Financial crisis at PAHO in the time of COVID-19: a call for action
Authors: Arlene King, Jon Kim Andrus, J Peter Figueroa
Journal: The Lancet (2020)

On May 21, 2020, at a special session of the Executive Committee of the Pan American Health Organization (PAHO), WHO Regional Office for the Americas, Carissa Etienne, Regional Director, declared that due to non-payment of Member States' contributions, PAHO stands on the brink of insolvency.1Pan American Health OrganizationSpecial session of the Executive Committee. Virtual session, 29 May 2020. Provisional agenda item 3.1. Current financial situation and adjustments to the Pan-American Health Organization strategic priorities.https://www.paho.org/hq/index.php?option=com_content&view=article&id=15792:special-session-of-the-executive-committee&Itemid=40453&lang=enDate: May 29, 2020Date accessed: June 20, 2020Google Scholar As of April 30, 2020, most of the non-payment is attributable to the USA (67%); however, late payments are outstanding from Brazil, Venezuela, Mexico, Argentina, Colombia, Chile, and others, to a total of US$164·6 million. This includes an unprecedented $63·8 million (57%) of 2019 assessed contributions. This financial crisis could not have occurred at a worse time. The Americas have recorded the greatest COVID-19 morbidity and mortality of any region. As of June 25, 2020, the COVID-19 Information System for the Region of the Americas has recorded 4·6 million cases and 230 400 deaths in 54 countries. The trajectory is worsening. Health security in the western hemisphere would be severely threatened without a functioning PAHO. Reserve funds will be exhausted by September, 2020. PAHO faces dire actions, including executing borrowing options and possible implementation of key staff furlough measures. PAHO was established in 1902 to promote public health action against infectious disease threats. A core value was Pan-Americanism, expressed in the countries' commitment to work together to improve the health of populations living in the poorest countries.2Andrus JK de Quatros C Ruis Matus C Luciani S Hotez P New vaccines for developing countries: will it be feast or famine?.Amer J Law Medicine. 2009; 35: 311-322Crossref PubMed Scopus (19) Google Scholar With PAHO's leadership, countries of the Americas eliminated polio in 1991, measles in 2002, rubella in 2002, congenital rubella syndrome in 2009, and neonatal tetanus in 2017. PAHO has played crucial roles in responding to numerous other infectious disease threats, controlling the rising tide of non-communicable disease and strengthening health systems. Leadership and coordination at global and regional levels are pivotal to minimising morbidity and mortality during the COVID-19 pandemic. PAHO must work with all member states to ensure a sustained response to the pandemic and equitable access to vaccine, treatment, and supplies. As health services have been adversely affected by COVID-19, we must anticipate and respond to epidemic-prone vaccine-preventable disease outbreaks as well as complications arising from disruption in the management of chronic diseases and cancer. This is a call to action to countries of the Americas to pay their outstanding contributions and avoid a financial crisis with known and unknown consequences. It is a call for all countries to work together to overcome the challenge of COVID-19 in the spirit of solidarity and protecting the health of all. AK is Chair of the Regional Certification Commission for the Polio Endgame, Pan American Health Organization (PAHO). JKA is Chair of the Regional Verification Commission for Measles and Rubella Elimination, PAHO. JPF is Chair of the Technical Advisory Group for Vaccine Preventable Diseases, PAHO. We declare no competing interests. Ending support for medical organisations puts the world at riskWe read with interest and deep concern the Correspondence from Arlene King and colleagues1 regarding the decision of some countries to stop (or delay) financing of WHO and, by default, the health organisations that depend on it, such as the Pan American Health Organization (PAHO). Although we do acknowledge the repercussions of the COVID-19 pandemic and how this unprecedented situation has affected not only the health of people living in the Americas but also the fragile economies, reducing the ability of health organisations to help to manage endemic, pandemic, and neglected tropical diseases by stopping financing of these organisations is a reason for global concern. Full-Text PDF PAHO needs reform and awareness, not solidarity and fundingIn a call to action, Arlene King and colleagues1 emphasise the potential for insolvency at the Pan American Health Organization (PAHO) and urge member states to pay their outstanding contributions. King and colleagues called on the spirit of solidarity in member states. However, PAHO, which was established well before WHO, has always had problems of solidarity. As such, it is apparent that solidarity might not be attainable in the near future to overcome the crisis at PAHO. Full-Text PDF