WHO has anchored the global health architecture since its founding in 1948, and it is impossible to imagine another institution filling the void if the international community were to let it atrophy. While also confronting and guiding the response to COVID-19, WHO is engaged in the most consequential reforms since its founding, including negotiating a global pandemic agreement and revising the International Health Regulations. Underpinning all these reforms is the need for robust and sustainable financing.

WHO's resources have consistently lagged behind its constitutional mandate. There is a deep misalignment between what governments and the public expect WHO to do and what the organisation is resourced to do. WHO is challenged by low levels of political will to increase its financing, strained government treasuries, and a battle over control of priorities.¹ These tensions were clear when the Working Group on Sustainable Financing, chartered by WHO's Executive Board, did not reach consensus by the January, 2022 deadline.¹ WHO's Executive Board has now charged the Working Group on Sustainable Financing with identifying a viable plan before the World Health Assembly in May, 2022.²

There is no time to lose. WHO's resourcing strategy must match its mission with assured financial support from member states buttressed by proven, innovative financing methods. By defining its priorities, delivering on them, and being transparent and accountable, WHO can more boldly pursue its public health mission.

WHO's revenue model has always been politically contentious with its first budget slashed by 23%, thus “preventing us from being an operating agency to any extent”.³ In 2022, WHO is expected to support a world health agenda with a budget less than that of a major research hospital or mid-sized subnational health agency.

The constitution of WHO gives the organisation flexibility to receive voluntary contributions from state and non-state actors to supplement mandatory assessed contributions from member states. That should have augmented its funding. Yet voluntary contributions have skewed WHO's revenue model such that more than 80% of its income now derives from them.4, 5 Voluntary contributions risk prioritising the parochial interests of major donors over collectively driven all-of-society activities. WHO has little control over its budget, suppressing fiscal predictability, lessening purchasing power, undermining longer-term investments, and diminishing the opportunity to attract and retain world-class scientists consistently.

Former German Chancellor Angela Merkel urged a special session of the World Health Assembly in 2021 to increase assessed contributions from member states to 50% of WHO's base programme budget.⁶ Yet despite high-profile advocacy, and that assessed contributions represented roughly half of WHO's budget in 2000,⁷ the Working Group on Sustainable Financing could not reach agreement. Member states variously cited already stretched government budgets, the need for WHO to work within its existing means, and the desire for governance reforms,¹ reflective of the need to ensure fiscal legitimacy, fairness, and justice.⁸ From a purely financial perspective, however, there is an opportunity to connect increases to assessed contributions with the inevitable tapering of country spending on the acute phase of the COVID-19 pandemic. Such expense substitution is politically easier to accomplish than newly taxing already pressured national budgets.

The tension for control between funders and implementors is nothing new, but a special dynamic exists when underwriting the activities of an intergovernmental organisation. For member states, there is little prospect for a financial return on investment and contributions are made from public treasuries. These realities unsurprisingly cause funders to engage in more risk-averse behaviours than other suppliers of capital, such as company shareholders or charitable foundations. Voluntary contributions, moreover, have become a way to dictate the terms of WHO's activities. The key questions for the future are who gets to set the global health agenda, and will WHO be relegated to an agency that simply implements particular donors' projects?

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