José Antonio Alonso
Professor of Applied Economics (UCM)
We find ourselves in a period where many of the pillars on which the post-war liberal order was built, including the multilateral system, seem to be crumbling before our eyes. The Trump administration's decision to withdraw the United States from the Paris Agreement and from some United Nations agencies, such as the WHO, UNRWA and UNESCO, and to reduce funding to many others (such as the UNDP and OCHA), is plunging the UN into the deepest funding crisis in its eight decades of existence. The country that gave rise to the multilateral system, the country without whose leading role the birth of the United Nations would not have been possible, is now the one most openly and directly prepared to demolish its creation.
But let us not fool ourselves: the crisis at the United Nations predates these unfortunate decisions, led by a government that seems to disregard international rules and agreements, embraces exclusionary nationalism and is determined to base international relations on the systematic use of threats and aggression. This weakness in the multilateral system affects many areas of global governance, but it particularly damages the international community's ability to regulate and provide global public goods, those that affect everyone, rich and poor, without the possibility of exclusion. Public goods are in demand because they are key to sustaining life, stability and progress for humanity.
Among these goods, global health occupies a prominent place. Not all aspects of health are considered international public goods, but those related to the fight against communicable diseases undoubtedly are. The case of COVID-19 illustrates this characterisation: no matter where the infection started, in an interdependent world its effects reach every corner of the planet. However, even those areas of health that are not international public goods are areas that affect a basic human right (the possibility of leading a healthy life), and it is therefore the role of public institutions – including multilateral ones – to establish the conditions for their protection and enjoyment. Trump's decisions are, if you will, the abrupt culmination of a long-standing process of disaffection with multilateral institutions, to which many countries have contributed. The root causes of this disaffection lie in two mutually reinforcing factors that have been developing over time: on the one hand, mistrust of the capacity and effectiveness of the multilateral system, as it is currently configured, to address collective challenges; on the other, the stubborn resistance of the major powers to relinquish part of their decision-making power and strategic autonomy in favour of concerted action at the international level. This has led to the paradox that, at a time when cooperative action at the international level is most needed to govern the processes of globalisation and address global challenges, the multilateral system from which to build that response is increasingly weakened and questioned.
The deterioration of the multilateral system will not only hinder future progress in global health levels, but will also jeopardise some of the achievements that were thought to have been definitively secured. For example, one of the most notable advances in this field came from global vaccination campaigns undertaken in the 1960s and 1970s with the support of private foundations, multilateral organisations and donors, which aimed to combat diseases (such as smallpox and polio) that were causing death or severe physical harm to populations in the developing world. We are currently witnessing a reaction from some governments, including Trump's, which question these therapies, contrary to historical evidence and scientific reasoning. What will happen to diseases that require these treatments, some of which have seen worrying resurgences in recent times? How can we deal with the next viral crisis?
However, multilateral activities in support of health go beyond the scope of vaccines or the prevention and treatment of communicable diseases. Their mandate also includes strengthening national health systems, combating non-communicable diseases of increasing incidence (such as heart disease, cancer and diabetes), improving maternal and child health levels, and preventing, monitoring and protecting populations from potential emergencies (including health emergencies). The weakening of the multilateral system will ultimately undermine progress on all these fronts.
Let us consider the central institution of the multilateral health system: the WHO. The budget planned for the 2026–27 biennium ($4.267 billion) already represents a 14% decrease compared to the previous biennium. Part of the budget corresponds to country contributions (which are being redefined following the departure of the United States), another part consists of voluntary contributions that have already been established (either because they have been accredited or because they are part of an ongoing multi-year process), However, there is still $1.649 billion (39% of the total) to be financed. Will there be the political will and financial muscle on the part of countries to respond to this demand? Let us remember that not only the United States has reduced its contributions, but also a large group of European countries – including the United Kingdom, France and Germany, the main providers of funding to the multilateral system – which have announced severe cuts in their aid, driven by the need to reduce their public deficits.
If this is the case with the WHO, which receives part of its funding from mandatory contributions from Member States, the position of other organisations or funds that depend crucially on voluntary contributions from countries is even more vulnerable. Take, for example, UNAIDS, the organisation responsible for combating HIV: the funding it received in 2024 ($170 million) was 17% less than it received three years earlier, in 2020, but, in addition, almost 50% of that year's funds came from the United States. How will this organisation, which is crucial for countries such as those in Southern Africa, maintain its activities following the decisions of the Trump administration? Let us turn to another illustrative example: GAVI, the global alliance on vaccines. In the period 2021-24, the United States contributed 24% of this organisation's funds, but another 24% of the resources were contributed by Germany and the United Kingdom, two of the countries that have announced cuts in their aid. How will this decline in the provision of resources affect this alliance, which is so central to the global health system?
The effects that may arise from the serious funding crisis affecting the ecosystem of multilateral health institutions at the global level should not be underestimated. Unfortunately, its impact will be measured in suffering and human lives, in economic and human costs, and in the increasing vulnerability of populations. It is therefore important for countries within the international community to reaffirm their multilateral commitment and show their willingness to compensate, at least in part, for the effects of the withdrawal of funds from the most reluctant donors. This is a way of preserving a system and values that are necessary to put life (of people and the planet) at the centre of concerns, in the hope that time will once again make those countries that are currently reluctant to see that, in an interdependent world, the best way to defend the national interest is through international cooperation.
As COVID-19 has taught us, what is not invested in preventive healthcare today ends up becoming an amplified (and sometimes irreversible) cost tomorrow. Therefore, global healthcare spending is not optional: it is a necessary investment in people and their abilities to enable them to choose the lifestyle they value. Moreover, as Nobel Prize winner Amartya Sen reminds us, among human capabilities, health occupies a privileged position because it is enabling in nature, conditioning the deployment of many other capabilities. Let us hope that a sufficient number of countries will take on board the implications of this assertion.