Trump and WHO: How much does the U.S. give? What's the impact of a halt in funding?

President Trump says he's halting U.S. funding for the World Health Organization for 60 to 90 days as his administration reviews the group's handling of the coronavirus pandemic. He made the announcement at his press conference on Tuesday, saying he wanted to suspend U.S. contributions "while a review is conducted to assess the World Health Organization's role in severely mismanaging and covering up the spread of the coronavirus."

Trump said that the WHO was slow to respond to the crisis and that the organization has been "China-centric."

"We regret the decision of the president of the United States," WHO Director-General Tedros Adhanom Ghebreyesus said in a press conference on Wednesday. "WHO is reviewing the impact of our work of any withdrawal of U.S. funding, and will work with our partners to fill any financial gaps we face and to ensure our work continues uninterrupted."

How much does the U.S. contribute to the WHO budget? And how might this affect the WHO's work?

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What is the mission of the World Health Organization?

The agency, founded in 1948, describes itself as "the directing and coordinating authority on international health within the United Nations system." It coordinates activities and provides guidance for their 194 member states and two associate members (Puerto Rico and Tokelau).

Activities range from promoting the polio vaccine to supporting childhood nutrition to playing a leadership role in the case of health emergencies.

"There will be guidelines on what kind of essential medicines there should be, what kind of essential diagnostics there should be, what might be the regimens to use in relation to HIV in different countries, taking into account the resources available,"says Rifat Atun, professor of global health systems at Harvard University. "Countries are not under any obligation legally to follow these guidelines, but many do in relation to epidemics."

The agency declared the coronavirus outbreak a "public health emergency of international concern" and has provided technical guidance for health workers on how to care for COVID-19 patients in medical settings and guidance to the public on how to protect themselves.

How big is the WHO budget?

The World Health Organization runs on a two-year budget cycle. For 2020 and 2021, its budget for carrying out its programs is $4.8 billion, or $2.4 billion per year.

"The WHO has a budget around the size of a large U.S. hospital. It's about one quarter of the budget of the U.S. Centers for Disease Control and Prevention," says Lawrence Gostin, a law professor at Georgetown University and director of the World Health Organization Collaborating Center on National and Global Health Law, which is an independent agency that works with that WHO.

"That's $2.4 billion a year to carry out all the activities that WHO does as the global health authority and arbiter of global health guidelines," says Kates.

(An additional $1 billion for this current budget cycle was included in the WHO's budget estimates in May 2019 as an allocation for emergencies).

Where do the funds come from?

Annual donations from its member states made up 51 percent of the WHO's funding, according to a report from its 2018-2019 budget cycle.

These contributions fall into two categories: assessments (i.e. membership dues) and voluntary contributions.

"The assessed money is like operational support," says Jennifer Kates, director of global health and HIV policy at the Kaiser Family Foundation. "Here's the money. You can figure out what to do with it."

Each member state pays assessment fees based on the country's wealth and population.

Countries also make additional voluntary contributions, as does the United Nations, philanthropic foundations and nongovernmental organizations. Donors typically earmark these monies for specific causes. The largest allocation from voluntary contributions goes to polio, which has an $863 million budget in 2020-2021. "It means that the organization is primarily driven by a lot of the outside influences of donors in terms of how it can budget," says Kates.

Over time, Kates says, voluntary contributions have grown to dominate the WHO's budget.

For the 2020-2021 budget, $957 million comes from assessments and $4.9 billion comes from voluntary contributions.

How much does the U.S. government contribute?

"The U.S. is the largest single government donor in the world," says Gostin, "so WHO's budget does rely very much on U.S. contributions."

For the two-year cycle of 2018 and 2019, U.S. contributions accounted for about 20 percent of the WHO's total budget.

The money comes in two streams. The U.S. contribution to the pool of assessed fees is $237 million. That's 22 percent of the total assessed fees, the largest share of any nation. By comparison, China contributes 12 percent of this pool of monies, and some low-income countries pay 0.1 percent.

In addition, the U.S. pledged more than $656 million for specific programs, according to the WHO's program budget portal. These voluntary contributions were earmarked for programs including polio eradication, health and nutrition services, vaccine-preventable diseases, tuberculosis, HIV — and preventing and controlling outbreaks.

In the recent past, the U.S. has also given the most money in voluntary contributions.

But as of March 31, the U.S. is behind in its payment of assessed fees. It currently owes $198.3 million in membership dues, including some amounts owed for previous cycles, according to the WHO's statement of account — a list of every country's payment status.

What does a U.S. funding freeze mean?

There is no definitive answer to this question. At the press conference, Trump said that the review would take 60 to 90 days and that a "very thorough investigation" is underway. But no details have been released on how the funding suspension will be executed.

And it is unclear whether the president has the authority to unilaterally halt funding for an international institution such as the WHO.

"If the money is already committed and already given, he probably can't take it away," says Gostin, but the president could withhold outstanding payments or instruct agencies such as the United States Agency for International Development ito scale back on cooperation with the WHO.

"A lot of the voluntary money is provided at the agency level," says Kates, so it's possible that the president could demand that the CDC for State Department stop providing money to the WHO for project work.