The Fractured Power
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AN ERRONEOUS CALCULATION
Sonia Shah's recent piece on ForeignAffairs.com, "How Private Companies Are Transforming the Global Public Health Agenda," makes a number of erroneous statements about how the World Health Organization (WHO) is financed and the sources of its funding. Chief among them is the following claim:
The fact is that WHO has two main sources of funding. All member states pay assessed contributions (the dues calculated relative to a country's wealth and population), which, since 2006, make up around 25 percent of the WHO's revenues. Assessed contributions are, by definition, government funds. The second source of funding indeed comes from voluntary contributions. These make up about 75 percent of WHO's annual income. But Shah misrepresented the case in stating that such voluntary contributions come primarily from private interests.
Read more at at Foreign Affairs' Special Report: Global Public Health.
To set the record straight: Eighty percent of WHO's budget now comes from governments. For the two-year budget period 2010-11, 53 percent of the voluntary contributions came directly from governments that chose to go beyond what their annual dues require; 21 percent came from other UN bodies (such as UNICEF, UNDP, and UNAIDS) and other multilateral bodies (such as the Global Alliance for Vaccines and Immunization); 18 percent from philanthropic foundations (such as the Bill & Melinda Gates Foundation, the UN Foundation, and the Rockefeller Foundation). Of the remainder, seven percent came from nongovernmental organizations, by far the largest of which was Rotary International for work on polio eradication.
For the entire year, just one percent came from private industry. And roughly half of that comprised a specific donation from local organizations in Japan to finance costs of a WHO office in Kobe. The other half came from pharmaceutical companies that directed their funds toward neglected and tropical diseases.
In addition to the miscalculation, Shah also quotes unreferenced figures from a 2008 Lancet article to substantiate the influence of private donors. In fact, the same article makes the point that "the private for-profit sector's direct contribution to WHO's extrabudgetary funds (read voluntary contributions) has dropped substantially, from 5 percent in 2000 to less than 1 percent in 2006-7." The authors go on to say that there is a mismatch between funding for infectious diseases and the growing burden on non-communicable diseases and that this mismatch is driven in part by earmarked voluntary contributions. This is a point with which we would agree, and which current budgetary and financing reforms seek to address.
CHRISTY FEIG is Director of Communications at the World Health Organization.
I wrote that voluntary contributions to the World Health Organization's budget come from private interests and others, not just private interests. The others are primarily the United States and the Gates Foundation, both of which have deep connections to the private sector and have used their influence to represent its interests.
There is a general feeling among member states that rich countries such as the United States "disguise trade and commercial interests under public health," as a Brazilian ambassador said at a recent WHO meeting. Consider the United States' recent pressure on the WHO to drop an adviser critical of trade agreements that favored the drug industry and to water down its sugar-intake recommendations after the sugar industry objected. The process is only growing more effective, as voluntary contributions dominate the agency's financing.
The Gates Foundation is similarly allied with private-sector interests. It's the largest single shareholder in Coca-Cola and Kraft Foods; its global health program is led not by public health experts but by top executives from the drug industry. The foundation's financial heft clearly influences the agency: WHO officials who publicly criticize the foundation can face prompt removal.
So long as private interests and these others pay the bills, it is clear who is influencing WHO.
(Image by dtpancio / flickr.)