Closing the Fissures in Global Health & Development Stewardship: 2025 & Beyond

Several governmental actions in early 2025 proved detrimental to global development aid. These include the United States' withdrawal from the World Health Organization (WHO), the rescinding of ongoing global development aid administered through the U.S. Agency for International Development, and the United Kingdom's cuts to global development aid.1,2,3 This adds to the already financially constrained landscape of development assistance. In fact, the United Nations indicates that humanitarian aid budgets declined from around 42 billion USD in 2022 to 32 billion USD by 2024. Over 900 million people in need receive humanitarian aid or development assistance from UN institutions on an annual basis. Countries facing serious humanitarian crises that risk deepening over the next two years, and in turn fueling more violence include Sudan, Mali and the Sahel region, Haiti, and the Democratic Republic of the Congo (DRC).4 Globally, complex, multicounty infectious disease out-breaks are on the rise, and food insecurity concerns persist, all of which are compounded by the climate crisis.5 The cessation of support for the WHO by the U.S. highlights several challenges (Table 1) and opportunities for rebooting the global health framework. The UN system has its origins in the 1940s, with U.S. President Franklin Roosevelt's "Freedom from Want and Need," or "Four Freedoms," underpinning both the creation of the U.N. and its subsidiary organizations, including the WHO.6 Soon after the establishment of the United Nations, the U.S. steered efforts to create the WHO, and Canadian psychiatrist Dr. Brock Chisholm, who became the organization's first Director-General, played a crucial role in its formation.Table 1: Impact of US withdrawal from the World Health OrganizationGiven its multilateral functions, the WHO has assumed the role of convening to set norms and standards, monitor health trends, coordinate international responses, and lead global health matters since its creation. Other international development organizations were established prior to the WHO (The Rockefeller Foundation in 1913; the International Committee of the Red Cross in 1863; Oxfam in 1942), but the WHO stands out with notable outcomes such as the eradication of smallpox (1980), the Framework Convention on Tobacco Control (2005), and the launch of the ongoing global polio eradication initiative (1988).7,8 Other global development organizations have evolved in OECD countries over time, such as USAID (1961), the UK’s Official Development Assistance (ODA) (1964), Australia’s AusAID (1974), Japan’s Japan International Cooperation Agency (JICA) (1974), and Germany’s GTZ (1975). These organizations have addressed population growth, health, and development challenges. It was the AIDS epidemic in the 1980s and conflict-related humanitarian needs that likely propelled the mainstreaming of global development aid. With a USD 110 billion pledge, the President's Emergency Plan for AIDS Relief (PEPFAR) remains the world's largest development aid initiative ever established.9 In his 2003 State of the Union Address, President Bush announced efforts to combat global HIV/AIDS. Later that year, President Bush signed the initial five-year, $15 billion authorizing legislation.10 The emergence of private philanthropies that financially empower academic institutions and implementing organizations has changed the landscape of development financing. Subsequent disease outbreaks and bioterrorism (SARS, Ebola, 2009 H1N1) solidified the concept of global health security (2014) and the emergence of other players, including China, South Korea, Taiwan, and the Gulf Cooperation Council countries (e.g., King Salman Humanitarian Aid and Relief Center, Qatar Foundation).11 The impact of the WHO's financial challenges and distancing from U.S. public health institutions will be most felt in resource-poor developing countries. This is because, parallel to the global developments, many emerging and developed countries have renewed interest and commitment to the institutionalization of public health, modelled after the entities such as the U.S. CDC, NIH, and FDA. These organizations strengthen disease control functions nationally and expand global collaborations through their respective bilateral outreach or development organizations. Moreover, the WHO has forged collaborations with these national entities, benefiting from staff and expertise exchanges. Country institutions have pioneered the development of select public health guidance from a national perspective, providing prototypes for the WHO and its member countries, such as the first pandemic mitigation guidance. Bilateral disagreements can impact single-country-led collaborations, whereas the WHO, being a multilateral entity, is largely free from such interruptions. The WHO's institutional memory of steering the global health agenda is immense. This is a forced but opportune time for the WHO to streamline its core functions to match current needs and excel in those areas. The current situation also signals to other development entities the need to focus and realign their core responsibilities to adapt to the challenging funding landscape. For its technical stewardship role, given that much of the global research and development data is in the public domain irrespective of the country of origin, the WHO can continue assimilating such information and developing globally relevant guidance. With respect to its multilateral stewardship role, the WHO should sustain its position by demonstrating its competency in mounting timely responses and sharing outbreak data for the global good. It is an opportune time for the WHO to recognize the emerging technical expertise in developed and financially able member countries and establish bi-directional learning opportunities. In a polarized and changing world, organizational growth depends on adaptability and the capacity to conform to evolving paradigms, while proactively preparing for even adversarial developments. Both development aid and global public health are complex fields that are intertwined with geopolitics and global development trajectories. As public health stewards, it is our duty to reinvent and realign ourselves with continuous changes. As public health servants, our goal is to inform the public about best health practices and, when possible, help them through the assimilation of scientific knowledge and transparency. The WHO can continue to play this role, and it presents a learning opportunity for other development and humanitarian agencies. It is important to note that despite declines in global development support from some members of the United Nations, other players are stepping up to fill the gap. The development efforts announced at the recent '4th Humanitarian Forum' in Riyadh attest to this trend. In its ten years of operation, the King Salman Humanitarian Aid and Relief Center has invested over 7 billion USD in 106 countries. In February 2025, the King Salman Humanitarian Aid and Relief Center energized the field of global development with its 500 million USD investment in the global polio initiative and another 140 million USD for various humanitarian needs in different countries. We need more players to add momentum to this giving trend. Together, we can instill optimism among the world’s needy in a challenging landscape. DISCLAIMER The views expressed in this article are those of the authors and do not necessarily reflect the views of KSrelief or its affiliates.

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