Public health experts have warned of major repercussions following the withdrawal of the United States from the World Health Organisation, undermining the nation’s standing as a global health leader and threatening a shift in world health dynamics, notes MedicalBrief.
In an executive order issued about eight hours after he took the oath of office, Trump cited a string of reasons for the withdrawal, including the WHO’s “mishandling of the Covid-19 pandemic” and the “failure to adopt urgently needed reforms”.
He said the agency demanded “unfairly onerous payments” from the United States, and complained that China paid less.
The move was not unexpected, reports The New York Times. Trump has been railing against the agency since 2020, when he attacked it over its approach to the coronavirus pandemic and threatened to withhold United States funding from it. In July 2020, he took formal steps to withdraw from the WHO.
But after he lost the 2020 election, the threat did not materialise. On his first day in office, 20 January 2021, former President Joe Biden blocked it from going into effect.
Leaving the WHO would mean, among other things, that the Centres for Disease Control and Prevention (CDC) will have no access to the global data the agency provides. When China characterised the genetic sequence of the novel coronavirus in 2020, it released the information to the WHO, which shared it with other nations.
More recently, the WHO has become a target of conservatives over its work on a “pandemic treaty” to strengthen pandemic preparedness and set legally binding policies for member countries on surveillance of pathogens, rapid sharing of outbreak data, and building up local manufacturing and supply chains for vaccines and treatments, among others.
Talks on the treaty broke down last year. In the United States, some Republican lawmakers viewed the agreement as a threat to American sovereignty.
Lawrence Gostin, a public health law expert at Georgetown University who helped negotiate the treaty, said a United States withdrawal from the WHO would be “a grievous wound” to public health but an “even deeper wound to American national interests and national security”.
Founded in 1948 with help from the United States, the WHO is an agency of the United Nations. Its mission, says its website, is to “confront the biggest health challenges of our time and measurably advance the well-being of the world’s people”.
That includes bringing aid to war-torn areas like Gaza and tracking emerging epidemics like Zika, Ebola and Covid-19. The annual budget of WHO is about $6.8bn; the United States has typically contributed an outsize share.
According to Gostin, it will take some time for the United States to withdraw. A joint resolution adopted by Congress at the agency’s founding addressed a potential withdrawal, and requires the US to give a year’s notice and pay its financial obligations to the organisation for the current fiscal year.
Collaborate
Gostin, who wrote a perspective in JAMA Network co-authored by Benjamin Meier from Gillings School of Global Public Health, and Loyce Pace, US Department of Health and Human Services, said the United States had been instrumental in establishing the WHO and been its largest state funder and most influential member for more than 75 years.
The three experts said the withdrawal will severely weaken American influence and diplomacy, and that the Trump administration should rather work to reform WHO to face rising health challenges, including H5N1 influenza and mpox clade Ib.
While the United States is officially compelled to give a year’s notice, Trump has pledged to withdraw from the WHO early in his second term, which the authors predict will be a strategic mistake.
Trump also has concerns – shared by previous administrations – regarding the inefficient management of the WHO’s budget and finances.
However, reform efforts are already under way at the agency, focused on increasing transparency, oversight and institutional accountability – all issues on which the WHO has demonstrated significant progress.
A world without WHO
After World War II, the United States was instrumental in establishing WHO as the UN coordinating authority on international health. Since its inception, United States leadership has been crucial in setting international norms and standards, most notably in the Declaration of Alma-Ata and the International Health Regulations (IHR).
America has played a leading role in fundamentally revising the IHR, most recently in amending the IHR on 1 June 2024, to reflect lessons learned during the pandemic.
US leadership within the WHO has also been crucial in setting global health standards and achieving global health successes, from the 1980 eradication of smallpox to ongoing progress to eradicate wild poliovirus. The National Institutes of Health (NIH) and CDC share crucial scientific data with the WHO’s vast system of collaborating laboratories.
US engagement with the WHO provides vital information on the transnational spread of pathogens, acting as a global alert system to warn and protect Americans from novel pathogens. Beyond disease surveillance, the agency is essential to scientific advancements by US pharmaceutical companies.
For example, annual seasonal influenza vaccinations are based on virus sample access, collaborative health research, and international safety standards co-ordinated under the WHO.
The pandemic made clear the WHO’s instrumental role in co-ordinating an international response. It spearheaded the Access to Covid-19 Tools Accelerator to spur development, production and equitable access to Covid-19 tests, treatments and vaccines. It worked with Gavi, the Vaccine Alliance and the UN International Children’s Emergency Fund (Unicef) to deliver affordable Covid-19 vaccines to low- and middle-income countries. The WHO also maintains partnerships with these agencies to respond to ongoing health emergencies, including mpox and polio.
Yet the pandemic response revealed deep flaws in the global health security architecture, requiring fundamental global health reforms. Thus, the Biden administration played a leading role in improving oversight of the WHO Health Emergencies Programme and other critical aspects of global preparedness.
Continuing United States engagement in ongoing WHO negotiations for a pandemic agreement is essential to secure American interests and to prepare for future emergencies.
Consequences of the withdrawal
There are likely to be major repercussions for global health, with substantial international shifts in resources and power – all to the considerable detriment of the US.
By far the largest state funder of WHO, the US contributed $1.284bn to the WHO during the 2022 to 2023 biennium. This funding bolsters global co-operation, from disease outbreaks and non-communicable diseases to digital health.
In cutting off resources to the WHO, the US will relinquish global influence. As the World Health Assembly continues to negotiate global health law reforms, the US would not even be at the table.
The financing gap left by the American withdrawal will allow US adversaries to secure influence previously held by United States diplomats. There will be a funding vacuum, and other nations will seek to extend their power by providing WHO financing in ways that may undermine fundamental US national interests and values.
The withdrawal will shift international leadership toward competing power structures, including by blocs such as the BRICS (originally Brazil, Russia, India, China and South Africa) nations, which are currently challenging the US-led world order.
The withdrawal will, additionally, feed into this BRICS rhetoric that the US does not value collaboration with the Global South, weakening partnerships and imperilling US leadership in the world.
Without global health funding and leadership in an interconnected world, America would find itself with far less protection from emerging outbreaks like H5N1 and heightened vulnerabilities to a wide range of global health threats.
Coupled with challenges to domestic scientific agencies, Americans will now face rising risks with diminished public health protections. A world without a robust WHO would be a far more dangerous one.
An imperative for US engagement
There is no substitute for an empowered, well-funded WHO to keep the world safer and healthier. It is the leading institution responsible for setting global scientific standards, building national health systems, providing technical assistance, and coordinating international responses to transnational health threats.
No state acting alone can prevent and respond to cross-border health threats. Given rapid international travel and trade, the United States is uniquely vulnerable as a destination and transportation hub.
WHO appeals
In a statement, the WHO said it regretted the decision to withdraw membership and hoped the US would reconsider.
“WHO plays a crucial role in protecting the health and security of the world’s people, including Americans, by addressing the root causes of disease, building stronger health systems, and detecting, preventing and responding to health emergencies, including disease outbreaks, often in dangerous places where others cannot go,” it said.
“The United States was a founding member of WHO in 1948 and has participated in shaping and governing WHO’s work ever since, alongside 193 other Member States, including through its active participation in the World Health Assembly and Executive Board. For more than seven decades, WHO and the USA have saved countless lives and protected … people from health threats. Together, we ended smallpox, and together we have brought polio to the brink of eradication. American institutions have contributed to and benefited from membership in WHO.”
The agency said that over the past seven years, it had implemented the largest set of reforms in its history, “to transform our accountability, cost-effectiveness, and impact in countries”.
The statement added that it looked forward “to engaging in constructive dialogue to maintain the partnership between the USA and WHO, for the benefit of the health and well-being of millions of people around the globe”.
Pepfar also in peril
The reverberations of the Trump administration and its decisions will undoubtedly have other ripple effects around the globe, including in Africa.
Even before Trump took office, the future of the flagship US HIV-Aids support programme President’s Emergency Plan for Aids Relief (Pepfar) was already hanging in the balance after United States officials said four nurses in Mozambique had performed abortions that are banned under the multibillion-dollar project, which has saved millions of lives globally.
Service providers funded through Pepfar are prohibited from providing abortions under rules against US foreign assistance being used for abortion-related activities, reports Reuters.
A review of service providers in Mozambique – where abortion is legal – found that four nurses had carried out 21 abortions since January 2021, said three US officials who briefed members of Congress on the matter last Thursday in a bid to show transparency and demonstrate that measures to ensure compliance with the ban on abortions were working.
The officials said it was the first time in the programme’s 20-year history that a Pepfar-funded provider had been found to have provided an abortion.
Pepfar was launched in 2003 under President George W Bush and enjoyed bipartisan support until recently. Republican opponents of abortion rights blocked a five-year reauthorisation in 2023, alleging – without evidence – that the programme had been hijacked by the Biden administration to empower pro-abortion NGOs.
Republican senator Jim Risch, chairperson of the Senate foreign relations committee that oversees the programme, said Biden’s administration had allowed taxpayer dollars to be used to perform abortions and called for an investigation of the CDC, one of the key agencies implementing Pepfar.
“This violation means that the future of the Pepfar programme is certainly in jeopardy,” Risch said in a statement. “I will not support one dollar of American money going towards abortion anywhere in the world, and I will do all I can to ensure this never happens again.”
In response, Gregory Meeks, the ranking Democrat on the House foreign affairs committee, said “using this unfortunate error as pretext to end funding for Pepfar, which has saved millions of lives by combating HIV around the world, would be a grave mistake”.
Funding for Pepfar was extended for one year last March.
Officials warn that millions of lives would be at risk if the programme is not extended further. The State Department says Pepfar, through which the United States has spent more than $100bn, has so far saved more than 26m lives globally.
Trump is unlikely to feel any more charitably disposed towards Pepfar than he has in the past, and the future looks bleak for the programme.
The New York Times article – Trump Withdraws US from World Health Organization (Restricted access)
See more from MedicalBrief archives:
Furore over Trump’s withdrawal of WHO funding
Trump’s policies set to damage health and science, journal warns
African activists fear Trump will cut birth control funds
Pepfar chief pushes for extension of programme
‘Colossal impact’ fears as US anti-abortion lobby threatens to kill Pepfar