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US President Donald Trump has threatened to halt funds to the UN's World Health Organisation (WHO).
While we don't yet know what form the funding freeze could take, or even if Mr Trump has the authority to withdraw, experts fear cutting out a large chunk of the WHO's funding could have disastrous effects on the world's most vulnerable countries.
The WHO has been criticised for its response to the pandemic, but what are the ripple effects of defunding it?
Firstly, how is the WHO funded?
The US is by far the WHO's biggest donor, giving almost $US900 million ($1.4 billion) to the WHO's budget for 2018 and 2019, according to information on the agency's website.
There are two funding streams: assessed contributions, and voluntary contributions.
Assessed contributions are what countries pay in order to be a member of the organisation — the WHO has 194 member states across the world.
The payment is calculated based on the country's wealth and population, which is why countries like the US pay more than lower-income countries.
Dr Davies said that budget is for operational purposes at headquarters, including costs like wages and flights, but several states have not paid their dues.
For several years now, the WHO says, these assessed contributions have made up less than a quarter of the WHO's financing.
The other three-quarters come from voluntary contributions, which can be flexible or earmarked for specific projects.
The US is by far the biggest donor to that, making up 15 per cent of the total voluntary contributions.
The Bill and Melinda Gates Foundation is the second-largest voluntary donor, contributing 9.8 per cent. Australia contributes 0.75 per cent, while China gives 0.21 per cent.
The WHO has a proposed budget of $7.5 billion ($US4.8 billion) for 2020–21.
So, how will a funding cut impact poorer nations?
WHO Director-General Dr Tedros Adhanom Ghebreyesus was asked directly about the shortfall a potential US withdrawal would create, and how it would impact the WHO.
Dr Tedros did not respond with a dollar amount, saying the group was still assessing how their programs will be affected.
"We will work with partners to fill any gaps and ensure our work continues uninterrupted," he said. "We will get back to you after our assessment is completed."
"We have been fighting the pandemic with every ounce of our soul and spirit. We will continue to do that to the end. That is our commitment to the whole world."
Karol Sikora, chief medical officer at Rutherford Health and former head of the WHO's cancer program, said countries with weaker health systems and lower-income countries stood to lose out if the US pulled the plug.
"If you withdraw funding, as Trump is suggesting, all that will happen is the poor people will suffer disproportionately around the world because they're the ones that gain the most from the WHO," he told the ABC.
Dr Sara Davies, an expert in global health governance at Griffith University, said if the cuts go ahead, "we will see the WHO have to make tough decisions about which programs it can continue".
"The WHO has been struggling with a diminishing operational budget for some time. The Trump decision accelerates the hard choices," she said.
Professor Adrian Bauman, co-director of the WHO Collaborating Centre for Physical Activity, Nutrition & Obesity at the University of Sydney, told RN Breakfast a US withdrawal would be "immediately disastrous".
There are 50 WHO Collaborating Centres based in Australia and more than 800 globally, which help support the WHO's health programmes around the world.
Professor Bauman said cuts to US funding would affect the work they do, including in extremely vulnerable regions like the Pacific.
"It impacts every WHO Collaborating Centre, and every country, because our capacity to help — particularly in low-income countries, and our neighbouring countries, will be impacted," he said.
"There won't be the support of overarching infrastructure to help contain this epidemic, or to help immunisation programs. We had the huge measles epidemic in the Pacific recently.
"Those kinds of things will be resurgent, and that will be a global health disaster: and the US won't benefit from that either, because the epidemic will be prolonged, the economic downturn will be bad for the US too, and the US will lose trust and leadership."
Apart from declaring pandemics, what does the WHO do?
The body's mission is to "promote health, keep the world safe, serve the vulnerable".
The WHO has a triple-billion target — 1 billion people benefiting from universal health coverage, 1 billion more people better protected from health emergencies, and 1 billion more people having better health and wellbeing.
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The WHO says "hitting the triple-billion targets would result in 30 million lives saved, 100 million healthy life-years improved and 2–4 per cent economic growth in low and middle-income countries" by 2023.
The majority of the WHO's work is centred on Africa and the Middle East, with eradicating polio a key focus of the group.
More than 67 per cent of funds are focused on Africa and the Middle East, and more than a quarter — 26 per cent — goes towards eradicating polio.
Around 12 per cent goes towards increasing access to essential health and nutrition services, while around 9 per cent goes towards vaccine-preventable diseases.
Is the WHO beholden to China?
The WHO has been criticised for not declaring the outbreak a pandemic sooner, and for advising against travel bans on China. Professor Sikora said those decisions have since proved to be big mistakes.
Taiwan has also accused the WHO of suppressing information about the country's coronavirus prevention measures. Taiwan is not a member of the WHO, which is only open to UN members (Taiwan was voted out of the UN in 1971 in favour of China).
"The WHO is facing so much criticism because of the efforts it went to ensure that, in the early stages, China provided as much information as possible," Dr Davies said. "The WHO is in a very difficult position."
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Global health politics researcher Jeremy Youde from the University of Minnesota Duluth said, "it's not accurate to say that the WHO is beholden to China".
"When there is a disease outbreak that begins in one country, it is imperative that the WHO engage with that country — and that's what we saw Tedros doing," he said.
"There has been criticism of his praise for China, and I understand that, but the WHO is limited in its ability to encourage states to cooperate with it.
"It can't impose fines or threaten to invade; it needs to try and persuade."
He said the WHO had to weigh up how best to engage with China at a time when public health and geopolitics intersect.
"Are Chinese authorities more likely to share data and work collaboratively if WHO officials publicly name-and-shame them for their shortcomings or if they praise their efforts and try to bring them into the fold?"
'More transparency' — Does the WHO need reform?
"The WHO does need reform. Everybody knows that," Professor Sikora said.
But he said it's the best organisation to deal with global health and help nations strategise — so rather than scrapping it, it should be improved.
He said the WHO was plagued by bureaucratic hang-ups.
"If it means firing top management, let's do that," he said.
"It's top-heavy. It concentrates on the diplomatic life, the cycle of embassy parties … there's a lot that could be changed."
"But we can do that without Trump just having a tantrum about it."
Dr Davies said there will need to be an independent review of the WHO's response to COVID-19, after reviews were held to investigate its adherence to procedure during the H1N1 pandemic and the Ebola outbreak in West Africa.
She said this would help "clear the air" and clarify whether the WHO Director-General and others in senior leadership had followed international health regulations.
"One reform may be the WHO has to provide more transparency in its decision-making processes," she said.
"This has been recommended since the time of H1N1 and I think COVID-19 has shown why transparency matters."
What happens now?
Despite some criticism of the WHO's handling of the crisis, many say threatening to cut funds during the biggest pandemic since the Spanish Flu is the wrong approach — including Bill and Melinda Gates, whose foundation is a major voluntary donor to the WHO.
The Bill and Melinda Gates Foundation has now announced an extra $US150 million ($238.6 million) to help speed up the development of treatments, vaccines and public health measures to tackle coronavirus.
Mr Trump's decision was "a crime against humanity" and a "betrayal of global solidarity", according to Richard Horton, the editor-in-chief of the Lancet medical journal.
Humanitarian group CARE said abandoning the WHO in this time of crisis "will only put more lives at risk".
"The Trump administration's decision to halt funding to the World Health Organisation is dangerous, self-defeating, and short-sighted," they said in a statement.
Asked about the Trump administration's announcement, Treasurer Josh Frydenberg told the ABC this morning that Australia would continue to support the WHO, given its positive track record in the Pacific region.
However, he also accused the WHO of making "significant mistakes" during the outbreak, saying the body was slow to declare the virus a pandemic, made the wrong calls when it told countries not to close their national borders and expressed support for wet markets.
Dr Davies and Dr Youde pointed out Mr Trump has sought cuts to several other global health initiatives and United Nations institutions.
Others, like US House of Representatives Speaker Nancy Pelosi, have suggested Mr Trump is attempting to deflect blame from his administration's response to the pandemic in the US, where more than 630,000 people have been infected and more than 30,000 have died.
"This decision is dangerous, illegal and will be swiftly challenged," she said.
Dr Youde said there were still many unknowns about what form the funding freeze would take.
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"Will it be all funds that the US gives to the WHO? Just the assessed contribution? Just the voluntary contributions? There are also questions about the president's authority to do this," he said.
"Depending on how this funding freeze gets implemented, it could have a fairly immediate budgetary effect on the WHO," he said.
"Even more importantly, though, it signals that the US is seemingly no longer interested in maintaining its leadership role within the global governance of health."
The withdrawal would create a power vacuum, he said.
"If the US is really concerned that other countries like China are too influential in the WHO, then freezing its funding just creates a vacuum thanks to the loss of American leadership — and that's a void that China or other countries could fill," he said.
"You're going to have a greater ability to influence the direction of the WHO from the inside rather than by standing on the sidelines."
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Topics: world-politics, covid-19, diseases-and-disorders, health, united-states, china, australia