Pandemic Proof: Funding the WHO for Pandemic Preparedness

Summary

---

Podcast Summary:

The CGD Podcast – Pandemic Proof: Funding the WHO for Pandemic Preparedness
Date: December 12, 2024
Host: Center for Global Development (Guest Host: Pete Baker)
Guest: Katerina Boehmer, Assistant Director General for External Relations, Partnerships and Governance, WHO

---

Overview

This episode of "Pandemic Proof" delves into the critical issue of financing the World Health Organization (WHO) for pandemic preparedness. Pete Baker hosts Katerina Boehmer from WHO to discuss how recent reforms—like the historic increase in assessed contributions and the first-ever investment round—aim to make WHO’s funding more predictable, flexible, and diversified. The conversation highlights both progress and persistent obstacles in securing sustainable financing for WHO, explores the allocation of new funds, and offers candid assessments of risks ahead in a political and economic environment growing more challenging for global health.

---

Key Discussion Points and Insights

1. Historical Context & Current Funding Challenges

• WHO’s Dependence on Unpredictable, Volatile Funding:
  • WHO’s annual budget has historically been about $2.1 billion, "equivalent to that of Mount Sinai in New York" (03:23), spread thinly across 194 countries and 154 country offices.
  • Only "16% of the WHO funding came from so called assessed contributions," i.e., country membership fees; the vast majority (84%) was from voluntary contributions, mostly designated and from "just 10 donors" (03:23).
  • Voluntary contributions are typically short-term, with "over half" being one-year commitments, resulting in inefficiencies and instability for staffing and program planning.
  • Underfunding of pandemic preparedness has been a chronic problem, briefly remedied during COVID before returning to a “period of neglect” (03:23).

“Our goal in a summary is very simple. It's funding that's predictable, flexible and diversified. Because we cannot keep firefighting with funds that arrive only when the fire has already started.”
— Katerina Boehmer, [00:03], [06:54]

2. Recent Reforms and the Investment Round

• Historic Change:
  • In 2022, the World Health Assembly resolved to cover at least "50% of WHO's core budget by 2030" through assessed contributions—a significant shift away from reliance on voluntary funding (07:52).
• The Investment Round:
  • Launched in 2024, it aims to raise $7.1 billion for WHO’s 2025–2028 work program.
  • As of the G20 summit in Rio, $1.7 billion has been pledged (totaling $3.8 billion, including pre-existing commitments) (13:48).
  • Notably, "28 of these first-time pledges are from low or middle income countries," demonstrating a more diversified donor base (07:52).
• Progress & Caveats:
  • Increased political commitment and flexibility of funding.
  • Yet, “the risk of over reliance on a few large donors persists”—diversification and further development of innovative financing are needed (07:52).

“Flexibility and predictability... we estimate to have doubled our predictability. However, ...it’s still far from perfect.”
— Katerina Boehmer, [07:52]

3. Realities of Amount Raised vs. Ambitions

• Despite progress, there’s a major gap between funds raised and the $7.1 billion goal. Some funding remains in the pipeline, and South Africa will champion continued fundraising during their G20 presidency in 2025 (13:48).

“For us, this investment round, in a way, is not yet over. We still will add all the money that comes in between now and the World Health Assembly next year.”
— Katerina Boehmer, [13:48]

4. How New Funds Will Support Pandemic Preparedness

• Allocation:
  • Funds are matched to a pre-approved, bottom-up budget created jointly with member states (15:41, 21:22).
  • Key priorities include: strengthening surveillance, workforce capacity (with a 10 million health worker gap), and equitable access to countermeasures (15:41).
  • Investment round funds “plug gaps identified in the WHO health emergency appeal” and complement, but do not duplicate, other mechanisms such as the Contingency Fund for Emergencies, the Pandemic Fund, and the IMF’s Resilience and Sustainability Trust (15:41).
• Increasing Threats:
  • WHO responded to 39 graded emergencies as of October, and expects incidents to rise given ongoing global and climate challenges (15:41).

5. Distinct Funding Mechanisms Explained

• Contingency Fund for Emergencies:
  • Designed for immediate, flexible response—can deploy funds within 24 hours to a country hit by crisis (19:05).
• Investment Round/Core/Base Budget:
  • Pays for WHO’s core workforce and ongoing capabilities, allowing sustained preparedness and “readiness muscle” rather than emergency firefighting (19:05).
• Other Mechanisms:
  • Coordination is prioritized to avoid overlaps with efforts like the Pandemic Fund, which is particularly focused on surveillance and lab capability (21:22).

“The contingency fund…is a very flexible funding mechanism that…can use within 24 hours to basically give to a country that has a very acute crisis... this is really the early funding that enables us to be agile, fast...That’s not the purpose of the investment round at all.”
— Katerina Boehmer, [19:05]

6. Budget Development and Prioritization

• Inclusive, Bottom-up Process:
  • National priorities are identified by countries in collaboration with WHO country offices, aggregated regionally and globally (21:22).
  • Health systems strengthening is a current top priority, with pandemic preparedness gaining more traction post-COVID and MPOX (21:22).

“This bottom up approach of developing a budget has become now the norm and is very transparent…Pandemic preparedness…can easily get forgotten by countries because it’s not always front of mind.”
— Katerina Boehmer, [21:22]

7. Risks and Persistent Gaps

• Funding Shortfalls:
  • No major increase in overall funding for pandemic preparedness post-COVID, and shrinking ODA and national health budgets threaten progress (21:22).
• Call for Cohesion:
  • “In those times, it’s going to be even more important that we work closely with all partners and …stand together and get the job done.” (21:22)

---

Notable Quotes & Memorable Moments

• On Mission-Critical Funding:
  “Because we cannot keep firefighting with funds that arrive only when the fire has already started. This can make a huge difference for global health security going forward.”
  — Katerina Boehmer, [00:03], [06:54]

• On Assessed vs. Voluntary Contributions:
  “Only 16% of the WHO funding came from so-called assessed contributions… 84% of the funding came from voluntary contributions from various donors. The vast majority… over 70% actually came from just 10 donors.”
  — Katerina Boehmer, [03:23]

• On New Donors:
  “28 of these first time pledges are from low or middle income countries, representing a real shift in how WHO is funded…shows also the significant political commitment from these member states countries to WHO.”
  — Katerina Boehmer, [07:52]

• On Investment Round Funding Gap:
  “At this point, as of the Rio highlight G20 summit, we received US$1.7 billion… that brings our funding to a current total of 3.8 billion of the 7.1 billion we need.”
  — Katerina Boehmer, [13:48]

• On Emergency Funding Mechanisms:
  “The contingency fund for emergency is really distinctly different… can use within 24 hours to basically give to a country that has a very acute crisis… allows the very early response that is very often needed.”
  — Katerina Boehmer, [19:05]

• On Persistent Global Inequity & Needed Change:
  “If I could prioritize one change, I think it would be to institutionalize equitable global financing for pandemic preparedness. This means establishing a binding commitment for all countries to contribute to a global health security fund based on the country's capacities and similar to what we see in climate financing… Every day the world spends $7 billion fighting wars and preparing for them, and we need just a tiny portion and fraction of that to make our world safe from pandemics and outbreaks.”
  — Katerina Boehmer, [24:46]

---

Important Timestamps

• 00:03 — Funding should be predictable, flexible, diversified (Katerina Boehmer)
• 03:23 — Historical context: WHO's budget constraints and funding flaws
• 07:52 — Sustainable financing reforms and impact so far
• 13:48 — Reflections on the investment round fundraising gap
• 15:41 — Allocation of new funds to pandemic preparedness and complementarity with other mechanisms
• 19:05 — Distinction between emergency fund and investment round/core funding
• 21:22 — How WHO’s budget process works: bottom-up and country-driven
• 24:46 — “One change” for global pandemic financing: binding, equitable global fund

---

Tone & Atmosphere

The conversation is frank, ambitious, and collaborative, balancing cautious optimism about recent funding reforms with realism about persistent and future challenges. Boehmer is open about both improvements and remaining shortcomings, and unafraid to call for bolder institutional changes comparable to those in climate finance.

---

Recap

The episode spotlights critical advances in WHO financing—for the first time, assessed contributions are set to make up half the core budget, new donors are entering the fold, and investment mechanisms are increasingly focused on flexibility and readiness. Yet, significant risks and funding gaps remain. The key takeaway: institutionalizing equitable, binding global financing for pandemic preparedness is urgently needed to break the current cycle of panic and neglect, and to future-proof global health security for all.

---

Transcript

[A]

Our goal in a summary is very simple. It's funding that's predictable, flexible and diversified. Because we cannot keep firefighting with funds that arrive only when the fire has already started. This can make a huge difference for global health security going forward.

[B]

You are listening to Pandemic Proof from the center for Global Development. In this podcast, we explore policies and reforms to better prepare and respond to infectious disease threats like COVID 19, but also other nasty viruses, microbes and fungi that can throw our health, our communities and our economies into crisis. Join us as we envision ways to better protect our world in the future. I'm your host, Javier Guzman. This episode will be guest hosted by my CGD colleague who is an expert in this field. Now let me turn it over to them.

[C]

Hi everyone, I'm Pete Baker, Deputy Director of the Global Health Policy Program here at cgd. I'm very excited to be hosting Pandemic Proof today on such an important topic as WHO financing the World Health Organization is the beating heart of our global health system, representing the collective effort of 194 countries to protect and promote our health. The current state of WHO funding, however, significantly hinders its ability to deliver on its mandate and promptly respond to crisis outbreaks and pandemics. In response to this last year, member states made a historic agreement to increase the provision of flexible funding, known as assessed contributions. And in 2024, WHO launched its first ever investment round, aiming to secure an additional US$7.1 billion for its 14th general program of work covering the period from 25 to 28. The investment round culminated at the G20 summit in Brazil in November, and so far it has received pledges of approximately $1.7 billion, which does actually make up to a total of $3.8 billion, with expected funding from other sources such as partnerships and agreements. These funds raised are really essential for the who, but it's far below what was hoped for, and the spectrum of cuts by the incoming Trump administration looms large on the horizon. Importantly, it's still unclear how much of these committed funds are truly flexible. This lack of flexibility could continue to hamper the WHO's ability to set priorities and act fast, which are two key pillars of pandemic preparedness and response. Within this context, I'm really delighted to have Joining me today, Katerina Boehmer, Assistant Director General for External Relations, Partnerships and Governance at who, to discuss the outcomes of the investment round and the opportunities and risks it presents for strengthening global health and pandemic preparedness. Katharina it's really great to have you here today. Thank you so much for speaking with me.

[A]

Thank you so much, Pete. And I'm really happy to have the opportunity to be here with you today.

[C]

Thank you. Perhaps we could start with a bit of history and context. So, prior to this year's investment round, how would you describe how WHO is financed for pandemic preparedness and how did this differ from other areas of routine expenditure? And can you offer some reflections on how this model had some challenges that were highlighted by Covid and MPOX?

[A]

When I started working for WHO early 2021, really at the height of the pandemic, I was surprised, if not almost shocked at how the organization was financed and at what a great job it did despite its weak state of financing. So just to give you the picture, briefly, firstly, WHO operates and operated on an annual budget equivalent to that of Mount Sinai in New York, approximately 2.1 billion per year. This budget funds our entire workforce and all the activities, not only at headquarters, but also in the regions and in our 154 country offices. The only additional budget is basically our health emergency appeal funding. And even that can only be implemented with the help of the core staff. And that again is funded from this base budget, as we call it. So when I arrived in 2021, what I found was only 16% of the who funding came from so called assessed contributions, I.e. the membership fees, and 84% of the funding came from voluntary contributions from various donors. But the vast majority of these voluntary contributions, over 70% actually came from just 10 donors. So not diversified and resilient at all. Over half of these voluntary commitments were just one year commitments and thousands of grant reports had to be written every year. So that resulted in significant inefficiencies in the inability to address country needs and serve with high quality, especially in Africa and Asia, which were sort of consistent pockets of poverty, as we call them. Our pandemic preparedness and also response efforts were particularly affected by these financing flaws. Pandemic preparedness historically has not been an attractive area for funding and has always been an underfunded area. And that briefly changed during COVID but since then we've re entered a period of neglect for funding pandemic preparedness. But what happened during COVID was that it became very visible that many or most countries had inadequate surveillance capacity, inadequate lab capacity, very weak health systems and clinical capacity to respond. And this led to very delayed public health responses, especially at the onset but throughout basically of the COVID 19 pandemic member states became acutely aware of, of our funding situation during the pandemic and send a powerful signal to the executive board in January 2021 that the WHO funding situation had to change. And that was sort of the beginning of our sustainable financing journey. We've been accompanied by member states, by our donors along the way, and it's taken us to Rio, where we had many world leaders express their support to our investment round and to our sustainable financing journey. And that journey is far from over. It's, you know, we're really in the midst of it. Our goal in a summary is very simple. It's funding that's predictable, flexible and diversified. Because we cannot keep firefighting with funds that arrive only when the fire has already started. This can make a huge difference for global health security going forward.

[C]

Thanks, Katrina. It's really interesting to hear the challenges and I'm particularly picking up on how you're saying that during the COVID pandemic, the WHO was to some extent held back by a lack of funding, too inflexible funding, and perhaps a narrow funding base from too few donors. How do you think then with that in mind, the kind of sustainable financing of working group and the resolution that came from that and this investment round, do you think it really addresses these challenges? And how does it address these challenges and what kind of ongoing risks do you see that are still there despite the improvements?

[A]

So our sustainable financing journey really focuses on two areas. One is increasing the assessed contributions and the other is to get the voluntary contribution portion more predictable, flexible and resilient. The World Health Assembly Sustainable Financing Resolution adopted by member states in 2022 was a pivotal step and really a historical achievement. I would say what it did was it formalized the commitment from Member states to cover at least 50% of WHO's core budget by 2030 through these assessed contributions. That's a big shift away from the reliance on voluntary contributions. And we've since taken the first step increase. If we get to these 50%, it would really a dramatic change in terms of how WHO is financed and it would make a dramatic change for our workforce. For example, in our country offices prior to this, and even until now, a lot of the people are in constant short term contracts, just 60 day contracts or six months contracts, that makes planning, operational work, implementation work really difficult. So to your question, have we made progress also through the investment round? Definitely. The answer to that is yes, maybe. Let me just say summarize this in three points. First, the investment round really helped us to enhance and drive political commitment to who. As I said, earlier we clearly saw a panic and neglect cycle driven by the COVID 19 pandemic. And the investment round to a certain extent was a defense strategy because given the very challenging political situation out there in the world, the economic downturns, so we saw a lot of cuts at the horizon from donors. And it was this political commitment that helped us to bring global health back on the agenda. Bring WHO on the agenda, but also the entire ecosystem of health and global health, which was really one priority of the investment round. And we had an enormous total number of statements from ministers, heads of states through this year, which really showed us unprecedented commitment to global health and who. So I would say that part has clearly been successful. Second, you know, flexibility and predictability. Of all the over 70 pledges we've received by now, the vast majority provides us with either fully flexible funding or thematic flexible funding. So we see clear improvements there and we estimate to have doubled our predictability. However, knowing that our predictability of funding, our visibility and planability was at such a low starting point, you know, that it's still far from perfect. Since the investment round launch in May, we've had 17 new pledges, mainly from member states, but also philanthropy and private sector donors. And many of these pledges are first time contributions to who, so come from new donors, which indicates a broadening of our donor base, a diversification, and what I find very remarkable within that is that 28 of these first time pledges are from low or middle income countries, representing a real shift in how WHO is funded on the voluntary contribution side, and shows also the significant political commitment from these member states countries to who. However, last, not least, the risk of over reliance on a few large donor persists. And to mitigate that, what do we have to do? I think first of all, deliver on our work, demonstrate and continue to demonstrate accountability, measure our successes, our value for money, which I think is so clear, but we don't always communicate it well and be fully transparent about what we do and how we spend our money. I think that will hopefully continue to put us up well on this journey and on its next steps, and we'll definitely continue to diversify. I think there's still a lot of room to broaden the donor base on the philanthropic side, on the private sector side, but also we've been traditionally very conservative and I think there's more we can do on the innovative financing side.

[C]

It's very inspiring to hear a kind of good news story in global health that can be hard to come by at times, particularly when multilateralism seems at risk and is shaky. And although we haven't been able to verify this, and I hope WHO will share this information in future, but that you're saying that you've got an increase in flexible funding as part of that, which is great to hear. I also appreciate your honesty with regards to the reforms at WHO and the better communication at WHO that's needed to convince donors to get behind WHO with flexible financing in the future. I guess I just wanted to offer you a chance to reflect on the total number, because from one perspective, the total number, particularly if you take, what is it, 1.7, which is the published number compared to the 7.1, it doesn't look so good. So would you like to offer any reflections on that? Was it an overambitious target?

[A]

Yeah. So at this point, as of the Rio highlight G20 summit, we received US$1.7 billion in terms of Pledgin, and that brings our funding to a current total of 3.8 billion of the 7.1 billion we need. The 3.8 includes pre existing commitments. It includes also commitments from donors that want to remain anonymous, don't want to pledge, et cetera. Right. So we still have a number of pledges to come in the pipeline. So for us, this investment round, in a way, is not yet over. We still will add all the money that comes in between now and the World Health assembly next year. And I think what was particularly remarkable also for us, and the highlight for me at the G20 summit last week, was that President Ramaphosa South Africa, announced that they, as a champion of the sustainable financing for WHO, will take the sustainable financing agenda into their G20 presidency for 2025, and will continue to help us to raise the funding we need for our global program of work 2025-2028.

[C]

Turning now more so directly to pandemic preparedness, how do you see the funds raised during the investment round to be allocated to pandemic preparedness? And particularly, how will that align with the other financing streams that you might think about. You've mentioned already the WHO Health Emergency Appeal. There's also the Contingency Fund for emergencies. But then there's also important other mechanisms like the Pandemic Fund, the IMF's Resilience and Sustainable Trust, Sustainability Trust. So I'd like to hear how you see that working in practice.

[A]

The investment round funding will be allocated against the budget, developed with and approved by all member states. So in other words, there's not full flexibility in how and where we put this money, but there's a pre approved budget and the flexible funding will be allocated against that. This budget was developed based on our 2025-2028 strategy. And this strategy very strongly prioritizes pandemic preparedness and acknowledges the criticality of preventing, detecting and responding to pandemics. So bolstering surveillance systems, strengthening workforce capacity and filling the 10 million gap that we see in healthcare workers and equitable access to medical countermeasures will all be a central piece of our next strategy and therefore of the funding that will benefit through the investment round. Importantly, these funds are designed to plug gaps identified in the WHO health emergency appeal and clearly complement the contingency fund for emergencies. Right. So you'll not see any duplication there. Those are really complementary efforts. We also avoid duplication with any other mechanisms like the Pandemic fund or the IMF's Resilience and Sustainability Trust Fund. We work as WHO very closely with these institutions to ensure a complementarity, but also avoidance of duplication, especially also at the country level. So I think in so far we are all clear. Having said this, let me perhaps add one point. We see a steadily increasing number of global health emergencies. As of October, we we as WHO were working on 39 graded health emergencies and we see a steady upward trend. We clearly see global health security under threat and climate change consequences are not expected to make this any better. Right. So I personally think these trends towards increased graded health emergencies will continue and that will mean that the funding we have available sw, but also the external sources you mentioned, will not be enough to address the health emergencies the world has to deal with. So I think going forward we all need to work together to make sure that we continue on this path we are on, which is to strengthen global health security for everyone.

[C]

If is there any more you could say on that distinction between the kind of pure investment round funding and your contingency fund or the emergency appeal or the external funds. Will this kind of core funding have any specific focus areas regarding pandemic preparedness or is it intended not to be broad? Partly, I'm coming from this from the perspective that there isn't much money in the global health architecture at the moment. There's certainly not enough money to deliver on all those pandemic and climate change risks you mentioned. And so it's important for each part to get the most for the money and to coordinate well. So I love your thoughts on that.

[A]

Yes, absolutely. So the contingency fund for emergency is really distinctly different from our base budget. So what that is is A very flexible funding mechanism that our health emergency Executive Director and Deputy Director General Mike Ryan can use within 24 hours to basically give to a country that has a very acute crisis, whether it's disease outbreak or whether it's another health emergency. So it allows the very early response that is very often needed and absolutely critical, and it's allowed us to be extremely fast in multiple crises, right? Whether it's Ukraine, you know, whether it's the recent MPOX outbreak, whether it's the cholera outbreaks that we see in Africa. So this is really the early funding that enables us to be agile, fast, bring commodities on the ground within a couple of days. So that's not the purpose of the investment round at all, but the investment round will fund the base budget or core budget and a lot of our health emergency people. So the workforce and the people that work in pandemic preparedness and response get their salaries paid from this base budget and is then complemented with a surge workforce. And that comes from the appeal funding and activity funding. So basically the base budget is funded through the investment round and the assessed contributions and that covers the core workforce that we need to respond to health emergencies, to outbreak situations.

[C]

Very nice. That makes sense. Katerina, I just wonder if you could offer any reflections on how the base budget is prioritized and allocated, because I think this links actually to two points you've made. One is convincing member states and donors to keep funding and keep funding flexibly because they believe the who's got good systems, but also to show that it articulates well with other agencies. It might be valuable for listeners to hear from you on what is the process by which the WHO then allocates to countries and themes for who.

[A]

This is a really bottom up process and one year long process to develop our budgets. It's done with our 194 member states with all our country offices and they prioritize their needs at a country level. So a certain ministry is asked to work closely with our country offices and identified their national priorities for the next four years. So this bottom up approach of developing a budget has become now the norm and is very transparent and transparently shared at all the regional committee meetings and then gets pulled together from the regional budgets basically into a global budget. Pandemic preparedness, as I said, can easily get forgotten by countries because it's not always front of mind, right? Front of mind are usually problems of clinical care, infectious disease problems. A high priority we see at the moment across member states is health systems strengthening, which has big effects for pandemic preparedness as well, for climate resilience as well as for treating infectious disease areas. And we do see that Covid, but also the more recent MPOX outbreak, for example, has really been, I would say, a wake up call for countries. And so we see the prioritization of pandemic preparedness going up. Clearly our activities and allocation at WHO have to be complemented by other mechanisms. You mentioned the Pandemic Fund earlier. And the Pandemic Fund is for us a very promising tool to strengthen surveillance and lab capacity, you know, so it's absolutely essential to do that and complements the domestic funding that countries bring to this area. It's not reached the levels of funding yet that it needs, and unfortunately it's also not been additional funding as everybody hoped for. Right. It's not funding that came out of the defense pockets, it's not new funding, unfortunately, truly new funding, but it would be so much needed. And that's where I personally, I'm still worried because despite the experiences that we encountered and all made during the pandemic, we've not seen any increases in funding. And now, given the economic outlook, given the multiple challenges the world faces, we see cuts in ODA funding in many, many countries. We see cuts to health funding at domestic level, but also at international level. And that doesn't put us off on a great start for securing better pandemic preparedness going forward. In those times, it's going to be even more important that we work closely with all partners and that we don't fragment ourselves further, but that we stand together and get the job done.

[C]

Exactly. With that last bit on mind, we always ask our guests one final question which is around. If you could prioritize one change in the global architecture for pandemic preparedness and response, what would it be?

[A]

If I could prioritize one change, I think it would be to institutionalize equitable global financing for pandemic preparedness. This means establishing a binding commitment for all countries to contribute to a global health security fund based on the country's capacities and similar to what we see in climate financing. I think from my perspective, such a binding commitment and a global health security fund would ensure fairness, would ensure sustainable and predictable funding for preparedness. It would massively reduce the dependency that the world currently has on just a few large donors, and it would address global inequities we see currently by channeling resources to the most vulnerable regions. It would and should not draw, as I said, from the scars ODA funding, but come from defense and security funding. Because every day the world spends $7 billion fighting wars and preparing for them, and we need just a tiny portion and fraction of that to make our world safe from pandemics and outbreaks.

[C]

Well, on that ambitious and optimistic note, Katerina, I thank you for so much for your time and thoughts today.

[A]

Excellent. Thank you so much.

[B]

Thanks for listening to Pandemic Proof from the center for Global Development. Very special thanks to the CGD Podcast team, Sophia Greenho, Stephanie Donahoe, and Soundeasy for making it happen. Pandemic Proof is available on the CGD Podcast stream, so make sure you you are subscribed to the CGD podcast on Apple, Spotify, or wherever you listen to podcasts. And remember, you can check out all of our work on pandemic preparedness and [e-mail] that's cgdev.org thank you very much.

[A]

Sam.