By JAMEY KEATEN

GENEVA (AP) — Stripped of U.S. funding, the World Health Organization chief on Monday appealed to member countries to support its “extremely modest” request for a $2.1 billion annual budget by putting that sum into perspective next to outlays for ad campaigns for tobacco or the cost of war.

After nearly 80 years of striving to improve human lives and health –- which critics say it has done poorly or not enough — the U.N. health agency is fighting for its own after U.S. President Donald Trump in January halted funding from the United States, which has traditionally been WHO’s largest donor.

“Two-point-one billion dollars is the equivalent of global military expenditure every eight hours,” WHO Director-General Tedros Adhanom Ghebreyesus said. “Two-point-one billion dollars is the price of one stealth bomber, to kill people.”

“And $2.1 billion is one-quarter of what the tobacco industry spends on advertising and promotion every single year. Again, a product that kills people.” he told the WHO’s annual assembly. “It seems somebody switched the price tags on what is truly valuable in our world.”

Tedros made no specific reference to the U.S. cuts but has said previously the U.S. pullout was a “mistake” and urged Washington to reconsider.

WHO has presented a budget for the next two years that is 22% less than originally planned, largely in response to U.S. and other Western funding cuts, and says it has landed commitments for about 60% of that. But it still faces a budget gap of $1.7 billion.

“We know that in the current landscape, mobilizing that sum will be a challenge. We are not naive to that challenge,” Tedros said.

“But for an organization working on the ground in 150 countries with a vast mission and mandate that member states have given us, $4.2 billion for two years — or $2.1 billion a year — is not ambitious. It’s extremely modest,” he said.

Cuts that could cost lives

As a result of the cuts, the U.N. health agency this year has seen a plunge in its ability to carry out its sweeping mandate to do everything from recommend reductions in sugar levels in soft drinks to head the global response to pandemics like COVID-19 or outbreaks like polio or Ebola.

Tedros and his team have been grappling with a response to the U.S. cuts as well as reduced outlays from wealthy European countries that are worried about an expansionist Russia and are putting more money toward defense, and less toward humanitarian and development aid.

Matthew Kavanagh, the director of Georgetown University’s Center for Global Health Policy and Politics, said other countries have used the U.S. cut in aid “as cover to do their maneuvering, with many countries in Europe reducing aid.”

“The WHO faces an existential crisis that goes well beyond a budget gap to the question of whether this sort of multilateralism can succeed in addressing global health in this new era of nationalism and misinformation,” he said, alluding to discord between many countries that could cost lives.

“Literally millions will likely die needlessly on the current trajectory and the world’s health ministers do not seem capable of a coherent response,” Kavanagh added.

Pandemic preparedness on the agenda

On tap for the nine-day World Health Assembly are two major advances that are aimed to buttress WHO’s financial strength and bolster the world’s ability to cope with future pandemics.

Member countries are expected to agree to raise annual dues, known as “assessed contributions,” by 20% to support WHO finances and reduce dependency on governments’ voluntary contributions — which change each year and make up over half of the budget.

They are also expected to agree to a hard-wrought “ pandemic treaty ” that was born of a desire to avoid any replay of the patchy, unequal response to COVID-19 when the next — and inevitable, most experts say — pandemic hits.

Among other things, the treaty would guarantee that countries that share critical samples of viruses will receive any resulting tests, medicines and vaccines and give WHO up to 20% of such products to make sure poorer countries can have access to them.

“Every World Health Assembly is significant, but this year’s is especially so,” Tedros said. “This is truly a historic moment.”

The treaty’s effectiveness will face doubts when the U.S. — which poured billions into speedy work by pharmaceutical companies to develop COVID-19 vaccines — is sitting out, and because countries face no penalties if they ignore it, a common issue in international law.

Kavanagh said passage of the treaty “could be a significant victory — evidence that the U.S. government may no longer be indispensable in global health” and could offer an opportunity for developing nations in the “global South” over the longer term.

Management shake-up as critics blast WHO

Trump has long derided WHO, including back in his first term when he pulled the United States out over its alleged kowtowing to China and other alleged missteps in the Covid pandemic. President Joe Biden put the U.S. back in.

On his first day back in office in January, Trump signed an executive order to pause future transfers of U.S. government funds to the WHO, recall U.S. government staff working with it, and announce a formal pullout by next January — under a one-year timetable required under U.S. law.

Other opponents continue to lash out at WHO. CitizenGo, an activist group that supports right-to-life and religious liberty issues, protested Monday against the pandemic treaty outside the U.N. compound in Geneva where WHO’s meeting was taking place.

The rally included a balloon sculpture in the shape of the world and a banner inveighing against “globalist elites” and showing an image of Tedros and billionaire Microsoft co-founder Bill Gates, a major WHO supporter, shaking hands while surrounded by dollars.

“In the aftermath of Covid, the WHO got together and thought was a good idea to centralize even more power,” said CitizenGo campaigner Sebastian Lukomski, accusing WHO of an effort to “remove more fundamental freedoms and not learn from the mistakes that were taking place during COVID.”

In the run-up to the assembly, WHO has been cleaning house and cutting costs.

At a meeting on its budget last week, Tedros — a former Ethiopian health and foreign minister – announced a shake-up of top management that included the exit of key adviser Dr. Michael Ryan from the job as emergencies chief.

Tedros said last week that the loss of U.S. funds and other assistance have left the WHO with a salary gap of more than $500 million.