Yet most public health professionals agree that the WHO is desperately in need of reform. It has been for a very long time. Despite a sprawling global mandate, the U.N. agency, which was founded in 1949, has an annual budget of just $2.2 billion—smaller than the largest American hospitals and a fraction of the $11.9 billion allocated to the U.S. Centers for Disease Control.

The U.S. is the largest single donor to the WHO, contributing over $400 million in 2019 including both assessed (mandatory) contributions and voluntary top-up donations from government and private sources (Though, in fact, the U.S. is currently $200 million in arrears.)

The WHO’s shoestring budget is largely because assessed contributions were frozen in the early 1980s amid the Reagan Administration’s outrage that U.N. bodies—particularly UNESCO—appeared to be tilting toward Moscow as more Kremlin-aligned third-world states joined up. As a result, assessed contributions have not risen in real terms since then and continue to be based on a combination of GDP and population. The U.S. today still provides around twice the assessed contributions of second place China.