The Funding Architecture

Part II of The Geneva Files documented the institutional response of the World Health Organization to the emergence of SARS-CoV-2 from Wuhan, China during the eight weeks beginning December 31, 2019. The documentary record of that response — the January 14, 2020 tweet, the January 22-23 Emergency Committee meeting at which the Chinese ambassador told the body that declaring a PHEIC was "out of the question," the January 28 Beijing meeting at which Director-General Tedros Adhanom Ghebreyesus praised the Chinese government for "setting a new standard for outbreak control" — established a pattern of institutional posture that aligned with Chinese governmental preferences during a period in which those preferences and the global public-health interest were not, by the subsequent documentary record, identical. Part II closed with a structural observation. The pattern was not principally the product of Chinese financial leverage. The pattern was the product of a financial architecture within which the World Health Organization, as an institution, has limited structural capacity to operate independently of major donor preferences regardless of which major donors those preferences belong to. Part III documents that financial architecture.

The argument of this Part is, deliberately, not the conventional one. The conventional argument about WHO financing focuses on China — on whether Chinese voluntary contributions have purchased Chinese diplomatic influence within the institution. The documentary record does not support the conventional argument in the form in which it is most often made. In 2019, China's combined assessed and voluntary contributions to the WHO totaled approximately $90 million. The United States contributed $419 million. The Bill and Melinda Gates Foundation contributed approximately $370 million. The Chinese share of WHO funding, in pure dollar terms, was not the principal financial leverage point on the institution. The principal financial leverage points were elsewhere.

This Part documents where they were, and what they have produced. The structural shift in WHO financing from assessed contributions to voluntary contributions over the period from 1970 to 2024 is the foundational change. The mechanism by which earmarked voluntary contributions transfer programmatic decision-making authority from member-state governance to individual donors is the operational consequence. The Bill and Melinda Gates Foundation's documented influence on WHO programming through its earmarked grants — quantified for the first time in peer-reviewed research published October 2025 — is the most substantial single donor case. The May 2022 World Health Assembly reform decision to restore assessed contributions to fifty percent of WHO funding by 2030, and the partial and contested implementation of that decision in the years since, is the institutional response. The continuing structural inability of the World Health Organization to function as a member-governed multilateral institution rather than as a donor-directed program-management entity is the documentary finding.

What follows is the documentary record.

The Original Architecture

The World Health Organization Constitution, adopted by the International Health Conference in New York on July 22, 1946 and entering into force on April 7, 1948, established the WHO as a specialized agency of the United Nations system with the responsibility for "the attainment by all peoples of the highest possible level of health." The constitutional architecture envisioned an institution governed by its member states through the annual World Health Assembly — the body composed of representatives of all member states, each member state holding one vote regardless of size, population, or financial contribution. The World Health Assembly was, in the institutional logic of the founding framework, the parliament of global health.

The financial architecture that supported this constitutional design was correspondingly democratic. The original WHO funding model relied principally on assessed contributions — the obligatory dues paid by each member state in proportion to the member state's GDP and population, calculated under a formula approved by the World Health Assembly itself. The assessed-contribution model was the model that the United Nations itself uses to fund its core operations, and that the WHO inherited from the broader UN system architecture.

The institutional logic of the assessed-contribution model is straightforward. Member states pay obligatory dues. The dues fund the institution's operating budget. The member states, through the governance bodies in which they participate, determine how the institution spends the budget. The institution's operational independence from individual donor preferences is structural — no individual donor can withhold funding to change institutional policy, because no individual donor's contribution is large enough to alter the institution's funding base unilaterally.

In 1970, this was substantially the architecture of the World Health Organization. Approximately eighty percent of the WHO's operating budget that year came from assessed contributions paid by member states under the formula approved by the World Health Assembly. The remaining twenty percent came from voluntary contributions, which were at the time predominantly unrestricted — meaning that the contributing donors transferred the funds to the WHO without earmarking them for specific programs, leaving allocation decisions to the institution's governance bodies.

The institutional architecture functioned, during this period, in approximately the manner the founding framework had envisioned. The World Health Assembly governed. The Secretariat in Geneva, headed by the Director-General, implemented the decisions of the Assembly. The regional offices and country offices delivered programmatic operations within the framework the Assembly had approved. The institution's relationship with individual member states was structured by the Assembly's collective governance rather than by the leverage of individual donors.

The architecture did not last.

The Transformation

The shift in the WHO funding model from assessed contributions to voluntary contributions occurred gradually over five decades. The pace of the shift was not uniform. The institutional logic that drove the shift was a combination of three factors operating concurrently: the freezing of nominal assessed contribution levels by member-state agreement; the inflation-adjusted real-dollar decline that this freezing produced; and the parallel growth of voluntary, earmarked contributions from a small number of major donors who used the earmarking mechanism to direct WHO programming toward their own priorities.

The Nominal Freeze

Beginning in the early 1980s, under pressure from major member states — principally the United States during the Reagan administration — the World Health Assembly adopted a policy of "zero nominal growth" for the WHO's assessed-contribution budget. Under this policy, the total amount of assessed contributions to the WHO would not increase in nominal dollar terms from one biennium to the next, regardless of inflation or of the growth in the WHO's operational requirements. The policy was justified as fiscal discipline. Its operational consequence was the gradual erosion of the assessed-contribution share of the WHO's overall financing.

The mathematics of zero nominal growth in an inflationary environment are straightforward. Holding nominal dollar contributions constant while general price levels increase produces a real-dollar decline of approximately the inflation rate annually. Over a forty-year period, with average inflation rates of two to three percent per year, the cumulative real-dollar erosion is substantial. The assessed-contribution share of the WHO's budget, which was approximately eighty percent in 1970, fell to approximately fifty percent by 1990 and to approximately twenty-five percent by 2010.

The Voluntary Growth

Concurrent with the freezing of assessed contributions, voluntary contributions to the WHO grew substantially. The growth was driven by three categories of contributor. The first was major member-state governments — principally the United States, the United Kingdom, Germany, and Japan — who, while supporting the zero nominal growth policy on assessed contributions, simultaneously increased their voluntary contributions through earmarked grants for specific WHO programs. The earmarking mechanism allowed these governments to maintain control over the specific uses of their contributions while still supporting the institution.

The second category was private philanthropic foundations, of which the Bill and Melinda Gates Foundation became, after its founding in 2000, the dominant contributor. The Gates Foundation's voluntary contributions to the WHO grew from approximately $7 million in 2001 to approximately $370 million annually by 2019, making the Foundation, by 2020, the second-largest single contributor to the WHO after the United States.

The third category was international development partnerships, principally the GAVI Alliance (the vaccine alliance founded in 2000 with substantial Gates Foundation support) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (founded in 2002 with substantial U.S. government and Gates Foundation support). These partnerships channeled donor contributions to the WHO for the specific disease-control programs they had been established to support.

By 2020, the cumulative effect of the assessed-contribution freeze and the voluntary-contribution growth had produced the institutional architecture documented in Part II of this series. Assessed contributions accounted for approximately twelve percent of WHO financing. Voluntary contributions accounted for approximately eighty-eight percent. Of those voluntary contributions, peer-reviewed research published in BMJ Global Health in 2023 established that approximately ninety percent were earmarked — meaning that the contributing donors specified the programs, diseases, or geographic regions for which the contributions could be used.

Over the period from 1970 to 2020, the World Health Organization's funding architecture was transformed from a member-state-governed model to a donor-directed model. The transformation occurred through institutional decisions made by the World Health Assembly itself.

What the transformation produced is the institutional architecture within which the WHO has operated for the past two decades. The institution's day-to-day operations are, in substantial part, determined not by member-state governance through the World Health Assembly but by the earmarking decisions of a small number of major donors. The Director-General's discretion over how the WHO's resources are deployed is substantially constrained by the earmarking commitments that the donors have already made. The institutional independence that the founding framework envisioned has been, in operational practice, substantially attenuated.

The Mechanism — How Earmarking Transfers Authority

The technical distinction between assessed contributions and voluntary earmarked contributions is, in its institutional consequence, the distinction between member-state governance and donor governance. The mechanism by which the distinction operates is worth examining in detail.

When a member state pays an assessed contribution to the WHO, the funds enter the WHO's general operating budget. The World Health Assembly has, in advance, approved a Programme Budget that specifies how the WHO will allocate the general operating budget across its various functional areas — communicable diseases, noncommunicable diseases, health systems, emergencies preparedness, corporate services, and so on. The funds are spent in accordance with the Programme Budget. The member state has no direct authority over how its specific contribution is used. The collective decision of the World Health Assembly determines the allocation.

When a donor — whether a member state, a philanthropic foundation, or another contributor — makes a voluntary earmarked contribution, the institutional logic operates in reverse. The donor specifies, as a condition of the contribution, what the funds can and cannot be used for. The earmarking can be at multiple levels of specificity. A donor might earmark contributions for "polio eradication" — a broad programmatic category that the WHO must spend on polio-related activities. A donor might earmark contributions for "polio vaccine procurement in Pakistan" — a much narrower category that constrains the WHO's discretion substantially. A donor might earmark contributions for a specific named project with specific deliverables and specific reporting requirements that the WHO must produce to maintain access to the funds.

The institutional consequence of earmarking, in its aggregate effect across the WHO's ~$2.4 billion annual budget, is that the World Health Assembly's collective decisions about WHO priorities — the Programme Budget that the Assembly approves every two years — are, in operational practice, second-order decisions. The first-order decisions are the earmarking decisions made by individual donors before the funds reach the WHO. The Programme Budget, in this institutional dynamic, becomes substantially a description of what the donors have already decided to fund rather than a prescription of what the WHO collectively chooses to prioritize.

The Illustrative Case

The illustrative case of how earmarking operates is documented in the WHO's own Programme Budget allocations. The category that receives the largest share of WHO spending in most years is "polio eradication" — a category that, on a strict assessment of global public-health need by mortality and disability-adjusted life years, would not be the highest-priority category. Polio in 2020 caused approximately one hundred forty cases of paralytic illness globally, predominantly in two countries (Afghanistan and Pakistan). Noncommunicable diseases — cardiovascular disease, cancer, diabetes, chronic respiratory disease — caused approximately forty-one million deaths globally in the same year, approximately seventy-four percent of total global mortality.

The disparity between the resources allocated to polio eradication and the resources allocated to noncommunicable diseases is not the product of a deliberate WHO decision that polio is more important than noncommunicable diseases. It is the product of the earmarking decisions of the WHO's largest voluntary contributor — the Bill and Melinda Gates Foundation — which has, since 2000, directed approximately $3.2 billion in earmarked grants to WHO polio-related programs. The Foundation's earmarking determines the allocation. The WHO's institutional priorities, as approved by the World Health Assembly, are honored to the extent that they align with the donor's earmarking. Where they do not align, the donor's earmarking prevails.

The Gates Foundation Case

The Bill and Melinda Gates Foundation is, by any documented measure, the most consequential single non-state donor to the World Health Organization in the institution's history. The Foundation's documented contributions to the WHO between 2000 and 2024 total $5.5 billion, distributed across 640 individual grants. The largest single grant — $676 million in July 2008 — was directed to polio eradication. The peer-reviewed quantitative analysis of the Foundation's grants to the WHO, published in BMJ Global Health in October 2025, is the most substantial public documentation of the Foundation's actual programmatic influence on WHO operations.

The peer-reviewed findings are documented. Of the $5.5 billion in Foundation grants to the WHO between 2000 and 2024, every single grant — all 640 of them, totaling 100 percent of the Foundation's contributions — was earmarked for specific purposes. The Foundation has, throughout the period of its WHO funding relationship, made no contributions to the WHO's unrestricted general operating budget.

The disparity between the Foundation's earmarking and global public-health need by mortality is documented. Noncommunicable diseases — cardiovascular disease, cancer, diabetes, and chronic respiratory disease — account for approximately seventy-four percent of global deaths, predominantly in low- and middle-income countries where the WHO operates. The Gates Foundation directed less than one percent of its WHO funding to this category. Polio — which has caused fewer than two hundred reported cases of paralytic disease globally in most recent years — received approximately fifty-nine percent of the Foundation's WHO funding.

The disparity is not necessarily a critique of the Foundation's own institutional priorities. The Foundation is entitled to direct its grants to whatever priorities it chooses; that is the Foundation's institutional prerogative. The disparity is, however, an institutional documentation of how the WHO's operational priorities have, in significant part, been shaped by the Foundation's priorities rather than by the WHO's own institutional assessment of global public-health need.

The Suzman Acknowledgment

The Gates Foundation's chief executive officer, Mark Suzman, in his annual letter published in February 2023, addressed the structural concern directly:

It's not right for a private philanthropy to be one of the largest funders of multinational global health efforts. But make no mistake — where there's a solution that can improve livelihoods and save lives, we'll advocate persistently for it. We won't stop using our influence, along with our monetary commitments, to find solutions. Mark Suzman — CEO, Gates Foundation, February 2023

The Suzman statement is, in its institutional candor, the clearest documented acknowledgment by the Foundation's own leadership that the structural concern about private philanthropic dominance of WHO funding is real. The Foundation, in its own characterization, does not consider its dominant funding position appropriate. It also does not consider that institutional concern sufficient to alter the Foundation's funding practices. The Foundation will, by its own statement, continue to use its "influence, along with our monetary commitments" to advance the priorities the Foundation has identified.

The structural question that the Suzman statement implicitly raises is whether the World Health Organization, as an institution, has the capacity to function independently of the largest single non-state donor whose CEO has publicly acknowledged that the donor will continue to use its monetary commitments to advance its own priorities through the institution. The documentary record of the past two decades suggests that the answer, in operational practice, has been substantially negative. The WHO's programmatic allocations have, in the period since the Foundation became its largest non-state donor, tracked the Foundation's earmarking decisions in the manner that the peer-reviewed analysis has documented.

The Other Donor Cases

The Gates Foundation is the most substantial single donor case. It is not the only case. The structural mechanism — earmarked voluntary contributions transferring programmatic authority from member-state governance to individual donors — operates equivalently for other major donors. The institutional consequence is consistent across the donor base.

The United States as Donor

The United States has been, throughout the period of voluntary-contribution dominance, the largest single contributor to the WHO. In 2022-23, U.S. contributions totaled approximately $1.28 billion across assessed ($219 million) and voluntary ($1.06 billion) contributions. The voluntary contributions were predominantly earmarked, with the largest U.S. earmarking categories being polio eradication (in coordination with the Gates Foundation's parallel funding), HIV/AIDS programs (PEPFAR-coordinated funding through the WHO), and tuberculosis-control programs.

The U.S. funding position has been twice withdrawn during the period covered by this series. The first withdrawal, announced May 29, 2020 and effective July 6, 2021, was reversed by the Biden administration on January 20, 2021. The second withdrawal, announced January 20, 2025 by President Donald Trump's executive order in his second term, remained in effect as of the publication of this article. The institutional consequence of the U.S. withdrawals has been to reduce the U.S. share of WHO financing and to increase, in proportional terms, the share of other contributors. The withdrawal has not, however, fundamentally altered the institutional architecture — it has shifted the donor mix without altering the donor-dependent structure.

The United Kingdom and Germany

The United Kingdom and Germany have been, throughout the period, among the WHO's top five contributors. Germany's contributions increased substantially after the 2020 U.S. withdrawal announcement, partially offsetting the U.S. reduction. The UK and German contributions are predominantly earmarked, with substantial portions directed to WHO emergency-preparedness programs (Germany), to maternal and child health programs (UK), and to specific regional WHO operations.

GAVI and the Global Fund

The GAVI Alliance and the Global Fund to Fight AIDS, Tuberculosis, and Malaria are institutional partnerships that channel donor contributions to the WHO for specific disease-control programs. GAVI's principal funder is the Gates Foundation; the Global Fund's principal funders are the U.S. government and the Gates Foundation. In institutional terms, GAVI and the Global Fund operate as intermediary structures that aggregate donor funds and then disburse them to WHO and other implementing partners according to programming agreements that are themselves substantially negotiated with the principal donors. The earmarking that originates with the donors persists through the partnership structure to the WHO.

The May 2022 Reform Decision

The institutional response to the structural concerns documented in the preceding sections has been, in its principal form, the World Health Assembly's May 2022 decision to substantially restore the role of assessed contributions in WHO financing. The decision, formally adopted at the Seventy-Fifth World Health Assembly, committed member states to increase assessed contributions gradually to reach approximately fifty percent of the WHO's Programme Budget by 2030.

The decision represented the most substantial reform to the WHO funding architecture in four decades. Its institutional logic was direct: the structural problems produced by donor-dominated voluntary financing required structural reform of the financing model itself, not incremental adjustments to the existing model. The decision was, in the framing of its supporters, the institutional response that the Independent Panel for Pandemic Preparedness and Response — documented in Part II of this series — had recommended.

The Implementation

The implementation of the May 2022 decision has been, in the period from 2022 through 2026, partial and contested. The 2024-25 Programme Budget approved in May 2023 included a first increment of increased assessed contributions, raising the assessed-contribution share of the WHO budget from approximately twelve percent to approximately twenty percent over the biennium. Subsequent biennial budgets are scheduled to continue the gradual increase, with the fifty-percent target to be reached by 2030.

The institutional resistance to the implementation has come from two distinct directions. The first has been from major donor governments that have expressed concern about the increased financial commitments the assessed-contribution increases would require. The United States, in particular, expressed concern during the negotiations preceding the May 2022 decision about the magnitude of the increased U.S. assessed contribution that the reform would produce; the 2025 U.S. withdrawal from the WHO has rendered this concern moot for the period of the withdrawal, but the structural question would return if a subsequent U.S. administration rejoined the WHO. The second source of resistance has been from donor governments and contributors that have been concerned about the loss of programmatic control that the shift from earmarked voluntary contributions to unrestricted assessed contributions would produce.

What Remains Unresolved

The May 2022 reform decision addresses one of the three structural mechanisms that produced the donor-dominated architecture documented in this Part — the proportion of assessed to voluntary financing. It does not, in its own terms, address the other two mechanisms. It does not require that voluntary contributions to the WHO be unrestricted rather than earmarked; donors retain their full earmarking authority over the voluntary contributions they continue to provide. It does not alter the institutional dynamics by which major donors — principally the Gates Foundation, GAVI, and the Global Fund — have established programmatic influence within the WHO that operates substantially independently of the assessed-contribution share.

The structural consequence is that, even if the May 2022 reform decision is fully implemented by 2030, the WHO will remain substantially dependent on voluntary, earmarked contributions for approximately half of its operating budget. The institutional architecture that produced the conduct documented in Part II — including the early-pandemic posture toward the Chinese government — will be modified, but not transformed. The Independent Panel's recommendations on financing reform have been partially adopted; they have not been fully implemented.

What the funding architecture table establishes is the magnitude of the structural transformation that occurred between 1970 and 2020. The institution that the WHO Constitution envisioned — a member-state-governed multilateral health authority with operational independence supported by member-state dues — became, over five decades, an institution substantially funded and substantially directed by individual donors operating through the earmarking mechanism. The May 2022 reform decision is, in this longer institutional history, an attempt to begin reversing the transformation. Its success in reversing the transformation will depend on whether the structural concerns documented in this Part — the earmarking authority retained by voluntary donors, the institutional dynamics produced by major-donor relationships, the substantive influence of donors like the Gates Foundation through their consistent programmatic priorities — are addressed in the period that remains before the next major test of the WHO's institutional independence.

The Pattern Across Three Parts

Read together, Parts I, II, and III of The Geneva Files document the institutional architecture within which the World Health Organization conducted its early-pandemic response and continues, in May 2026, to operate.

Part I documented the selection of a Director-General whose path to the office included contested classification practices for disease outbreaks during his prior tenure as Ethiopia's Health Minister, an African Union endorsement secured under Mugabe's chairmanship, Chinese diplomatic support during the 2017 campaign, and a first major personnel decision — the Mugabe Goodwill Ambassador appointment — that the international community rejected within four days.

Part II documented the institutional response of the WHO under that Director-General's leadership during the eight-week period from December 31, 2019 through approximately the end of February 2020, including the January 14 tweet, the January 22-23 Emergency Committee meeting, the January 28 Beijing meeting, and the February 15 Munich speech in which Tedros characterized the Chinese response as having "bought the world time."

Part III has documented the funding architecture within which the institution operates. The structural shift from approximately eighty percent assessed contributions in 1970 to approximately twelve percent assessed contributions in 2020. The transfer of programmatic authority from member-state governance to individual donor earmarking. The documented influence of the Bill and Melinda Gates Foundation as the largest non-state donor, with all $5.5 billion of its contributions to the WHO between 2000 and 2024 earmarked for donor-specified purposes. The May 2022 reform decision and the partial, contested implementation of that decision in the years since.

The institution that the WHO Constitution envisioned became, over five decades, an institution substantially funded and substantially directed by individual donors operating through the earmarking mechanism.

The pattern that emerges from the three Parts considered together is structural. The conduct documented in Part II is not the product of a corrupt Director-General acting in isolation. It is the product of an institutional architecture in which the Director-General, regardless of personal background, operates within substantial constraints imposed by the funding model. The structural reform required to address the conduct documented in Part II is not principally the replacement of the Director-General. It is the reform of the institutional architecture itself.

The constitutional architecture of the WHO, codified in the 1948 Constitution, envisions an institution capable of independent assessment of public-health emergencies and capable of clear communication of those assessments to all member states regardless of political consequence. The funding architecture as it has actually operated since approximately 1990 has not supported the institutional capacity that the constitutional architecture envisions. The May 2022 reform decision, if fully implemented, will begin to restore that capacity. The structural reform that the post-pandemic period requires is not, in May 2026, complete.

The next Part of this series — The IHR (2005) and the Pandemic Treaty — will examine the multilateral regulatory framework within which the WHO operates and the contested negotiations through which member states have, in the period since 2021, attempted (and failed) to reform that framework. Part V will examine the WHO-convened study mission to Wuhan in January-February 2021 and the conflicts of interest among its members. Part VI will provide the structural reckoning that the documentary record across all six Parts establishes.

What This Part Establishes

This Part has documented a funding architecture. It has not, deliberately, made certain claims that the documentary record does not support.

It has not established that the Bill and Melinda Gates Foundation acts in bad faith or with intent to harm. The Foundation's stated mission — improving global public health through technical solutions to infectious diseases — is, on its own terms, a legitimate philanthropic mission. The Foundation is, by its own institutional logic, entitled to direct its grants to the priorities its leadership has identified. The structural concern documented in this Part is not about the Foundation's intentions. It is about the institutional consequence of the Foundation's documented funding patterns operating within the WHO's earmarking architecture.

It has not established that voluntary, earmarked contributions to the WHO are, in themselves, illegitimate. Donors are entitled to earmark their contributions. The WHO is entitled to accept earmarked contributions. The institutional concern is not the existence of earmarking but its aggregate effect on the institution's operational independence when earmarked voluntary contributions constitute approximately eighty-eight percent of the institution's operating budget.

It has not established that the WHO's financing problems can be resolved by member-state government action alone. The structural shift to voluntary contributions was, in significant part, the product of member-state government decisions over four decades. The reversal of the shift requires equivalent member-state government commitment over a comparable period. The May 2022 reform decision is an important first step. Its full implementation will require sustained institutional commitment that, in May 2026, has not been demonstrated by all of the major member states involved.

What this Part does establish is that the institutional architecture within which the World Health Organization operates has been transformed, over the period from 1970 to 2020, from a member-state-governed multilateral institution funded principally by obligatory dues to a donor-directed program-management entity funded principally by earmarked voluntary contributions. The transformation was the product of institutional decisions made by the World Health Assembly itself under pressure from major member states. The transformation has substantially constrained the institution's operational independence. The conduct documented in Part II — the early-pandemic response that the Independent Panel for Pandemic Preparedness and Response characterized as "too cautious" and reflective of "an evident desire to maintain good relations with the Chinese government" — occurred within this institutional architecture and was, in significant part, a function of it.

The structural reform required to address the conduct documented in Part II is not principally a matter of replacing institutional personnel. It is a matter of reforming the institutional architecture itself. The May 2022 reform decision begins that reform. The full implementation of the reform requires sustained institutional commitment over the period from 2022 to 2030 and beyond. The institutional commitment, in May 2026, is not yet adequate to the structural reform that the documentary record establishes is required.

The documentary record of the funding architecture has been laid. The institutional response to that record, in the period from May 2022 through May 2026, has been partial and contested. The Geneva Files will continue to document, in the parts that follow, the structural mechanisms through which the institutional response has been constrained and the institutional reforms that remain to be implemented.