Two countries account for over half the unpaid membership dues at the World Health Organisation: on 31 March, the United States owed $196 million, while China’s outstanding bill stood at $57 million.
They’re not alone: 151 members collectively owed $473 million in unpaid dues – about 20 percent of the WHO’s annual budget – and a quarter of it was more than a year late. But the size of the US and Chinese debts highlight the WHO’s reliance on its largest members.
The United States has announced a suspension of its funding for the WHO in reaction to what it alleges as weaknesses in the UN agency’s COVID-19 response. “Pay your bills!”, said Meg Davis of the Global Health Centre at Geneva’s Graduate Institute. “Just like the rest of us have to pay our taxes, or face consequences, those countries should be paying their bills as well.”
Having to chase late payments is nothing new – a WHO spokesperson said the level of outstanding payments was not unusual at this point in the year, even though invoices are technically due in January. From 2014-2018, the WHO was owed an average of $140 million on 31 December.
Members that fall behind on at least two years of bills can lose the right to vote. The United States owes 1.7 times its annual obligatory contributions, not enough to pose a risk to its voting rights in 2020.
But Davis told The New Humanitarian that excluding any nation, especially a large one, is problematic. “How can you address global health without the biggest players at the table?” she said. “It’s very difficult for WHO to hold countries accountable” for paying on time.
While the WHO’s coffers are filling up with extra funding for COVID-19 – it is set to comfortably meet a funding target of $450 million in additional earmarked funds – the pandemic, criticism from the White House, and geo-strategic rivalries have all generated fresh interest in the financing of the global health body.
Some commentators point to China’s COVID-19 funding to the WHO as a signal of its intent to win influence at the expense of the United States. “I think that’s been overstated,” said Davis, adding, “the problem that WHO faces is not a problem of being under the thumb of China”, but of needing a “very sensitive, prickly authoritarian state” to be a partner in global health issues.
The WHO’s reliance on shifting donor preferences makes it less stable, said Davis, explaining that budget uncertainty leads, for example, to the use of temporary consultants rather than established staff, leaving it “weaker as an institution overall”.
The WHO relies on two types of funding: about 20 percent comes from membership dues or “assessed contributions” from its member countries. The rest comes as voluntary payments from member countries, foundations, and the private sector.
Assessed funding has the advantage, for the WHO’s management, of not being tied to specific projects, unlike funds for polio vaccination, Ebola control, or COVID-19.
Some 45 countries have paid their membership dues in full, 77 owe just this year’s amount or less, and some 74 have outstanding bills from before 1 January 2020.
The United States is the largest contributor to the WHO’s core budget ($115 million a year). But it pays much more – an average of $450 million per year, according to a WHO fact sheet – as the largest voluntary contributor as well. The handout said the United States had paid $316 million in voluntary funding in 2020 before the freeze, so the larger threat to the WHO is if its biggest donor continues to withhold discretionary funding in future years.
While the United States owes the most in dollar terms, others are further in arrears in terms of the size of their original bill. For example, Somalia owes nine years’ worth of payments, but its annual fee is set at the minimum rate: $4,790.
Each state is assigned a share of the assessed budget proportional to the size of its economy, ranging from 22 percent (the US rate) to 0.001 percent.
Countries that don’t pay eventually lose the right to vote in the WHO’s assembly. In 2019, Central African Republic, Comoros, Guinea-Bissau, South Sudan, The Gambia, Ukraine, and Venezuela were all barred from voting. A state can get back its voting privileges by agreeing to a gradual repayment plan, one example being Somalia.