Can the World Health Organization still be the World’s health conscience? - 2 | A house built on donor sand
The world’s health guardian lives on the charity of those it must sometimes defy. Can an institution funded by politics still speak the truth of science?
Dr. Monir Islam and I speak at length about the claim that WHO has grown too political and less science-driven. He concedes that such perceptions are not entirely misplaced. “This perception, while sometimes oversimplified, is not entirely unfounded,” he explains. “WHO operates in a political space (it is a Member State-driven organization) but it must remain a scientifically credible authority above political pressures. Maintaining that balance is difficult, especially when the organization is under-resourced and increasingly dependent on voluntary funding and political goodwill.”
He goes on to note that in recent years, worries about politicization have extended beyond institutional structure to leadership culture. “Critics have pointed out that under Dr. Tedros’s tenure, decision-making has become more centralized, and at times, less transparent.”
The challenge is built into the system. Unlike the IMF or World Bank, where voting power reflects financial contribution, WHO adheres to the UN principle of one country, one vote. In theory, this gives each Member State equal voice. In practice, wealthy donor nations still wield disproportionate influence, particularly during the annual World Health Assembly, where the organization’s strategic course is set. Formal equality and informal power pull against each other, constantly testing WHO’s legitimacy.
At the same time, WHO’s scientific rigor sometimes alienates those it intends to serve. Technical language and bureaucratic procedures can feel remote from the realities of the communities on the ground. That distance feeds a perception that WHO is detached from everyday struggles, especially in poorer regions. “Ultimately,” Dr. Islam tells me, “WHO’s strength lies in its ability to blend rigorous science with effective, inclusive communication and diplomacy. The challenge is to reduce political interference without losing the technical rigor that underpins its credibility, while also improving how it connects with diverse populations.”
MONEY, POWER, AND THE PRICE OF INDEPENDENCE
If science is WHO’s moral compass, money is its gravitational pull. The organization’s funding structure reveals how its autonomy can be quietly eroded by the very governments it serves. WHO’s budget consists of two main streams: assessed contributions, mandatory dues based on national GDP, and voluntary contributions, which are optional and often earmarked for specific projects.
In the 1970s, assessed contributions accounted for about 70 percent of the total budget. Today, they barely reach 20. The rest comes from voluntary funds, many of them directed by powerful states, philanthropies, or corporate partners. Those earmarked donations dictate priorities: money follows politics.
“When over 80 % of its budget is made up of voluntary contributions, most of which are earmarked for specific priorities set by donors, WHO has limited room to act autonomously or strategically across all global health needs,” Dr. Islam stresses. The result is predictable- an agency that “walks on eggshells,” cautious not to offend major funders. Controversial subjects such as the origins of COVID-19 or the politics of vaccine equity become exercises in careful phrasing.
He adds that financing is only one side of the coin. Leadership and governance are the other. “When a Director-General is elected with the backing of select donor countries, rather than through transparent, broadly supported multilateral processes, concerns naturally arise about whose interests are being prioritized … A more predictable, assessed contribution-based funding model is important, but so is a leadership model that reflects the diversity and sovereignty of all Member States.”
WHEN THE BIGGEST DONOR WALKS AWAY
The fragility of that system became painfully clear when the United States (U.S.), WHO’s largest single contributor, turned its back. During the first months of COVID-19, President Trump accused the agency of being “China-centric” and announced a suspension of U.S. payments. A year later, the U.S. formally notified the UN of its intent to withdraw, a decision reversed on President Biden’s first day in office.
But when Trump returned to power in 2025, few doubted he would do it again. On his first day, he signed the executive order Withdrawing the United States from the World Health Organization. Although international law requires a year’s notice and payment of existing obligations, Washington froze transfers almost immediately. WHO could express only “regret”, and scramble to fill a hole hundreds of millions of dollars wide.
Heading for the exit: President Donald Trump signs an executive order withdrawing the US from the World Health Organization on 20 January 2025 (Photo: Associated Press/Alamy)
The agency had been warned, yet appeared unprepared for the financial shock. The outgoing Biden administration had already left $130 million in unpaid dues for 2024. Combined with Trump’s freeze, WHO suddenly faced a $260 million shortfall. The consequences rippled fast: staff reductions, suspended programmes, and a looming crisis of confidence inside the institution itself.
In February 2025, at the Executive Board meeting, Dr. Tedros announced sweeping budget cuts for 2026–2027 - down from $6.8 billion to $4.2 billion - promising that layoffs would begin “carefully and strategically.” The reassurance did little to calm internal anger. For an organization chronically under-funded even in good times, the new austerity felt existential.
By September, tensions exploded into the open. WHO’s Headquarters Staff Association issued an unprecedented statement condemning the restructuring process for “failing to ensure fairness and transparency.” Two weeks later, an Extraordinary General Assembly passed a motion of no confidence against the 2025 prioritization process, “noting that those responsible failed to ensure fairness and transparency throughout the process.”- the first ever during the tenure of a sitting Director-General. Tedros dismissed it, insisting it did not reflect “the real feeling of the staff.” But the symbolism was unmistakable: a rebellion inside Geneva’s marble corridors against the man who had come to embody both the organization’s power and its paralysis.
When I ask Dr. Islam what this means, he pauses. The vote, he says, signals not just frustration over cuts but a deeper fatigue — “a crisis of confidence within the institution itself.”
WHO HOLDS THE WATCHDOG TO ACCOUNT?
In my seventeen years at WHO headquarters, I never once experienced a full financial or programme audit in the departments where I worked. By contrast, during my earlier seven years at UNICEF, I went through two. It left me wondering: who actually keeps WHO accountable?
Dr. Islam agrees that the system is structurally conflicted. “Member States collectively own and govern WHO … However, this also means that political interests and power imbalances among Member States directly influence WHO’s agenda, funding, and leadership.” In effect, the organization is accountable to the same actors who shape its policies, both judge and jury.
He points to the long struggle over the Framework Convention on Tobacco Control as a prime example: five years of negotiations stalled by resistance from tobacco-producing countries and the lobbying power of multibillion-dollar corporations. Even today, he notes, WHO struggles to push strong measures on sugar or alcohol consumption despite ample scientific evidence on the harmful effects.
Internally, accountability mechanisms existm review panels, evaluation offices, external oversight committees, but they remain largely procedural. “Real accountability remains weak, especially at the highest levels,” he tells me. Compliance boxes are ticked, yet cultural accountability - humility, ownership, responsibility - rarely follows. “The concentration of decision-making power around the Director-General and his inner circle of senior advisors has further eroded horizontal checks and balances.”
“During COVID-19, we saw very little willingness from leadership to openly acknowledge mistakes, learn from them in real time, or invite meaningful internal critique,” Dr. Islam says. “This is not an issue of individuals alone, but of institutional culture.”
For an organization created to hold nations accountable, WHO is discovering how difficult it is to hold itself to the same standard.
Tomorrow – When equity became a casualty: How the pandemic shattered the illusion of fairness, and tested WHO’s moral authority.
