Suffer the Children! Trump's decision to halt WHO funding will hurt the most vulnerable in developing countries
Children from developing countries could be the worst hit by President Donald Trump’s announcement to halt funding to the World Health Organization (WHO) while his administration reviews the organization's handling of the coronavirus pandemic.
The US provides funding for critical program areas such as polio eradication (27.4% of US funding was allocated to this), increasing access to essential health and nutrition services (17.4), vaccine-preventable diseases (7.7%), tuberculosis (5.74%), establishing effective coordination and operations support (5%), infectious hazard management (4.66%), HIV and hepatitis (4.65%), and country-health emergency preparedness and the International Health Regulations, 2005, (4.45%), among several others.
Where does the financing go? According to WHO, the funds go to the Eastern Mediterranean, Africa, Headquarters, South-East Asia, Europe, Western Pacific, and the Americas.
Some of these projects such as polio eradication are critical, and lack of funds could hurt decades-long efforts. Polio is a highly infectious viral disease, which mainly affects children under five.
One in 200 infections leads to irreversible paralysis. According to the WHO, polio now survives only among the world's poorest and most marginalized communities, where it stalks the most vulnerable children. The three countries that have never stopped transmission of polio are Afghanistan, Nigeria and Pakistan.
Nutrition is a major cause of death and disease in the world. The WHO estimates that a stronger focus and right investment in nutrition within health services could save 3.7 million lives by 2025.
According to experts, millions of people are suffering from different forms of malnutrition. In 2019, 144 million children globally under the age of five were stunted, 47 million wasted (low weight for height) and 38 million overweight.
Around one in 10 children are born with low birth weight, and in South Asia, it is one in four. An estimated 45% of deaths among children under five are linked to undernutrition. These deaths often occur in low and middle-income countries where childhood obesity levels are rising at the same time, say experts.
"The world has made progress in nutrition but major challenges still exist. There has been a global decline in stunting (low height-for-age ratio) between 1990 and 2018, the prevalence of stunting in children aged under 5 years declined from 39.2% to 21.9%, or from 252.5 million to 149.0 million children, though progress has been much slower in Africa and South-East Asia,” says the WHO.
Essential health packages in all settings need to contain robust nutrition components but countries will need to decide which interventions best support their national health policies, strategies and plans, say experts.
Obesity — which is a major risk factor for diabetes, cardiovascular diseases, musculoskeletal disorders and some cancers — is on the rise. The prevalence of children considered overweight rose from 4.8% to 5.9% between 1990 and 2018, an increase of over 9 million children.
Adult overweight and obesity are also rising in nearly every region and country, with 1.9 billion people overweight in 2016, of which 650 million (13% of the world’s population) are obese, says the WHO.
Another disease that disproportionately affects the poor is tuberculosis (TB). Over 90% of TB cases occur in low and middle-income countries that have fragile healthcare infrastructures and constrained resources available and therefore struggle to tackle one of the world’s deadliest communicable diseases, say experts.
TB resulted in an estimated 10.4 million new cases in 2016 and 1.7 million deaths, according to the WHO.
The TB epidemic continues despite an available, cost-effective and broadly implemented vaccine for infants – Bacille Calmette-Guerin (BCG) – and the carefully managed use of drugs. “This is because BCG vaccination is only partially effective. It provides some protection against severe forms of pediatric non-pulmonary TB, such as TB meningitis, but is unreliable against adult pulmonary TB, which accounts for most of the TB disease burden (and transmission) worldwide."
"Besides, infection with Human Immunodeficiency Virus (HIV) infection can increase the likelihood of TB acquisition by up to 25-fold, and resistance to previously effective TB drug regimens is increasing,” says the WHO.
HIV is also a major global public health issue, having claimed more than 32 million lives so far. Approximately 37.9 million people were living with HIV in 2018, shows estimates. The numbers differ vastly by region: 25.7 million people in Africa were living with HIV in 2018, followed by 3.8 million in South-East Asia, 3.5 million in the Americas and 2.5 million in Europe.
According to experts, due to gaps in HIV services, 770,000 people died from HIV-related causes in 2018 and 1.7 million people were newly infected. Further, children infected with HIV through vertical transmission from their HIV-infected mother are at risk of developing severe vaccine-related disease.
Therefore, children known to be HIV infected should not be vaccinated with BCG, which can protect against TB.
Meanwhile, the WHO's Programme Budget Portal provides details of the organization's work, financing and implementation progress. With quarterly updates, the portal gives a breakdown of the WHO’s work, navigating through the different categories, programs and outputs through which work is delivered.
Estimates show that assessed contributions from the US are 236,912K (amounts invoiced to each member state for the current biennium), while specified voluntary contributions are 656,092K (totaling 893,004K). The numbers have been updated till the fourth quarter of 2019.
The details on specified voluntary contributions show that the US makes up for 14.67% of the funding, followed by the Bill & Melinda Gates Foundation at 9.75%.
Some of the other projects where US funding was used includes emergency operations (2.97%), prevent and control outbreaks (2.33%), reproductive, maternal, newborn, child and adolescent health (2.24%), strengthen surveillance, early warning and health information management (1.9%), access to medicines and health technologies and strengthening regulatory capacity (1.85%), neglected tropical diseases (1.8%), emergency core services (1.71), and malaria (1.42%) among others.
For the COVID-19 pandemic, the WHO’s strategic preparedness and response plan have outlined a funding need of at least $675 million for critical response efforts in countries most in need of help through April 2020. "As this outbreak evolves, funding needs are likely to increase," says the WHO.