Editorial 1: The U.S.’s exit from WHO, a chance to reshape global health

Context

It is time for the countries in the global south to support WHO and initiate collaborative actions to reshape the global health agenda.

Introduction

On January 20, 2025, the United States government issued an executive order to withdraw from membership of the World Health Organization (WHO). This has raised apprehensions that reduced funding for WHO would impact the functionality of the organisation. However, as the executive decision by the U.S. government has already been made, it is time to reflect on some fundamental questions such as why a single country’s exit from WHO is causing so much concern. How can the U.S.’s exit from WHO be converted into an opportunity to create a stronger WHO? Why is there a need for an increasingly greater role of countries in Asia and Africa in global health.

Funding intricacies

• WHO’s funding system: To understand the impact of the U.S.’s withdrawal on WHO funding, we need to understand WHO’s funding system. There are two broad categories of funding sources.
• Assessed contributions (AC): In the first category, the assessed contribution (AC) is a fixed amount each WHO member-state must pay annually as a sort of membership fee. This is what the U.S. President has argued as being disproportionately high (for the U.S.) and cited as one of the four reasons for the U.S.’s decision regarding its withdrawal.
• AC’s role in WHO funding: The assessed contributions ensure assured funding, which WHO uses to pay the salaries of regular staff, both technical and administrative, and maintain day-to-day functioning. This is the minimum resources the organisation needs to ensure continuity of operations.
• Voluntary contributions (VC): The other funding pool is from voluntary contributions (VC), which come from a range of donor agencies and additional contributions from WHO member-states. VCs are broadly for projectsand other time-bound activities. WHO uses VC funds in the hiring of short-term staff and consultants.
• VC funds’ unpredictability: The problem with VC funds is that these are, as the name suggests, voluntary, always time-bound, linked to specific activities, and thus unpredictable.
• Examples of VC funds: For example, many member-states and donors provide funds for polio elimination, patient safety, primary health care, or antimicrobial resistance-related work. These contributions are tight-jacketed and non-transferable to other activities.
• Impact of U.S. withdrawal on VC funds: With the U.S.’s withdrawal from WHO, the VC would also be impacted, as many U.S.-based or U.S.-aligned donors may either reduce or, worse, completely stop the funding to WHO. The ongoing turmoil and uncertain fate of USAID would additionally impact WHO funding.
• Overall financial impact on WHO: Clearly, the financial impact on WHO is likely to be far greater than the direct share of the U.S. government funds for WHO.
• Criticism of WHO: Another argument given for the U.S.’s withdrawal, which has been used frequently by some others to criticise WHO, is that the organisation is highly bureaucratic, acts slow, and is in need of urgent reforms.
• Need for reform: This is partially true, and to be fair in assessment, every global institution needs some reforms, and WHO is not any different.
• WHO’s importance: In this era of emerging and multi-sectoral challenges such as antimicrobial resistance, climate change, global warming, animal health, increasing re-emergence of diseases, and a steep rise in lifestyle diseases, the world needs a stronger WHO, more than ever.

Why institutions fail

• Book by Acemoglu and Robinson: In their book, Why Nations Fail: The Origins of Power, Prosperity, and Poverty, Daron Acemoglu and James A. Robinson (who were conferred the Nobel Prize in Economics in 2024) hypothesize that nations thrive upon the foundation and the strengths of functioning and stronger institutions.
• Global institutions for peace and health: Expanding the analogy at a global level, the world needs stronger institutions for peace and global health.
• Damage to global collaboration: In the last few decades, the fibres of global collaboration have been damaged. There is rising nationalism in many countries, and ‘Nation first’ is becoming a vote-catcher for many leaders.
• Hyper-nationalism and global institutions: This phenomenon of hyper-nationalism is global but relatively new and, thus, arguably more virulent in high-income countries. Hyper-nationalism often undermines global institutions.
• Impact of U.S. exit from WHO: With the U.S.’s exit from WHO, the likelihood of key multi-country alliances such as G-7, G-20, and others stepping in to support and fund WHO are feeble.
• Moral imperative to protect global institutions: Yet, for its tremendous body of work in the last 75 years, it is a moral imperative for all countries to explore alternatives to protect and save global institutions.
• Role of global south in supporting WHO: The legitimate governments and elected political leaders in the global south and countries such as India, Brazil, South Africa, Thailand, Egypt, and many others need to step up to support WHO specifically and the United Nations in general.
• Gap in global health priorities and funding: There is an inexcusable gap in global health priorities and funding.
• Underfunding of health challenges in Asia and Africa: The health challenges which affect the countries in Asiaand Africa are grossly underfunded. mPox did not get global attention till it started affecting people in high-income countries in 2022.
• Unequal distribution of mPox vaccines and drugs: The vaccines and drugs against mPox are barely available in the Democratic Republic of the Congo and other settings where disease is most rampant but are offered liberally in the U.S., which has only a few mPox cases.
• High-income countries shaping global health policies: This is a reminder that high-income countries continue to shape the policies, health agenda, and command influence in global health, inadvertently widening health inequities.
• Global health’s ‘He who pays the piper’ issue: Global health has arguably been a case of ‘He who pays the piper calls the tune’.
• Dependence on experts from select countries: The decision to recall U.S. government personnel who have been seconded to WHO and
  • subsequent apprehension that such a step would slow down ongoing programmes reflect how global health agencies are too dependent on subject experts originating from a single or select few countries.
• Diversifying global health expertise: Global health will be better off if a pool of subject experts in various areas of public health are available from different countries and the majority of countries.

The global south must act

• Global south’s role in WHO funding: First, countries in the global south, especially Asia and Africa, must team up to supplement the WHO funding gap after the U.S.’s exit. BRICS could be one such platform.
• Investment in training experts: Second, countries such as India, Ethiopia, Ghana, and others in the global south need to invest in the training of experts not just in public health but also in global health (these are different areas).
• Example for India: For example, India should have trained experts in conditions which affect Africa and diseases that are not prevalent in India.
• Pooled technical expertise: The era of providing only financial support to any country is behind us. It is time for ‘pooled’ technical expertise in health, as in any other sector.
• Regional institutions for global health: Third, the countries in the global south should set up a few premier institutions at the country or regional levels through inter-country collaboration to train their experts in global health.
• Expertise from low- and middle-income countries: It is the expertise from low- and middle-income countries which will be of help to each other and to WHO by the secondment of such experts.
• Lower-cost expertise: That way, global health can improve at a much lower cost than by expertise from high-income countries.
• Reforms in WHO: Fourth, we have been hearing of reforms in WHO for a long time.
• Trimming staff and moving headquarters: One of the steps which should be considered urgently is to trim staff and move the headquarters to one of the regional offices in Brazzaville (Congo), Cairo, Manila, or New Delhi. This would reduce the headquarters’ operational costs.
• Strategic relocation: Though this might be a problem in terms of air connectivity,
  • the time and focus of WHO’s work needs to be on geographies where attention is needed: Africa and Asia.
  • It would be a very strategic move to scale down the headquarters and move specific divisions to the regional offices.

Conclusion

It is very likely that four years later or some time in future, when there is a new U.S. President, the U.S. would rejoin WHO. However, till then, the U.S.’s withdrawal should be explored as an opportunity for the public health community and political leadership in the global south to initiate country and regional level and collaborative actions to reshape the global health agenda, which is much under the influence and the guidance of high-income countries. Global health should not be at the mercy of funding or the expertise from one or a handful of high-income countries. It must be truly a joint venture for the entire world, led by the global south.

 

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Editorial 2: India-Indonesia ties as a beacon for global relations

Context

In strengthening their bonds, the two countries can lay the foundation for a more prosperous and sustainable future for Asia and the world.

Introduction

It was a great honour for this writer to have accompanied President Prabowo Subianto of Indonesia, who was the chief guest at India’s spectacular 76th Republic Day celebrations. The magnificence of the occasion was not only reflected in the vibrant displays of India’s democracy, diversity and military strength, but was also a timely reminder of the deep and enduring relationship between the countries, which can be a beacon for wider international relations.

The evolution of ties

• 1950 Republic Day: Indeed, as India celebrated its first Republic Day in 1950, marking its new destiny as a sovereign and democratic nation, it was Indonesia’s founding father, President Sukarno, who graced the occasion as chief guest.
• Strengthened Ties: In subsequent decades, as the two countries embraced their independence, they have built strong ties, spanning economics, politics and culture.
• Fourth visit of an Indonesian President: In fact, this year was the fourth time that an Indonesian President has been chief guest at the Republic Day celebrations.
• Prabowo’s visit: Mr. Prabowo’s visit, and his meeting with Indian Prime Minister Narendra Modi, highlighted the shared ambition of the two leaders to further increase collaboration in areas that include trade, maritime security, health and technology.
• Economic potential: As two of the world’s largest and fastest growing economies, Indonesia and India have immense potential to become the cornerstone for prosperity and security for the entire Indo-Pacific region and beyond.
• Trade agreement 1966: First, whilst the two countries signed a trade agreement back in 1966, from today’s vantage point there is a huge amount that can be done to grow economic ties between the two countries.
• CEOs forum: As Chairman of the Indonesian Chamber of Commerce, this writer co-chaired the CEOs Forum alongside Indian business leader Ajay S. Shriram in New Delhi.
• Bringing together senior business leaders from India and Indonesia, we identified five key sectors that should be prioritised to unlock mutual growth, boost innovation and strengthen bilateral ties, i.e., in energy, food and agriculture, health care, manufacturing and technology.

Trade and security as pillars

• Bilateral trade potential: Throughout the discussions, it became clear that there are immense opportunities to increase bilateral trade, which currently stands at just under $30 billion. There is the potential to quadruple the volume of trade in the next 10 years.
• Confidence in partnership: Ambitious growth targets reflect the confidence the two nations have in each other’s potential and in their continued partnership.
• Economic growth forecasts: Against a backdrop of global economic uncertainty, India and Indonesia are forecast to grow by 6.5% and 5.1%, respectively, this year, well above the global growth average of 3.3%.
• Market expansion and workforce: This growth reflects their expanding markets, young and dynamic workforces, as well as growing consumer demand.
• Investment potential: There is huge untapped potential for both countries to benefit from intelligent investmentthat can position them as leaders in energy transition.
• Current investment levels: While Indonesian investment in India stands at $653.8 million and India has invested $1.56 billion in Indonesia, this only scratches the surface of what is possible.
• Deepening investment: By deepening their investments and supply chains in sectors such as clean energy, technology, and manufacturing, the two countries can lead the global effort against climate change.
• Security as a pillar: Security is the second pillar of the India-Indonesia partnership, with significant strides made in strengthening defensive ties, culminating in the Comprehensive Strategic Partnership in 2018.
• Maritime security: The partnership has been particularly strong in enhancing maritime security in their shared waters.
• Counterterrorism and cyber security: During Mr. Prabowo’s visit, Mr. Modi and Mr. Prabowo committed to strengthening collaboration in areas such as counterterrorism and cyber security to ensure the safety of both countries.
• Geopolitical importance: As two large, populous nations with growing military capabilities, cooperation is essential to address the complex geopolitical dynamics of the Indo-Pacific and safeguard its stability and prosperity for generations to come.

International relations

• Global context of the bilateral relationship: A third element of the bilateral relationship is how it fits in the global context. Outside of the Indo-Pacific, India and Indonesia are both navigating a geo-political environmentthat is constantly shifting.
• Indonesia in BRICS: At the start of the year, Indonesia was formally invited to join the BRICS group of emerging economies. In that club of powerful emerging economies, it joins India and, of course, China too.
• Relationships with Western countries: At the same time, both Indonesia and India have important relationships with the United States and other western countries.
• Trump administration and tariffs: The new U.S. administration led by President Donald Trump has threatened to introduce a new set of tariffs, and it remains to be seen what will happen.
• Impediments to free trade: It is obvious that tariffs and non-tariff barriers are impediments to free trade and carry risks for the global economy.
• Indonesia’s resources: Indonesia, as a key source of natural resources such as nickel, copper, tin, and bauxite, wants to be able to export to the U.S., India, and other markets.

Conclusion

President Prabowo’s visit to India was a reminder of the importance of Indonesia’s bilateral relationship with Indonesia. Their partnership, 76 years old, continues to grow in strength and their potential to shape the future of the Indo-Pacific and the global economy is vast. As the two countries continue to work together through trade, security and their geo-political ties, they will not just strengthen the bonds between the two great nations but also lay the foundation for a more prosperous and sustainable future for Asia and the world.