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“The question is not to diminish funding; the question is to increase funding": The World Health Organization interview

Dr Hans Kluge (Credit: WHO/Europe)

7 min read

Donald Trump said he would suspend funding to the World Health Organization in the pandemic. Now, some in the UK question our membership. Sophie Church speaks to Europe’s regional director Hans Kluge about why the WHO is preparing for the worst

The World Health Organization (WHO) was founded in 1948 to promote good health for everyone, everywhere. Since then, it has helped in eradicating smallpox, reducing polio by 99 per cent and developing an Ebola vaccine. 

But today critics say the WHO has become bogged down by bureaucracy: a Geneva-led quango enjoying power without responsibility. Most recently, its handling of the Covid-19 pandemic – playing down the potency of the virus while applauding China’s commitment to transparency – caused widespread anger. 

In 2020 Donald Trump said he would suspend the United States’s funding to the WHO on the basis it had covered up the spread of Covid-19. There are now murmurs that British taxpayer money would be better spent on the NHS than the WHO.

It is not sustainable to rely only on attracting a workforce from other countries

But today Dr Hans Kluge, regional director for Europe at the WHO, says it would “hurt both of us” if the United Kingdom were to turn off the taps.

“Would it hurt? Yes, it would hurt, because the WHO is the only legitimate institution driven by member states to co-ordinate international health, health policy, and stand strong for the vulnerable,” says Kluge proudly, speaking to The House on Zoom – a large WHO flag in the background.

“Let’s be honest, it gives the UK a global leadership role in health,” he says. “The WHO gives the UK a very, very important platform to show leadership and credibility, so I think it will hurt both of us.”

Dr Hans Kluge (Credit: WHO/Europe)
Dr Hans Kluge (Credit: WHO/Europe)

In 2022, the UK sent the WHO around £320m. In contrast, the NHS England budget for next financial year will be £164.9bn. Stopping UK funding for the WHO would not solve the NHS’ structural issues, Kluge says, pointing to the relatively small proportion of money the NHS would stand to gain. 

“To put things in perspective, the whole budget of WHO – not in Europe but globally – is the same budget as a specialist hospital in Geneva. That’s crazy. And we are supposed to solve every health issue in every corner of the world,” he says. “The question is not to diminish funding; the question is to increase funding.”

The WHO is watching cautiously as Trump beats a path back to the White House, but Kluge remains sanguine. “The United States of America, of course, is the number-one donor of WHO. So that would obviously have huge implications,” he says, “but our WHO director general [Tedros Adhanom Ghebreyesus] has successfully weathered this the last time.”

Still, the WHO is planning for a future where Trump regains power. “Of course, we are concerned about this, and we should be concerned about this. But we are doing a risk analysis already, trying to forecast and look ahead.”

What does this risk analysis look like?

“We are looking into potential new partnerships, while being ready to dialogue with any government,” he says. “Second is financially: there need to be calculations for new recruitments, and for the next year to be a bit more careful, particularly in engaging long-term liabilities. So, it’s a bit of a cautionary period, while preparing ourselves to be ready to dialogue with anyone.”

In Europe, the WHO is strengthening relationships with a number of countries, including Norway, which is “waiting to beef up their contributions”. 

But these defunding discussions could not come at a worse time. “We are in permacrisis: it’s like a permanent period of crisis and tension,” says Kluge.  

While ongoing wars, infectious diseases and mental health are all contributors to this permacrisis, he says the decline of the health workforce is the single biggest issue our health system faces. “If you ask me what the number-one crisis in the health system is in my region, I believe it’s very clear: it’s the health workforce. There is no health without a health workforce.”

The problem is especially acute in the UK, he says, where the pandemic has amplified chronic underinvestment in the NHS.

We are doing a risk analysis already, trying to forecast and look ahead

“The NHS was the crown jewel of the UK, but it has not followed an upwards trajectory. Now, there is a new role of physician associates but it doesn’t solve the problem; they can do some things but they cannot take over the role of doctors. It is not sustainable to rely only on attracting a workforce from other countries.”

On whether the world will suffer another pandemic, Kluge is certain: “This will not take another 100 years.” But can the WHO be trusted for next time?

“I disagree that WHO underperformed during the pandemic,” he says. “Are there lessons to learn? Absolutely. But we have never seen as fast a production of very high-quality, evidence-based guidelines as during the pandemic.”

In March 2021, a group of world leaders, including Boris Johnson, pledged to create a pandemic treaty. During Covid, wealthy nations hoarded supplies of vaccines, diagnostic devices and personal protective equipment. This treaty would ensure all countries were treated fairly in a future pandemic.

Dr Hans Kluge (Credit: WHO/Europe)
Dr Hans Kluge (Credit: WHO/Europe)

“If the global community fails with the pandemic accord, it means that we have learned nothing, and that we are not in a better place for the next pandemic,” warns Kluge.

However, the treaty must be ready for the World Health Assembly in May, and the WHO’s Europe director is unsure whether this deadline will be met. “It will be tough. It’s possible, but it will be tough.”

Does the treaty still need tweaking?

“Yes, everyone has to take a step forward,” he says, accepting that certain areas – the US and European Union, for example – will see the sharing of intellectual property rights as a “red line”. Now, he says the biggest sticking point concerns what proportion of vaccines will be shared with the WHO to distribute fairly: “Twenty per cent, 30 per cent: these are the kind of negotiations.”

Negotiations are being slowed down by what Ghebreyesus calls “a torrent of fake news, lies, and conspiracy theories” circulating online. Such theories have even infiltrated Parliament, albeit with little impact – with independent MP for North West Leicestershire Andrew Bridgen asking why the House is “so content with giving away powers and sovereignty to the unelected, undemocratic, diplomatically immune World Health Organization” being met with short shrift from Commons leader Penny Mordaunt

Kluge says the WHO is working with tech companies – Facebook and Google, for instance – to quell the conspiracy theories. But the organisation is also working with figures in local communities to build trust. This could be a certain priest in an Orthodox community, he says, or a local football player.

Kluge calls these “tense geopolitical times” where the WHO is an “easy target”. Now, he is seeking inspiration from organisations such as Unicef, which are more proactive with communication. 

“That’s a big lesson learned,” he says. “Actually I say to my people: if you’re working 12 hours a day, we have to work 10 hours, and for two hours, we have to explain to the world what the hell we did during those 10 hours.”

Kluge believes the world would be in a worse place without the World Health Organization. But even if the WHO brand perished, he says the structure of a global health organisation must remain. 

“I strongly believe that even our – I won’t say ‘enemies’, but the people who are sceptical of WHO – can at least agree on one thing: that if WHO was not there, we should create another,” he says. “Because if we lose our values, then who is going to stand up for the poor and the vulnerable?” 

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