World Health Group’s AIDS Fight Hampered by Lack of U.S. Support

Concern is growing within the American public health community that the United States is hampering the World Health Organization’s ability to fight deadly infectious diseases, including the international AIDS epidemic, by failing to pay its assessed share of the agency’s budget.

As a result, the United Nations agency has had to reduce its staff, close offices and cancel programs at the same time as it is trying to raise additional millions of dollars for its AIDS control efforts. The across-the-board cutbacks are spread over a wide variety of activities, ranging from nutrition and sanitation to malaria control.

Forcing Cutbacks

The budgetary shortfall has forced the WHO to cut its 1986-87 programs by $35 million and to project at least an additional $50-million cut in programs for 1988-89, according to Marjory Dam, a WHO officer in Washington.

“The principal structure of the organization is being dismantled,” said Dr. Donald A. Henderson, dean of the Johns Hopkins School of Public Health. “Even if you put money into AIDS, the basic skeleton has to be there or you are really in trouble.”

The reduction in U.S. payments has its roots in Gramm-Rudman spending limits and a 1985 congressional cutback in American support for the U.N. and its specialized agencies, designed to force greater efficiency in their operations.

In 1986, the WHO received $10 million from the United States, compared to the $63 million that had been agreed upon. Total U.S. contributions to the U.N. and its agencies were $255 million.

For 1987, the Geneva-based WHO has yet to receive any of America’s $63-million assessment. But Congress is expected to approve some of the 1987 monies and another $36 million of the 1986 assessment and send it to the agency after October, although such partial funding might still leave the WHO as much as $38 million short over the two-year period, Dam said.

Other major WHO contributors, including the Soviet Union and U.S. allies, are up to date on their payments, Dam said. Their contributions each represent 10% or less of the agency’s regular budget; the U.S. assessment represents about 25%.

“We have failed to meet our obligations for no good reason,” said Ruth Roemer of the UCLA School of Public Health, president of the American Public Health Assn.

Roemer and Henderson, who directed the WHO’s smallpox eradication program from 1966 to 1977, are leaders of a lobbying effort to restore the full U.S. payments to the WHO, which has also elicited the support of the Assn. of Schools of Public Health and six former surgeon generals of the United States.

AMA May Join Effort

This week, the American Medical Assn. may join the effort as well, when its House of Delegates, meeting in Chicago, considers a resolution calling on the United States to “meet its full treaty commitments and financial obligations to the WHO.”

Public health officials concede, however, that they remain uncertain that the Senate and House appropriations committees will restore full WHO funding as part of the fiscal 1988 budget. These committees will consider this appropriation in the next several months.

The 1985 congressional fund cuts, authored by Sen. Nancy Landon Kassebaum (R-Kan.), reduced U.S. support for the U.N. and its agencies from about 25% of their total budgets to less than 20%. In response, many U.N. groups have had to roll back their budgets by freezing hiring, canceling meetings and reducing travel. The U.N. itself reduced spending and in late 1986 approved a package of fiscal reforms.

The cutbacks, however, were not applied equally. Financing for the WHO was severely slashed. In contrast, the U.S. contribution to the U.N. was not cut as much. “This is quite shocking because there has never been any criticism of WHO that is has been inefficient,” Roemer said.

In fact, the United States, in voting to approve the 1986-87 WHO budget at the 1985 World Health Assembly, praised the organization for adopting a zero-growth budget that increased support for health programs in individual countries by about 4%, according to Dr. William Foege, executive director of the Carter Center at Emory University and a former president of the American Public Health Assn.

The WHO cutbacks will particularly hurt the organization’s ability to help Third World countries build primary health-care networks, which are considered a prerequisite for the control of specific conditions such as tuberculosis, diarrheal diseases or AIDS.

The WHO special program on AIDS is seeking $37 million in 1987, of which about $32 million has been received, Dam said. The United States has pledged the remaining $5 million and is expected to make its contribution soon, according to Dr. Jeff Harris, AIDS coordinator for the U.S. Agency for International Development.

In addition, Harris said, the agency will distribute $3-million worth of condoms this year and spend $6 million to directly assist AIDS control programs in Third World countries.

The cost of international AIDS control programs will roughly double in each of the next four years, according to the WHO’s Dr. Jonathan Mann. He estimated that the organization will need $650 million for AIDS control programs alone in 1991, a figure that is more than the entire budget of the organization for 1988 and 1989.