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What's at stake as Trump new era bites health sector

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In this file photo. State Minister for Health Margaret Muhanga (2nd right) and Ministry of Health Permanent Secretary Diana Atwine (3rd left) receive Pfizer  Covid-19 vaccines from former US ambassador to Uganda Natalie Brown (right) at Entebbe Airport in 2022. Trump’s decision to leave the World Health Organisation will affect global vaccination. PHOTO/STEPHEN OTAG

US President Donald Trump’s decision to leave the World Health Organisation (WHO) and suspend foreign aid has sent shock waves.

Given Uganda's heavy reliance on the WHO and the US government, Uganda’s health experts project significant impacts on the country’s health system, especially on epidemic response, guidelines (standards) for services, and capacity development for the health workforce.

President Trump reportedly signed the Executive Order to begin the process of withdrawing the US from the WHO after arriving back at the White House as he starts his second term. This move also makes it the second time he has ordered the US government to pull out from the WHO, citing mishandling of Covid-19 by the global health agency.

USA is one of the founder members of the organisation and one of the largest funders, providing around 20 percent of funds for WHO operations. The organisation's annual budget is $6.8 billion (Shs25 trillion). WHO, in a statement yesterday, pleaded with the US government, to reconsider its position on withdrawing and indicated they would have dialogue with them.

“The World Health Organisation regrets the announcement that the United States of America intends to with-
draw from the Organisation,” the statement reads.

“WHO plays a crucial role in protecting the health and security of the world’s people, including Americans, by ad-
dressing the root causes of disease, building stronger health systems, and detecting, preventing and responding to
health emergencies, including disease outbreaks, often in dangerous places where others cannot go,” it reads further.

Founding member
The global health agency noted that the United States was a founding member of WHO in 1948 and has participated in shaping and governing WHO’s work ever since, alongside 193 other member states, including through its active participation in the World Health Assembly and executive board.

“For over seven decades, WHO and the USA have saved countless lives and protected Americans and all people
from health threats. Together, we ended smallpox, and together we have brought polio to the brink of eradication. Ameri-
can institutions have contributed to and benefited from membership of WHO,” the WHO reasoned.

“With the participation of the United States and other member states, WHO has over the past seven years implemented the largest set of reforms in its history, to transform our accountability, cost-effectiveness, and impact in countries. This work continues.

“We hope the United States will reconsider and we look forward to engaging in constructive dialogue to maintain the partnership between the USA and WHO, for the benefit of the health and wellbeing of millions of people around the globe,” the WHO appealed to the US government.

In the Executive Order, the British Broadcasting Corporation (BBC) reported the US government as stating they are withdrawing "due to the organisation's mishandling of the Covid-19 pandemic that arose out of Wuhan, China, and other global health crises, its failure to adopt urgently needed reforms, and its inability to demonstrate independence from the inappropriate political influence of WHO member states".

Dr Peter Waiswa,an associate professor at Makerere University School of Public Health, told this publication that in ad-
dition to the withdrawal from the WHO, he is also concerned about the possible impact of President Trump’s “America
first”policy.

He said the withdrawal of the US government would affect Uganda through reduced funding to the WHO, which is
essential in Uganda’s epidemic response and building capacity of health workforce in service delivery.

“There is only one pointer now, take care of your own business,” Dr Waiswa said, adding: “This is not a bad thing. Four years ago,we never took it seriously (when President Trump first made the orders) even now, we are there.”

“First of all, the whole idea of cuts [in funding to WHO] is because the Trump’s agenda of America first. And it might
spin over to many things, even to how much support they give to countries like Uganda,’’ the health policy expert noted.
Dr Waiswa believes that soon, other US agencies supporting or working in Uganda might also get more reduction
in funding.

“They finance a lot of the malaria control, the PMI (President’s Malaria Initiative), HIV through PEPFAR (The US Presi-
dent’s Emergency Plan for Aids Relief), a lot of disease control through CDC (Centres for Disease Control and Prevention),
and United States Agency for International Development-USAID in general, maternal and child health,” he says.

However, our previous investigations revealed that even during President Biden’s administration, financing, for example, for the HIV/Aids fight in Uganda was going down and the government was trying to increase domestic funding to bridge the funding gap.

The PEPFAR support declined from $426 million (Shs1.57 trillion) in the 2022/2023 Financial Year to $388 million (Shs1.43 trillion) in the 2023/2024 Financial Year, after Uganda enacted the Anti-Homosexuality law in May 2023.

Uganda has around 1.5 million people living with HIV. Statistics from Uganda Annual Joint Aids Review Report for the 2023/2024 Financial Year, indicate that the government of Uganda's funding towards HIV/Aids increased from $80.6 million (Shs298 billion) in 2020 to $100.4 million (Shs371 billion) in 2024.

However, this was very low compared to the funding need, which stood at $732.5 million (Shs2.7 trillion) in
2020 and $851.5 million (Shs3.16 trillion) in 2024.

The Global Fund, however, increased its support towards the response from $99.7 million (Shs368.8 billion) in 2020 to $135 million (Shs499 billion) in 2024 as support from PEPFAR declined.

Uganda’s capacity
Dr Herbert Luswata, the president of the Uganda Medical Association (UMA), describing the move by President Trump as a big blow. He doubts Uganda’s capacity to bridge the gaps that may be created.

“WHO has been involved in very many initiatives and research. But most importantly when it comes to handling the epidemics. Because they usually provide human resource in terms of experts,” he observed.

“Where they don't provide human resource, sometimes they provide funding for recruitment of experts within Uganda. And they pay allowances and salaries. When you look at the history of Covid-19, they were a very big player,” he added.

Top officials at the Ministry of Health couldn’t be reached for comments as they didn’t pick up the calls. But the spokesperson of the ministry, Mr Emmanuel Ainebyoona, told this publication in a brief statement that they “are still monitoring the development” and that they would comment on coming days.

Dr Waiswa on the other hand, said the funding cut by the US government to WHO would affect the access to standards and guidelines,which the WHO has been providing Uganda.

“WHO is the technical agency for health, which sets a lot of the standards that we follow. If you go to the ministry [of Health] or anybody, they will say, Oh give me the WHO standards. This is what countries copy and paste into their policies. All the vaccines, drugs and equipment, WHO is the one which does approval,” he explained.

The health policy specialist also observed that the US Food and Drug Administration (FDA) is essential in WHO work.
“For most of the medicine again,we follow FDA approval. If FDA has done the work, then WHO just copies because they (FDA) have everything –financial resources and technical support. But also, WHO is in 190 countries that's from the UN and more, so it has been a major player. So a lot of things might affect us in many ways,” he noted.

The health policy specialist also observed that even before this development,there were already cracks developing within WHO.

“Already, WHO is becoming weaker with limited funding and many people are exiting it. Actually, a lot of the directors of WHO exited that time around Covid. So, I think they are going to lose a lot of technical people and also, a lot of their work will be shut down around the guidelines and standards and epidemic investigation and control,” he said.

“All this work around the vaccines, do we withdraw this drug or this vaccine or how do we investigate this disease? A lot of it is within WHO. And it comes both with the technical expertise and the money. But also, they do the connection because they have a lot of the convening power."

“So, we can claim we have this capacity, and maybe the country has done some capacity building, but every time there is an outbreak here, the Ministry of Health runs to WHO for money. They don’t do almost anything by government’s funding except during Covid times when Parliament woke, but when Covid was gone they forgot,” he added.

Dr Luswata also said WHO has been facilitating research on the new strains of the different organisms when the pandemics come.

“And they coordinate with other countries to provide data sharing and find solutions which can usually work and developing guidelines which they share with many ministries in different countries, including Uganda,” he noted.

“So, when USA pulls out as a partner of WHO, it is going to affect the funding. The USA is one of the biggest funders of
WHO and when the funding goes down, it is going to affect greatly the work of WHO, meaning, the support in the member countries is also going to reduce,” he added.

Dr Luswata also expressed worry about Uganda’s readiness to take charge of the health system.
“It makes matters worse in a country like Uganda where health is not prioritised, the funding to the health sector
in Uganda is not a big priority as the recommendations we have from WHO,” he said.

“The push from the WHO and other agencies has played a big role to ensure that the health sector moves in the coun-
try. So, regrettably, it will be a very major blow,” he added.