Date: April 25, 2025
Prepared by: Financial Analyst, xAI
Executive Summary
The World Health Organization (WHO), a specialized agency of the United Nations, has been a cornerstone of global health governance since its founding in 1948. The U.S. withdrawal from the WHO, initiated by President Donald Trump on January 20, 2025, has significantly disrupted the organization’s financial stability, given the U.S.’s historical role as its largest donor. This report assesses the WHO’s current financial situation, the outlook without U.S. funding, the primary public and private sector funders, and the specific involvement of Bill Gates and his organizations. The analysis draws on recent data and developments to provide a comprehensive overview of the WHO’s financial and strategic challenges.
1. Overview of the World Health Organization
The WHO, headquartered in Geneva, Switzerland, is mandated to coordinate global health responses, set health standards, and provide technical assistance to its 194 member states. Its key activities include disease surveillance, pandemic preparedness, vaccine distribution, and addressing non-communicable diseases. The WHO’s biennial budget for 2024–2025 is $6.83 billion, funded through two primary streams:
- Assessed Contributions (ACs): Mandatory dues from member states, based on GDP and population, constituting approximately 16.8% of the budget ($1.148 billion for 2024–2025).
- Voluntary Contributions (VCs): Discretionary funds from governments, philanthropic organizations, NGOs, and private entities, making up over 80% of the budget. These are often earmarked for specific programs, limiting WHO’s flexibility.
The WHO’s reliance on voluntary contributions has long been a structural vulnerability, as it reduces autonomy and aligns priorities with donor interests. The U.S. withdrawal exacerbates this challenge, threatening the organization’s ability to fulfill its mandate.
2. Financial Situation Post-U.S. Withdrawal
2.1 Impact of U.S. Withdrawal
The U.S. has historically been the WHO’s largest donor, contributing $1.28 billion (16–18% of total revenue) in the 2022–2023 biennium, including $264 million in assessed contributions for 2024–2025. On January 20, 2025, President Trump signed an executive order to withdraw the U.S. from the WHO, halting future funding and recalling U.S. personnel. While U.S. law requires a one-year notice period and payment of outstanding dues (unpaid for 2024–2025), the immediate cessation of voluntary contributions has created a significant shortfall.
Recent posts on X and reports indicate a projected budget deficit of $560–650 million for 2026–2027, with the WHO proposing a 21% budget cut to $4.2 billion. This has led to operational reductions, including staff layoffs (potentially 40% of personnel), program consolidation (from 10 divisions to 4), and cuts in hiring and travel.
2.2 Current Financial Situation
The WHO’s 2024–2025 budget remains partially insulated due to early payment of U.S. assessed contributions by the Biden administration, but the loss of voluntary contributions (79% of U.S. funding) is critical. Key impacts include:
- Program Vulnerabilities: Programs like the Global Polio Eradication Initiative, maternal and child health, and epidemic preparedness face significant risks, as U.S. voluntary contributions heavily supported these areas.
- Operational Constraints: The WHO is already implementing cost-saving measures, such as reducing staff and non-essential activities, to address the shortfall.
- Donor Dependency: The organization’s reliance on voluntary contributions (over 80% of funding) amplifies the impact of the U.S. exit, as few donors can match its scale.
2.3 Strategic Implications
The U.S. withdrawal not only strains finances but also diminishes WHO’s global influence and the U.S.’s role in shaping health priorities. Experts warn that the exit could weaken global disease surveillance, vaccine coordination, and pandemic preparedness, increasing risks for both the U.S. and the world. Additionally, Argentina’s announced withdrawal and potential “domino effect” among other nations could further erode WHO’s universality and funding base.
3. Financial Outlook Without U.S. Funding
3.1 Short-Term Outlook (2025–2026)
The WHO faces immediate financial strain, with a $600 million shortfall projected for the 2026–2027 biennium. The organization’s response includes:
- Budget Cuts: A proposed reduction to $4.2 billion, impacting staff, programs, and operational capacity.
- Fundraising Efforts: The WHO launched its first “investment round” in 2024 to diversify donors, but these reforms are unlikely to offset the U.S. loss in the short term.
- Program Prioritization: Non-critical programs may be scaled back, with a focus on high-impact areas like polio eradication and emergency response.
Other major donors, such as Germany and the Bill & Melinda Gates Foundation, are unlikely to fully bridge the gap. European countries face their own fiscal and political constraints, and private philanthropies lack the capacity to replace state-level funding.
3.2 Long-Term Outlook (2027–2030)
The WHO aims to increase assessed contributions to 50% of its budget by 2030 to enhance financial autonomy. However, without U.S. participation, achieving this goal is challenging:
- Reduced Global Influence: The absence of U.S. funding and expertise may shift influence to other players, such as China, which could expand bilateral health partnerships but is unlikely to significantly increase WHO contributions.
- Program Sustainability: Sustained cuts could undermine long-term initiatives, such as polio eradication and non-communicable disease programs, increasing global health risks.
- Potential Reforms: The crisis may accelerate WHO’s financing reforms, but success depends on collective member state commitment, which is uncertain given Argentina’s exit and potential further withdrawals.
4. Primary Funders: Public and Private Sectors
4.1 Public Sector Funders
In 2022–2023, the top public sector contributors to the WHO were:
- Germany: $856 million (second-largest donor, ~12% of budget).
- European Commission: $468 million.
- United Kingdom: $396 million.
- Canada: $204 million.
- Japan: $167 million.
- France: $161 million.
Germany briefly surpassed the U.S. as the largest donor in 2020–2021 during Trump’s first-term funding suspension, but its capacity to scale up further is limited by domestic priorities. Other nations, such as the UK and Japan, are also constrained by economic and political challenges, making significant increases unlikely.
4.2 Private Sector Funders
Key private sector contributors include:
- Bill & Melinda Gates Foundation: $830 million in 2022–2023, the third-largest donor (~12% of budget).
- GAVI, The Vaccine Alliance: $481 million.
- Rotary International: $177 million.
The Gates Foundation is the most significant private donor, but its funds are heavily earmarked, particularly for polio eradication, limiting WHO’s flexibility. GAVI, also supported by Gates, focuses on vaccine access, while Rotary International prioritizes polio initiatives.
5. Involvement of Bill Gates and His Organizations
5.1 Bill & Melinda Gates Foundation
The Bill & Melinda Gates Foundation is the WHO’s second-largest overall donor, contributing $531 million in 2018–2019 and $830 million in 2022–2023. Its funding focuses on:
- Polio Eradication: A significant portion supports the Global Polio Eradication Initiative, a priority shared with the U.S. and Rotary International.
- Vaccine Programs: Support for GAVI and vaccine-related initiatives, including childhood immunization.
- Global Health Advocacy: The Foundation engages with WHO, UNICEF, and the Global Fund to strengthen health systems and surveillance.
The Foundation’s influence is substantial, raising concerns about private philanthropy shaping WHO’s agenda. Critics argue that its earmarked funding aligns with the WHO‘s priorities and the Foundation’s goals, potentially sidelining other health needs. In 2020, CEO Mark Suzman acknowledged that it is “not right” for a private entity to be among WHO’s top funders, urging member states to increase contributions.
5.2 Bill Gates’s Advocacy
Since the U.S. withdrawal, Bill Gates has actively lobbied the Trump administration to maintain global health funding, including for WHO, GAVI, and the Global Fund. In early 2025, he met with National Security Council officials, Republican and Democratic lawmakers, and Trump himself to advocate for continued support. Gates has emphasized that the Foundation cannot fill the funding gap left by the U.S., with its $8 billion annual budget insufficient to replace billions in U.S. aid.
Gates has publicly supported WHO’s role, warning that its weakening could jeopardize global health security, particularly for polio eradication and pandemic preparedness. However, his response has been described as cautious, possibly to avoid antagonizing the Trump administration.
5.3 GAVI and Other Initiatives
The Gates Foundation co-founded GAVI, which contributed $481 million to WHO in 2022–2023. GAVI’s focus on vaccine access complements WHO’s immunization programs, but its funding is also earmarked, reinforcing donor-driven priorities. Gates’s broader influence extends through partnerships with the Global Fund and UNICEF, amplifying his role in global health governance.
6. Strategic and Financial Challenges
6.1 Financial Vulnerabilities
- Donor Dependency: Over 80% of WHO’s budget relies on voluntary contributions, with only 25% fully flexible. The U.S. withdrawal exacerbates this, as no single donor can replace its scale.
- Shortfall Risks: A $560–650 million deficit threatens core functions, with cuts already impacting staff and programs.
- Earmarked Funding: Donor-specified funds limit WHO’s ability to address emerging or underfunded health issues.
6.2 Strategic Risks
- Global Health Security: Reduced WHO capacity could weaken disease surveillance and pandemic response, increasing risks globally.
- Geopolitical Shifts: The U.S. exit may cede influence to China or others, altering global health governance.
- Reform Challenges: While WHO aims to increase assessed contributions, member state commitment is uncertain, especially with potential further withdrawals.
8. Conclusion
The U.S. withdrawal from the WHO under President Trump has precipitated a financial crisis, with a projected $560–650 million shortfall and a proposed 21% budget cut. The WHO’s heavy reliance on voluntary contributions, coupled with the loss of its largest donor, threatens its operational capacity and global health leadership. Germany and the Bill & Melinda Gates Foundation are key funders, but neither can fully replace U.S. contributions. Bill Gates’s significant influence, through his Foundation and advocacy, underscores the tension between private philanthropy and WHO’s autonomy. Without strategic reforms and new funding sources, the WHO risks diminished effectiveness, potentially undermining global health security. The next year is critical for diplomatic efforts to mitigate the impact and secure the organization’s future.
