What a US exit from the WHO means for global health

Amy Maxmen, Tribune News Service

For decades, the United States has held considerable power in determining the direction of global health policies and programs. President Donald Trump issued three executive orders on his first day in office that may signal the end of that era, health policy experts said. Trump’s order to withdraw from the World Health Organization means the U.S. will probably not be at the table in February when the WHO executive board next convenes. The WHO is shaped by its members: 194 countries that set health priorities and make agreements about how to share critical data, treatments, and vaccines during international emergencies. With the US missing, it would cede power to others. “It’s just stupid,” said Kenneth Bernard, a visiting fellow at the Hoover Institution at Stanford University who served as a top biodefense official during the George W. Bush administration. “Withdrawing from the WHO leaves a gap in global health leadership that will be filled by China,” he said, “which is clearly not in America’s best interests.”

Executive orders to withdraw from the WHO and to reassess America’s approach to international assistance cite the WHO’s “mishandling of the COVID-19 pandemic” and say that U.S. aid serves “to destabilize world peace.” In action, they echo priorities established in Project 2025’s “Mandate for Leadership,” a conservative policy blueprint from the Heritage Foundation. The 922-page report says the U.S. “must be prepared” to withdraw from the WHO, citing its “manifest failure,” and advises an overhaul to international aid at the State Department. “The Biden Administration has deformed the agency by treating it as a global platform to pursue overseas a divisive political and cultural agenda that promotes abortion, climate extremism, gender radicalism, and interventions against perceived systemic racism,” it says. As one of the world’s largest funders of global health — through both international and national agencies, such as the WHO and the U.S. Agency for International Development — America’s step back may curtail efforts to provide lifesaving health care and combat deadly outbreaks, especially in lower-income countries without the means to do so alone. “This not only makes Americans less safe, it makes the citizens of other nations less safe,” said Tom Bollyky, director of global health at the Council on Foreign Relations. “The US cannot wall itself off from transnational health threats,” he added, referring to policies that block travelers from countries with disease outbreaks. “Most of the evidence around travel bans indicates that they provide a false sense of security and distract nations from taking the actions they need to take domestically to ensure their safety.”

Technically, countries cannot withdraw from the WHO until a year after official notice. But Trump’s executive order cites his termination notice from 2020. If Congress or the public pushes back, the administration can argue that more than a year has elapsed. Trump suspended funds to the WHO in 2020, a measure that doesn’t require congressional approval. U.S. contributions to the agency hit a low of$163 million during that first year of COVID, falling behind Germany and the Gates Foundation. Former President Joe Biden restored U.S. membership and payments. In 2023, the country gave the WHO$481 million. As for 2024, Suerie Moon, a co-director of the global health center at the Geneva Graduate Institute, said the Biden administration paid biennium dues for 2024-25 early, which will cover some of this year’s payments.

“Unfairly onerous payments” are cited in the executive order as a reason for WHO withdrawal. Countries’ dues are a percentage of their gross domestic product, meaning that as the world’s richest nation, the United States has generally paid more than other countries. Funds for the WHO represent about 4% of America’s budget for global health, which in turn is less than 0.1% of US federal expenditures each year. At about $3.4 billion, the WHO’s entire budget is roughly a third of the budget for the Centers for Disease Control and Prevention, which got $9.3 billion in core funding in 2023.

The WHO’s funds support programs to prevent and treat polio, tuberculosis, HIV, malaria, measles, and other diseases, especially in countries that struggle to provide health care domestically. The organization also responds to health emergencies in conflict zones, including places where the US government doesn’t operate — in parts of Gaza, Sudan, and the Democratic Republic of the Congo, among others. In January 2020, the WHO alerted the world to the danger of the COVID outbreak by sounding its highest alarm: a public health emergency of international concern. Over the next two years, it vetted diagnostic tests and potential drugs for COVID, regularly updated the public, and advised countries on steps to keep citizens safe.

Experts have cited missteps at the agency, but numerous analyses show that internal problems account for the United States’ having one of the world’s highest rates of death due to COVID. “All nations received the WHO’s alert of a public health emergency of international concern on Jan. 30,” Bollyky said. “South Korea, Taiwan, and others responded aggressively to that — the U.S. did not.”

Nonetheless, Trump’s executive order accuses the WHO of “mishandling” the pandemic and failing “to adopt urgently needed reforms.” In fact, the WHO has made some changes through bureaucratic processes that involve input from the countries belonging to it. Last year, for example, the organization passed several amendments to its regulations on health emergencies. These include provisions on transparent reporting and coordinated financing.