income and wealth.
I am here because, like you, I believe we need to leave no argument unstated, no stone unturned, to persuade governments to agree to secure the financing we need. COVID has proven for all to see that the real enemy we fight in this world today is not any other nation nor any dogma or creed, but ill health, disease, poverty, deprivation and squalor. Charged with an ever more urgent responsibility to attack these evils rooted in inequalities and conflict, our message is clear: the World Health Organization cannot any longer be expected to rely on, or have to justify, the ad hoc, piecemeal lottery of global health funding that is more akin to a whip-round at a charity fundraiser than a serious, grown-up attempt to move beyond begging-bowl politics with sustained, consistent and realistic financing for vital work that saves livelihoods and lives.
So, let us be forthright in informing and educating governments about the true, shocking facts: that WHO is being asked to combat infection, research new treatments, monitor and tackle new diseases, and more generally promote human well-being with a basic budget of just US$ 2 billion a year. We must not allow anyone to forget that what we send to WHO - to make the difference between life and death in low-income countries - is no more than 25 cents a year, per person, in the world. That is less than the cost of a cup of tea or coffee or a newspaper. That BASIC budget is so miniscule – US$ 2 billion set against the world's annual income of nearly US$ 100,000 billion. That amount is less than the budget of an average-size US hospital and almost 100 times less than we pay out for pet foods every year.
The proper funding of global health finance is undeniably the best insurance policy in the world.
Take COVID itself. We know that the economic cost, according to the International Monetary Fund, will be US$ 9 trillion by 2025, and another US$ 5 trillion if we fail to combat new variants. This far outweighs, by trillions, even the most generous costing of the health interventions we need.
Let us also remind people that there are ethical as well as epidemiological and economic reasons for funding WHO properly. WHO exists not just to provide global solutions to global problems to benefit everyone, but it is our one sure bulwark in the fight against the gross health inequalities that distort and disfigure our world. Let us remember that with COVID vaccination rates, 3% in low-income countries and 70% in the rest, the citizen of a low-income country has a 142 times poorer chance of being vaccinated against COVID than their richer counterpart. Someone in a low-income country has an 80 times poorer chance of ever being tested for COVID; they have an even lower chance of accessing ventilators and, in most poor countries, even the most basic oxygen and drugs.
An injustice anywhere is, in my view, a threat to justice everywhere, and this is where the World Health Organization can transform lives. And so, we have to ask our potential funders: do we really value human life in the South, so little and so cheaply, that even when we have the miracle of a vaccine, drugs and treatments that global health coordination, led by the WHO, can make available to all, we are prepared to continue to spend on a patient in the global South only a tiny fraction of what we spend in the global North?
Funding the WHO is a test of our common humanity, and so I want to echo the case supported by 75 member states for fair burden-sharing by raising assessed contributions to 50%.
Fair burden-sharing is what pays US$ 10 billion a year for UN peace-making. Fair-sharing based on regularly updated quotas is what finances the IMF and the World Bank. Fair-sharing is what inspired the funding of most of the initial work of WHO. And so it cannot be right that the purest of global public goods - the control of disease - is subject to the least burden-sharing of all and is the most reliant on charity.
Fair-sharing is what was agreed to when 50 years ago, in an attempt to eradicate smallpox, we levied individual Member States based on their ability to pay. Fair burden-sharing is what we inexplicably diluted in 1990 when we abolished real term rises in assessed contributions, and in 1996 when we froze even the cash contributions as the work of WHO expanded. Yes, global health will need important additional sources of finance: the use of special drawing rights , IMF World Bank funds, greater corporate contributions, donations from foundations, the expansion of the global airline tax or similar taxes to raise money hypothecated to health.
If WHO is to discharge its duty to combat global ill health and improve global health, it must be given more than funds earmarked for countries’ pet projects but sufficient guaranteed funds that allow us to end the disgrace of 25% of staff being on temporary contracts. The modest proposal you have put forward which would double Member States’ assessed contributions by 2028, is indeed a test of our humanity. Only by sharing and solidarity can we show we really do feel the pain of others, and that we do believe in something bigger than ourselves.