Financial crisis at PAHO in the time of COVID-19: a call for action.

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. 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. 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.