Sobre el futuro de la Organización Mundial de la Salud se cierne una preocupante nube en uno de los momentos más decisivos de su historia.
El presidente Donald Trump ordenó este martes suspender las contribuciones de Estados Unidos al presupuesto de la organización justo cuando el ente es una referencia en la lucha en el mundo contra la pandemia del coronavirus.
El mandatario estadounidense dijo que la medida se aplicaría mientras se realizaba una revisión papel de la OMS en las «graves» fallas en la gestión de la pandemia del covid-19, así como en el presunto «ocultamiento» del alcance de los contagios.
«Si la OMS hubiera hecho su trabajo de enviar expertos médicos a China para calibrar la situación de forma objetiva en el terreno y criticar la falta de transparencia de China, el brote se podría haber contenido en el foco con muy pocas muertes», especuló Trump, que acusa al ente de seguir al gobierno del gigante asiático, foco de origen de la pandemia.
Contribuciones obligatorias y voluntarias
Fundada en 1948 como parte del sistema de la Organización de Naciones Unidas, la OMS tiene como objetivos «promover la salud, mantener el mundo seguro y servir a los vulnerables».
La institución, cuya sede está en Ginebra (Suiza), dispuso para el bienio 2018-2019 de un presupuesto por unos US$5.600 millones, que se nutre fundamentalmente de dos fuentes distintas.
En primer lugar, están las contribuciones obligatorias que hacen sus 194 estados miembros.
Se trata de cuotas que son fijadas por la ONU de acuerdo con una fórmula compleja que toma en cuenta la riqueza y la población del país. Es dinero que sirve básicamente para pagar por los salarios y los gastos administrativos.
En 2018- 2019, esas aportaciones representaron en torno a unos US$950 millones.
En segundo lugar están las contribuciones voluntarias que permiten a donantes estatales y no estatales comprometer fondos para campañas sobre temas concretos como, por ejemplo, la vacunación contra la polio, el cuidado de la salud de las mujeres o la erradicación del tabaquismo.
En 2018-2019, estos fondos fueron de unos US$4.300 millones.
El «problema»
Jack Chow, exembajador de Estados Unidos para la lucha global con el VIH y ex subdirector de la OMS, afirma que en los últimos tiempos la OMS se ha vuelto cada vez más dependiente de esos recursos, que ya forman la parte más abultada de su presupuesto.
«Esto genera un problema porque entonces son los donantes quienes establecen la agenda que debe seguir la OMS, en lugar de que esta obedezca a su criterio profesional», apunta Chow en conversación con BBC Mundo.
De acuerdo con la información financiera más reciente ofrecida por la OMS, Estados Unidos es el principal contribuyente al haber comprometido unos US$893 millones para el bienio 2018-2019, de los cuales hasta el cuarto trimestre de 2019 ya habían sido desembolsados unos US$553 millones.
Eso equivale al 14,67% de todos los recursos recibidos por esa organización.
Por contraste, China tenía comprometidos unos US$86 millones, de los cuales había desembolsado unos US$7,9 millones. Lo que equivale a 0,21% de los fondos.
Trump acusa a la OMS de no haber cuestionado al gobierno de China, donde se originó la pandemia actual.
Después de Estados Unidos, el segundo mayor contribuyente a la OMS no es un Estado, sino un ente privado: la Fundación Bill y Melinda Gates, que comprometió unos US$530 millones, de los cuales había hecho efectivos unos US$367 millones, equivalente a 9,76%.
Los Gates fueron críticos con la orden de Trump de suspender las contribuciones.
El tercer mayor contribuyente es GAVI, una asociación en la que participan organizaciones de los sectores público y privado que buscan incrementar el acceso que tienen a las vacunas los 73 países más pobres del mundo.
Suman aportaciones por US$316 millones, un 8,9% de los fondos recibidos por la OMS.
Reino Unido es el cuarto mayor donante y el segundo Estado que hace más aportaciones con desembolsos hasta el cuarto trimestre de 2019 por unos US$294 millones, equivalentes a 7,79% del presupuesto.
En América Latina, los países que tienen las mayores cuotas son Brasil (US$35,5 millones), México (US$13,7 millones) y Argentina (US$8,5 millones).
El impacto sin el dinero de EE.UU.
Por lo tanto, el impacto, si se concreta la retirada de las aportaciones de Estados Unidos, será alto para la OMS.
«La decisión de Trump de dejar de financiar la OMS tendrá consecuencias de largo alcance», dice el doctor Jack Chow en conversación con BBC Mundo.
«La principal misión de la OMS es evitar el colapso de sistemas de salud frágiles en todo el mundo. Los asesores de la OMS trabajan con departamentos de salud, médicos comunitarios y trabajadores sanitarios para ayudarlos a dar la mejor atención a sus pacientes», agrega.
«Esta medida de Trump podría significar poner fin a varios programas clave, la retirada de muchos asesores de la OMS de países de todo el mundo y, en consecuencia, más personas en lugares como América Latina pueden estar en peligro no solamente por el covid-19 sino por muchas otras enfermedades como la tuberculosis o la malaria«, alerta Chow.
De acuerdo con las cifras más recientes publicadas por la OMS, de los recursos aportados por Estados Unidos para el bienio 2018-2019, la mayor parte va destinado a la zona del Mediterráneo oriental, que abarca unos 22 países que van desde Marruecos hasta Pakistán.
Esta región ha recibido unos US$201 millones, equivalentes al 36% de los desembolsos hechos por Washington.
La segunda zona que recibe más fondos es África, que incluye 47 países de ese continente. Los desembolsos de Estados Unidos destinados allí suman US$151 millones.
El tercer destino más importante del dinero estadounidense son las oficinas centrales de la OMS, que reciben en torno a US$101 millones que luego son empleados tanto para sus gastos operativos como para distintas campañas de salud.
Solamente una parte muy pequeña de las aportaciones de Estados Unidos, unos US$280.000, en torno a 0,5%, se han empleado en el financiamiento de actividades de la OMS en países de América Latina y del Caribe.
En términos de campañas de salud, más de una cuarta parte de las contribuciones de Estados Unidos han estado dirigidas a la erradicación delapolio en el mundo (US$158 millones o 27% del total).
Otros US$100 millones han sido empleados en programas destinados a garantizar el acceso de las personas a servicios de salud y de nutrición básicos; mientras que unos US$44 millones se han usado en programas de vacunación contra enfermedades prevenibles.
Con US$33 millones, la lucha contra la tuberculosis también ha recibido importantes aportaciones.
Pero, estos son solamente algunos de los programas principales pues además se destinan fondos a la lucha contra el VIH y la hepatitis, a la prevención y control de epidemias, al combate de enfermedades tropicales, a salud reproductiva, a acceso a medicamentos, entre otros asuntos.
En el caso del covid-19, la OMS solicitó en marzo pasado unos US$675 millones adicionales para combatir la pandemia y se espera que pida ahora al menos US$1.000 millones más.
«Solo empeora las cosas»
Chow coincide con la visión de que la organización necesita ser reformada y reforzada.
Señala que tanto la OMS como China son criticables por haber «puesto un velo sobre la información y sobre la gravedad del peligro que venía» con la crisis del coronavirus, pero advierte que este no es el momento adecuado para ejecutar una decisión como la de Trump.
«El mejor momento para valorar y criticar a los países y a la OMS será cuando la pandemia haya sido derrotada. Atacar y dejar sin fondos a la OMS en medio de una crisis intensa solamente empeora las cosas», critica Chow.
«Esto es como quitar el financiamiento al cuerpo de bomberos justo cuando enfrentas un incendio devastador«, concluye.
Fuente: BBC /Ángel Bermúdez
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