 Hello and welcome everyone to People's Health Dispatch. This is the first interview that we are going to do in a series of videos and interviews covering the Executive Board meeting of the World Health Organization, taking place from 30th of January to 7th of February. So there are a lot of many, many issues which are being discussed at this meeting and which are of importance for public health and for people. But there are certain things which are really core to WHO and its functioning, which actually impacts everything that WHO does. And one of them is the financing of WHO, of course. So over the past few decades, we have seen that how there have been problems with funding of WHO and WHO has been looking for more and more financing. There have been attempts made to address this problem. And in this meeting as well in the Executive Board, there are three reports which are going to be discussed. And so one of them, a couple of them are the regular reports which talk about the regular funding and where how much funding is being allocated to which program. But there is a third report this time which is very important, which is going to be tabled, which is on sustainable financing. And it is talking about something new, a new proposal, which is replenishment. So we will talk about all these issues and also look at in the end what are the solutions to certain problems that WHO faces today. So today we are joined by people who really have been following these issues for a long time and throw some light and give us insights on these topics. Dr. Andrew Hamer, who is a senior lecturer in Global Public Policy at Queen Mary University of London. We are also joined by Dr. Gargi Telagapalli, who is a medical doctor and a public health expert associated with the People's Health Movement. Welcome, both of you. And we are really delighted to have you on this very important topic. So Gargi, maybe first I will come to you. And if you can just in very simple terms unfold and tell us a little about the funding of WHO, the assessed one and the voluntary funding, what does that mean? And where does WHO stand with all these things today? So the crisis that faced by every United Nations organization to an extent is the crisis of funding. And the crisis of WHO, like any other United Nations organization, is related to funding. And this despite going through a pandemic, we seem to be not realizing the importance of organizations such as the World Health Organization. And this constant underfunding has undermined the work of the World Health Organization, but also puts a doubt or question on the legitimacy of the work of the organization, which to an extent is a very unfortunate situation because we have realized all through this pandemic that the most important organization that needs to be coordinating the health and issues of medicine, science and public health is a World Health Organization because it's made up of its member states, which are countries. What we see here is, despite being in a pandemic, the amount of money that's being given to the World Health Organization, we are looking at a budget of around $7.5 billion. Earlier, they thought that they'll be able to raise a bit lower, but they have been able to raise a bit higher last year. This was in 2022. So what we see is, they are looking at financing almost $7.5 billion when they actually budgeted themselves for $6.7 billion. I just was looking at some budgets before coming here. The marketing budget of Procter & Gamble for 2021 was $8 billion. Similarly, some sort of similar values where Amazon was spending around $4.85 billion. Unilever was also spending something like $4.74 billion. So what we are actually seeing is the World Health Organization, which is supposed to be coordinating the science, the medicine, the public health of the world, all the countries together, seems to be running at such low budgets that actually are equal to the marketing or advertisement budgets of large corporations. So that's a very unfortunate situation. And if you compare it with something like the National Institutes of Health of the US, they have a budget of around $45 billion, which is for a single country. Of course, they do work outside USA. But still, so what you're seeing all these numbers that are being provided to the World Health Organization, if I can say in very simple terms, are peanuts. So they are being given very less amount of money. And that amount of money also comes in the form of tight funding, most of those types, or let us say, non-flexible funding, where the donor is saying that this is the work you need to do and this is the work that I want to get it done through your organization. And somewhere, large portion of this fund seems to be going towards non-controversial areas, which to an extent health emergencies. And polio, last year we have seen, suddenly you saw Tel Aviv, London and New York have polio samples being found in their sewerage. And immediately, they start pumping in money for this program. But what you see is the difficult areas of working on social, commercial determinants of health, looking at the effects of industries. In particular, during COVID, we saw how patents were creating barrier for access to vaccines and so on. This sort of the work on these controversial areas, which are equally important, doesn't really happen. And do note that WHO is actually a technical organization, which predominantly was created to provide standard settings, scientific work, as well as technical guidance to countries. So this sort of work is taking a bad backseat, unfortunately, due to the kind of funds that are being given. So maybe just briefly, we can also talk about the historicity of this problem. It is not a new problem. It has existed before in 70s and 90s. There was a freeze of funding for WHO and the rich countries. They have played unfortunate parts at times. So maybe in brief, if we can throw some light on that also. Historically, there has been a freeze from, I would say, from the 60s itself on different United Nations organizations, from the Congo crisis and so on. But when you see, you see it has only gotten worse, where countries have won, they have, from the 80s, they have really not paid or increased funds. And when they increase the funding towards the World Health Organization also, it is usually around 3% once in a couple of years. So this is kind, it almost doesn't even cover the inflation rates. And the second thing is, there is no guarantee that the next year, the same country is going to provide you. So you have a situation where you really don't want the WHO to be doing certain kind of work, which doesn't question privatization, which doesn't question the kind of neoliberal understanding of health. That health is not a human right, but it's something that needs to be purchased in the market. So what it has also done is it kind of has captured the policy making space all over the world, wherein WHO also to an extent, because of these pressures, has opened itself up to various players who have their very different understanding of health. For example, the most often discussed organization Billion Melinda Gates Foundation comes with very biomedical understanding of the issues. Nobody is questioning biomedical, but the equity of it, understanding that there are magic bullets is one thing. We have seen from the early 2000s also various organizations have come up, which are kind of doing parallel work. And like we say, the WHO office actually around the corner, there's another building where all the bigger organizations stay like GAVI, Global Fund and so on and so forth. They say that the actual decisions are usually taken in the other one. So what we see is the work of WHO seems to be slowly getting diluted, which is an alarming situation for everyone, because the Global South doesn't really still have that sort of capacity by itself. Not all the countries, I wouldn't generalize it, but don't have the kind of capacity to still understand or work on the policies. And what happens effectively is they look towards WHO. WHO is in a very tight situation. It's both equities, regional offices, country offices, all of them are, their work is kind of scaled down. As far as technically, you might see staff, you might see a lot of response during health emergencies or until recently, you would see almost one third of the budget was on polio response towards polio myelitis. So polio is a clear case wherein from the 80s, almost one third of the budget of WHO was going towards this particular issue. And the issue has never got solved. Actually, it's still continuing. So this fund or contributory crunch has led them to work in silos in very vertical veins on some of the diseases. And this is a cutting across not just polio, but every disease, looking at diseases in vacuum and not really discussing or forcing countries to work on social economic issues. Thank you. So taking on from the influence of Gavi and Global Fund, Andrew, I come to you. I think these are the organizations who have informed the whole replenishment model that has been proposed by the working group on sustainable financing. And you've been working on it. So can you tell us a little about what is this replenishment and how does that language or the idea actually corresponds to how IMF and World Bank, they look at the social sector like health, etc. So should we get worried and how much? I mean, I guess I'd start off by saying that the World Health Organization has had a replenishment mechanism ever since it started. And those are the assessed contributions it receives from its member states. But as Gargay was saying, in relative terms, the assessed contributions as a percentage of the overall budget has reduced. So it's kind of, depending on how you calculate it, it's 12% or 14% of the overall budget. So it's small. I mean, assessed contributions are really important because they're the most flexible. But it allows the WHO to fill the gaps basically because of the way that the model of funding is structured. Quite often, WHO's health priorities are overfunded by member states who just give it too much money, basically. And some other health issues don't receive enough money. And so the assessed contributions are important because the more of them the WHO gets, the easier it is to fill the gaps. And also, most people perhaps don't realize this, but assessed contributions, they pay for the WHO staff costs and the WHO vehicles and travel, all the essential things that allow the WHO to function. So a couple of years ago, the executive board said, look, we're going to set up this working group on sustainable financing to work out what the WHO's core functions were, work out how much it needed, and work out who was going to pay for it based on a couple of basic principles around amounts and priority setting. So this working group just met. It had about seven meetings and it was trying to provide answers to those questions. Right from the outset, one of the groups invited was the representative from the intergovernment, the independent panel on pandemic preparedness and response, which had published in its report a month previously. And one of the core recommendations of that group, which was headed by Helen Clark was, let's have a replenishment mechanism. That's what the WHO needs. So over the course of the meetings, the replenishment mechanism became the recommendation that was provided by the working group on sustainable finance. So that's why we're talking about a replenishment mechanism. We don't know very much about it and how it's going to impact WHO. And the executive board next week is meeting and it's going to talk about it. It's going to consider the recommendation. And by the end of the executive board meeting, I guess we'll know more about it. I guess there are some good things. I guess ultimately, the replenishment mechanism, if it was successful, it would mean that 100% of the base segment is funded by assess contributions. 50% come from the increase in assess contributions from its member states. And that was a recommendation that the working group put forward to have 50% of the 2022-23 program budget. By 2030 would be 50% would come from assess contributions. The other 50%, ideally, this is the idea of the replenishment mechanism, comes from this replenishment system. Best case scenario, the base program, the base segment, is 100% funded by assess contributions. That would be an amazing outcome. It doesn't cover the issue that Gal Gea is talking about in terms of the total money that the WHO gets, but at least its base segment would be fully funded by assess contributions. That's a good thing. I mean, there are some problems which I can go through in terms of the replenishment. I mean, it's early days, we don't know. We don't know very much about it. But some things to consider would include things like, well, why would non-state actors contribute to it? What's the incentive? It's kind of hinting, I think, at the fact that there would have to be some kind of dialogue between the donors and the WHO. If you give us this money, you can have perhaps more of a say in how the money gets spent. One of the worries that the WHO has is that it's funded by a small number of big donors. We know who they are. It's the Gates Foundation. It's Gavi. A small amount of money comes from the World Bank. Would this replenishment model improve the situation or just make it worse? Would we end up with some more money coming from Gates going into the base segment in addition to the money that it pays for everything else? Again, we have to kind of wonder about that really. Will the tail wag the head even more than it does already? There's a governance structure issue. Is it possible for a replenishment mechanism to fit with the governance of the WHO? Replenishment mechanisms normally require quick wins, results. You need to be able to show that the money you get works. Can that work within the long-term planning process WHO has and the very broad range of things that it needs to deal with? How much resources are going to be required to do it? Is it going to go through the WHO Foundation? Is it going to sit somewhere else? These are all questions that need to be answered and I'm sure they will be discussed next week at the Executive Board. So, if I get you correctly by replenishment model, what we mean is that the non-state actors will be filling the gap that WHO faces in terms of financing for its base programs, which basically are important to run the WHO itself. And then those are the NSA's who are going to have more say than as much as they already have. And these are going to be very specific ones because only very few have that much money to donate. So, that's what we are coming to, right? Yeah. I mean, we don't want to be too conspiratorial here because we don't have enough information to base our decisions on. We only have the notes from the seven meetings of the working group on sustainable financing to go on. So, we don't have very much detail. But the WHO wants to get more money from the non-state sector. And in terms of influence, these things are subtle. It's very difficult to demonstrate influence. But the WHO does recognize this kind of disconnect between who sets the priorities and who pays the money. And it wants to somehow bring those things together in what it terms a more realistic funding process. And how that plays out, we'll just have to buy and see. Thank you. Gargay, you want to add something to this? It's going to be a huge PR exercise where countries are going to come together. All these non-state or private and corporate organizations are going to come together and say, no, we have donated this much to solve XYZ problems. The examples that are given here are successful models of replenishment, which is the global fund and so on. Are themselves not a huge success in the first place? These organizations really could not solve the issues that they set forward to solve in the first place. Global fund, I think, recently added seventh replenishment in November 2022. It of course got the money that it wanted. But did it solve the crisis of AIDS, tuberculosis, malaria that it set out to solve is a question in itself. So these are tried and tested failed models even in the corporate world. It's basically crowdfunding on a large scale, if I can be in plain words, where half the time you are actually spending on short term goals, you need to kind of show that $1 was donated. And with this $1, I was able to achieve this. This brings me to the last question, I think, which is as important. So we do recognize that there is problem with funding, how much funding WHO has been receiving. And there are these models. But according to you, what is that one thing that can be done to actually solve the problem and without going into the failed models? And both of you can maybe mention one thing each Andrew first. I'm an academic. And I've recently been working on a study, which is looking at voluntary contributions. Most of the focus when you look at the literature, most of the focus is on assessed contributions. And the argument is, WHO needs more assessed contributions, it needs more assessed contributions. From a research point of view, we really need to understand the incentives, which drive this increase in voluntary contributions. And that means talking to the donors. We need to understand why the donors prefer to do it this way. Is it something about the WHO's governance? Is it something about its institutions, incentive structures, etc., etc. So that I would put my money on doing research into that. And I hope, I mean, I don't think that the sustainability issue has gone away just because the working group on sustainable financing has done his work. That does not mean that this debate is over. Somebody needs to take it forward. And if that's through the agile member states task group, so be it. But we can't drop this particular ball and think that it's a done deal because there are so many more questions to ask about sustainable financing. Don't think that this is the end of that. And I really hope that this is taken up by the WHO and has continued to be explored. Just to add, are we in a world where there is no money? Sometimes it's the question. We are kind of looking at the same by should be bigger and so whenever we talk about climate change or health or education, most of the times we say that there is no funds. At the same time, we see something like this is also the year we have been talking about conflicts and war and so on. And we look at the arms and conflict, the world is spending around two trillion and more on the issues of war and conflict. And on the other side, you don't actually give enough money and for every single dollar that you give, you are asking excessive amount of accountability. It isn't so naive that they don't know that they have to give more flexible funds. There are also the inherent way these countries of course have their own political side. They believe in market. They get very angry in the World Health Organization if there is even a single mention that deals with trade and regulatory aspects. I think in this very executive board, there was a document on looking at competitive laws and so on. It was just supposed to be a small research paper on competitive laws, which seems to have been shot down. Andrew is a bit too sweet in that sense, but I don't think people are too naive there and their intention is also do the safe and non-controversial things. It's very happy until then, but once you go into the larger issues that touch on trade and certain aspects, it becomes a bit difficult. So hopefully, good thing, despite critically commenting on this a lot, we would all agree that this push to solve the underfunding is a good one. There is no second question about it. It was very much necessary and to an extent, Germany has taken a bit of lead on this matter. They've also increased their funding a bit and so on. So where it's due, some of these countries have been trying. There are a bit of learnings from the pandemic, not as much as we want, but there is also a positive side and hopefully the WHO is able to sustain itself and do the good work it does. So thank you both and I think we can end by saying say no to war and say yes to health for all. That is the message I think we get from this interview. Thank you so much.