On January 23, WHO Director-General Tedros Adhanom Ghebreyesus sent a memo to staff announcing the cost-cutting measures. Reuters obtained a copy of the memo.
“This announcement has made our financial situation more acute,” Tedros wrote, referring to the US withdrawal plans. WHO’s budget mainly comes from dues and voluntary contributions from member states. The dues are a percentage of each member state’s gross domestic product, and the percentage is set by the UN General Assembly. US contributions account for about 18 percent of WHO’s overall funding, and its two-year 2024-2025 budget was $6.8 billion, according to Reuters.
To prepare for the budget cut, WHO is halting recruitment, significantly curtailing travel expenditures, making all meetings virtual, limiting IT equipment updates, and suspending office refurbishment.
“This set of measures is not comprehensive, and more will be announced in due course,” Tedros wrote, adding that the agency would do everything it could to protect and support staff.
The country’s pending withdrawal has been heavily criticized by global health leaders and US experts, who say it will make the world less safe and weaken America. In a CBS/KFF Health News report examining the global health implications of the US withdrawal, Kenneth Bernard, a visiting fellow at the Hoover Institution at Stanford University who served as a top biodefense official during the George W. Bush administration, did not mince words:
“It’s just stupid,” Bernard said. “Withdrawing from the WHO leaves a gap in global health leadership that will be filled by China,” he said, “which is clearly not in America’s best interests.”
The United States noticed its withdrawal from the World Health Organization (WHO) in 2020 due to the organization’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. In addition, the WHO continues to demand unfairly onerous payments from the United States, far out of proportion with other countries’ assessed payments. China, with a population of 1.4 billion, has 300 percent of the population of the United States, yet contributes nearly 90 percent less to the WHO.
Health experts fear that a US withdrawal from the agency would significantly diminish the agency’s resources and capabilities, leave the world more vulnerable to health threats, and isolate the US, hurting its own interests and leaving the country less prepared to respond to another pandemic. The New York Times noted that a withdrawal would mean that the US Centers for Disease Control and Prevention would lose, among many things, access to global health data that the WHO compiles.
It remains legally unclear if Trump can unilaterally withdrawal the country from the WHO, or if the withdrawal also requires a joint act with Congress.
There’s a good chance you’ve seen headlines about HMPV recently, with some touting “what you need to know” about the virus, aka human metapneumovirus. The answer is: not much.
It’s a common, usually mild respiratory virus that circulates every year, blending into the throng of other seasonal respiratory illnesses that are often indistinguishable from one another. (The pack includes influenza virus, respiratory syncytial virus (RSV), adenovirus, parainfluenza virus, common human coronaviruses, bocavirus, rhinovirus, enteroviruses, and Mycoplasma pneumoniae, among others.) HMPV is in the same family of viruses as RSV.
As one viral disease epidemiologist at the US Centers for Disease Control summarized in 2016, it’s usually “clinically indistinguishable” from other bog-standard respiratory illnesses, like seasonal flu, that cause cough, fever, and nasal congestion. For most, the infection is crummy but not worth a visit to a doctor. As such, testing for it is limited. But, like other common respiratory infections, it can be dangerous for children under age 5, older adults, and those with compromised immune systems. It was first identified in 2001, but it has likely been circulating since at least 1958.
The situation in China
The explosion of interest in HMPV comes after reports of a spike of HMPV infections in China, which allegedly led to hordes of masked patients filling hospitals. But none of that appears to be accurate. While HMPV infections have risen, the increase is not unusual for the respiratory illness season. Further, HMPV is not the leading cause of respiratory illnesses in China right now; the leading cause is seasonal flu. And the surge in seasonal flu is also within the usual levels seen at this time of year in China.
Last week, the Chinese Center for Disease Control and Prevention released its sentinel respiratory illness surveillance data collected in the last week of December. It included the test results of respiratory samples taken from outpatients. Of those, 30 percent were positive for flu (the largest share), a jump of about 6 percent from the previous week (the largest jump). Only 6 percent were positive for HMPV, which was about the same detection rate as in the previous week (there was a 0.1 percent increase).
The H5N1 bird flu situation in the US seems more fraught than ever this week as the virus continues to spread swiftly in dairy cattle and birds while sporadically jumping to humans.
On Monday, officials in Louisiana announced that the person who had developed the country’s first severe H5N1 infection had died of the infection, marking the country’s first H5N1 death. Meanwhile, with no signs of H5N1 slowing, seasonal flu is skyrocketing, raising anxiety that the different flu viruses could mingle, swap genetic elements, and generate a yet more dangerous virus strain.
But, despite the seemingly fever-pitch of viral activity and fears, a representative for the World Health Organization today noted that risk to the general population remains low—as long as one critical factor remains absent: person-to-person spread.
“We are concerned, of course, but we look at the risk to the general population and, as I said, it still remains low,” WHO spokesperson Margaret Harris told reporters at a Geneva press briefing Tuesday in response to questions related to the US death. In terms of updating risk assessments, you have to look at how the virus behaved in that patient and if it jumped from one person to another person, which it didn’t, Harris explained. “At the moment, we’re not seeing behavior that’s changing our risk assessment,” she added.
In a statement on the death late Monday, the US Centers for Disease Control and Prevention emphasized that no human-to-human transmission has been identified in the US. To date, there have been 66 documented human cases of H5N1 infections since the start of 2024. Of those, 40 were linked to exposure to infected dairy cows, 23 were linked to infected poultry, two had no clear source, and one case—the fatal case in Louisiana—was linked to exposure to infected backyard and wild birds.
Enlarge/ A negative stain electron micrograph of a mpox virus virion in human vesicular fluid.
The World Health Organization on Wednesday declared an international health emergency over a large and rapidly expanding outbreak of mpox that is spilling out of the Democratic Republic of the Congo.
It is the second time in about two years that mpox’s spread has spurred the WHO to declare a public health emergency of international concern (PHEIC), the highest level of alarm for the United Nations health agency. In July 2022, the WHO declared a PHEIC after mpox cases had spread across the globe, with the epicenter of the outbreak in Europe, primarily in men who have sex with men. The outbreak was caused by clade II mpox viruses, which, between the two mpox clades that exist, is the relatively mild one, causing far fewer deaths. As awareness, precautions, and vaccination increased, the outbreak subsided and was declared over in May 2023.
Unlike the 2022–2023 outbreak, the current mpox outbreak is driven by the clade II virus, the more dangerous version that causes more severe disease and more deaths. Also, while the clade I virus in the previous outbreak unexpectedly spread via sexual contact in adults, this clade II outbreak is spreading in more classic contact patterns, mostly through skin contact of household members and health care workers. A large proportion of those infected have been children.
To date, Democratic Republic of the Congo (DRC), where the virus is endemic, has reported more than 22,000 suspect mpox cases and more than 1,200 deaths since the start of January 2023. In recent months, the outbreak has spilled out into multiple neighboring countries, including Burundi, Central African Republic, Republic of the Congo, Rwanda, Kenya, and Uganda.
Earlier on Wednesday, the WHO convened an emergency committee to review the situation, in which experts from affected countries presented data to independent international experts. The committee concluded that the outbreak constituted a PHEIC, and WHO Director-General Dr. Tedros Adhanom Ghebreyesus followed their recommendation.
“The emergence of a new clade of mpox, its rapid spread in eastern DRC, and the reporting of cases in several neighboring countries are very worrying,” Tedros said in a statement announcing the PHEIC. “On top of outbreaks of other mpox clades in DRC and other countries in Africa, it’s clear that a coordinated international response is needed to stop these outbreaks and save lives.”
On Tuesday, the Africa Centers for Disease Control and Prevention declared a similar emergency. Africa CDC Director General Dr. Jean Kaseya said the declaration will “mobilize our institutions, our collective will, and our resources to act—swiftly and decisively. This empowers us to forge new partnerships, strengthen our health systems, educate our communities, and deliver life-saving interventions where they are needed most.”
For now, the US Centers for Disease Control and Prevention assess the risk to the US public to be “very low,” given that there is limited and no direct travel between the US and the epicenter of the outbreak. So far, no clade I cases have been detected outside of central and eastern Africa.
The Centers for Disease Control and Prevention is putting clinicians on alert about the growing risk of measles cases and outbreaks amid a global surge in transmission.
Between December 1, 2023, and January 23, 2024, there have been 23 confirmed measles cases in the US, including seven direct importations by international travelers and two outbreaks with more than five cases each, the CDC noted. Most of the cases were in unvaccinated children and teens.
Measles outbreaks in the US are typically sparked by unvaccinated or undervaccinated US residents who pick up the infection abroad and then, when they return, transmit the disease to pockets of their communities that are also unvaccinated or undervaccinated.
Globally and in the US, vaccination rates against measles—via the measles, mumps, and rubella vaccine (MMR)—have fallen in recent years due to pandemic-related health care disruption and vaccine hesitancy fueled by misinformation.
“The increased number of measles importations seen in recent weeks is reflective of a rise in global measles cases and a growing global threat from the disease,” the CDC’s outreach message, titled “Stay Alert for Measles Cases,” read.
According to data from the World Health Organization, the European region saw an over 40-fold rise in measles cases in 2023 as compared with 2022. The region tallied over 42,200 measles cases last year, compared with just 941 in 2022.
This week, the WHO reported a rapid escalation of measles cases in Kazakhstan (which the WHO considers part of the European region). Kazakhstan has recorded the highest incidence of measles cases in the region, with 13,677 cases in 2023. That corresponds to over 639 cases per million in the population. In the news release Tuesday, Kazakhstan’s health minister reported that there are “currently 2,167 children in hospital with measles, 27 of them in a serious condition.”
The outbreak is largely spurred by unvaccinated children who missed their routine immunizations during the pandemic. Sixty-five percent of the reported measles cases are in children under age 5, the WHO noted. The country is now trying to catch children up on their vaccines to curb the outbreak.
“Measles is highly infectious, but fortunately, can be effectively prevented through vaccination,” WHO’s Regional Director for Europe, Hans Henri P. Kluge, said in the news release. “I commend Kazakhstan for the urgent measures being taken to stop the spread of this dangerous disease.”
Meanwhile, measles is flaring up in many other places. Last week, the UK Health Security Agency warned of the potential for an ongoing measles outbreak to spread. As of January 18, there were 216 confirmed cases and 103 probable cases in the West Midlands region since October 2023. Authorities warned that any areas with low MMR vaccination rates are at risk of an outbreak.
The vast majority of Americans have received their MMR vaccines on schedule. In this case, the two standard, recommended doses are considered 97 percent effective against measles, and the protection is considered for life. But anyone who is unvaccinated or undervaccinated is at high risk of infection in the event of an exposure. The virus can linger in air space for up to two hours after an infected person leaves the area, the CDC notes, and is highly infectious—up to 90 percent of unvaccinated people exposed will fall ill. Once infected, people are infectious from four days before the telltale measles rash develops to four days afterward.
