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Picture: REUTERS/DENIS BALIBOUSE
Picture: REUTERS/DENIS BALIBOUSE

Donald Trump’s withdrawal of the US from the World Health Organisation (WHO) on day one of his second term means the country will stop its financial contributions.

The US contributed nearly 18% of the organisation’s budget last year, so the withdrawal will severely diminish its influence and international health co-operation.

Such a drastic policy shift will have profound implications for public health in Africa and globally by causing major disruptions to key global health initiatives. For instance, by impeding global pandemic preparedness efforts that require WHO support.

The US withdrawal comes at a pivotal moment. The WHO has projected an acceleration of climate-driven disease outbreaks in Africa that require global co-operation on pandemic preparedness and response to be tackled effectively.

Significant time, resources and effort have been invested in multiple failed rounds of global negotiations to conclude a pandemic agreement for this purpose. An underfunded WHO will have difficulty facilitating consensus around a meaningful pandemic treaty.

This is a concern for African nations in particular. During the Covid-19 pandemic and the ongoing mpox outbreak African nations suffered from a lack of access to infection prevention and control products.

Without a pandemic agreement they fear a status quo in which wealthy nations favour bilateral agreements that prioritise their own populations and exclude low- and middle-income countries.

The problem is that history does not support the assumption that a stronger international framework of co-operation could erase these recurring disparities.

During the Covid-19 pandemic multilateralism failed to implement the International Health Regulations (IHR) treaty that governs this type of event. The international community has convinced itself that a new treaty — a pandemic agreement — will succeed where the IHR failed in preventing vaccine inequities.

African countries cling to the unlikely hope that this pandemic agreement will facilitate equitable access to vaccines, diagnostics and treatments during health emergencies. The problem is that history does not support the assumption that a stronger international framework of co-operation could erase these recurring disparities.

African nations rely on WHO support to tackle the many challenges they face. Many have fragile, under-resourced health systems that rely on international co-operation through the WHO to manage disease, prevention programmes, health emergencies and build capacity for effective public health responses.

An underfunded, weak WHO will worsen the region’s vulnerability. The WHO’s role goes beyond managing outbreaks such as ebola in West Africa. It also covers areas like training health workers and capacity strengthening. The WHO is central to supporting the transformation African health security needs.

The US withdrawal will also affect US investment in Africa’s pharmaceutical and vaccine manufacturing efforts. Both are key to reducing disparities in security of access to medical products during disease outbreaks.

The US has been a major supporter of global health security initiatives and pharmaceutical technology partnerships. Its withdrawal from the multilateral framework would weaken partnerships essential for in pharmaceutical production capacity development and technical co-operation critical for these projects’ success.

Health sovereignty

What is stake for the Africa region if WHO support for African health development is limited is a curtailing of African ambitions for health sovereignty and an accentuation of its vulnerability to emerging health threats.

Progress made so far towards strengthening Africa’s capacity to produce vaccines and medicines locally, such as the mRNA technology transfer hub established in SA with WHO support, could stall without sustained investment.

US withdrawal from the WHO is a major blow to the organisation’s ability to deliver on its mandate, but there are also potential upsides. For instance, it could facilitate the conclusion of the pandemic agreement on which African nations pin their hopes.

However, unless other countries step in to fill the funding gap left by the US, health programmes targeting disease outbreaks and the routine health needs of Africa’s most vulnerable populations are likely to suffer.

In particular, Africa must find sustainable ways of dealing with its intractable health security dilemma. Charity begins at home. African nations must be the first to step up, as did 14 African nations, including SA, that pledged over $45m towards the WHO investment initiative to generate sustainable financing for the organisation during the WHO regional committee for Africa.

African countries should increase domestic funding for health to protect their economic security. Global health challenges are accelerating in scope and frequency in an interconnected world. Africa should not be expected to do this alone. African nations should “friendshore” their efforts to safeguard health security by attracting external investment. 

The ideal of inclusive international co-operation under the WHO that African nations yearn for has proven unattainable for a long time. A sustainable future for Africa’s public health lies not in global solidarity, but in effective regional collaboration.

Former Africa CDC director John Nkengasong put it this way: “Covid-19 showed Africa that global solidarity has its limits.”

Regional co-operation among African nations working together to solve shared challenges is the sustainable way forward. The WHO remains a vital institution for supporting intra-African co-operation on health security.

Increasing domestic funding for health and ensuring a strong sustainably financed WHO might enable African countries assert greater control over their health systems and attract investment into African pharmaceutical and vaccine manufacturing, which is so critical to Africa’s health and economic security.

• Dr Hwenda is founder and CEO of Medicines for Africa. 

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