On day one of his return to the White House, President Trump signed an executive order that begins the process of withdrawing the United States from the World Health Organization. Termination of U.S. membership would cut the multilateral agency’s funding by 22%, severely challenging the WHO’s ability to carry out its global public health mission.
Throughout WHO’s 76-year history, the U.S. has been the organization’s most important sponsor. The U.S. contributed $1.2 billion to the WHO in 2023, more than twice as much as any other member country. As the most prominent international public health apparatus with 194 member states, the WHO plays a critical role in global health security, disease outbreaks and surveillance, and mobilization of cooperation across numerous public and private entities.
Currently, no other organization has the capacity to coordinate international rapid response efforts, to share medical research and innovation and to disseminate critical intelligence. To illustrate, this includes, among other activities, the entity’s instrumental work on multiple Ebola crises in Africa, worldwide measles outbreaks and seasonal influenza strain sequencing, used to develop annual flu shots. The WHO is also indispensable in efforts to eradicate HIV, malaria, tuberculosis and dozens of neglected tropical diseases, such as leishmaniasis, Dengue fever and river blindness. NTDs refer to a diverse group of parasitic and bacterial diseases that cause significant morbidity and mortality in more than one billion people around the globe, which disproportionately affect poor and marginalized populations.
From its inception, the WHO has spearheaded numerous programs that have saved tens of millions of lives. One of the first major projects the WHO was involved in was a global immunization campaign that eventually led to the eradication of smallpox in 1980. And since 1977, the WHO Essential Medicines List—which is revised and updated every two years—has been a vital guide for many nations in their medication procurement policies. Essential medicines are intended to be available in all healthcare systems, at all times, in adequate amounts, and in the appropriate dosage forms.
The WHO’s roadmap for NTDs, drawn up in London in 2012, contains goals on public-private partnership commitments with respect to logistics for the distribution of existing treatments, drug donation programs and R&D funding of new pharmaceutical development. Though there was substantial disruption as a result of the COVID-19 pandemic, since 2012 there has nonetheless been significant progress in the implementation of large-scale prevention of disease and treatment of patients suffering from NTDs.
If the U.S. indeed withdraws from the WHO, the severe cuts to funding would be extraordinarily challenging for the multilateral agency, potentially curtailing public health works globally.
The WHO was founded in 1948 and is based in Geneva, Switzerland. It is a subsidiary organ of the United Nations. As a specialized agency of the U.N., the WHO is responsible for international public health. Here, its role is to coordinate with all 194 member states in a wide range of public health activities, such as vaccination campaigns, water sanitation projects and support for countries dealing with health emergencies.
The U.S. became a WHO member through a 1948 joint resolution passed by both houses of Congress. According to Lawrence Gostin, expert in public health law, unilateral action notifying the U.N. that the U.S. is withdrawing violates U.S. law because it does not have explicit approval of Congress to leave WHO. Additionally, under U.S. law the country must give the WHO one year’s notice, and has to meet its financial obligations to the organization for the current year.
Trump First Signaled WHO Exit in 2020
During his first term in office, Trump declared he would withdraw funding for the World Health Organization, pending a “review” of the organization’s “role in severely mismanaging and covering up the spread of coronavirus.”
In the initial stages of the public health crisis surrounding the novel coronavirus the WHO was evidently misled by the Chinese authorities. It appears that from late December though the middle of January, Chinese authorities concealed, and in some cases quashed reports regarding a then nascent, mysterious pneumonia-like illness.
The Chinese government did inform the WHO’s China office on December 31, 2019, about dozens of cases of “mysterious pneumonia” in Wuhan. But, what the government didn’t reveal is that the virus had already been sequenced in Chinese laboratories, and found to be very similar to Severe Acute Respiratory Syndrome. Subsequently, the Hubei Provincial Health Commission ordered the laboratories to stop testing and destroy existing samples. Given that SARS is transmitted human-to-human—though, as it turned out, less contagious than the novel coronavirus—obfuscating such a vital piece of information for several weeks would have serious repercussions.
It appears that at the beginning of the COVID-19 pandemic the WHO was led astray by the Chinese authorities. On January 18, 2020, the WHO tweeted “preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel coronavirus (2019-nCoV) identified in Wuhan.”
However, by late January, the WHO began posting repeated warnings to nations around the world about the novel coronavirus and its human-to-human transmissibility. On January 30, 2020, the WHO declared a global health emergency. Director-General Tedros Adhanom Ghebreyesus expressed particular concern about the “potential for the virus to spread to countries with weaker health systems and which are ill-prepared to deal with it.” The WHO also offered to supply diagnostic test kits, which the U.S. refused, but many other nations accepted.
Under the Biden administration, the U.S. reverted to a business as usual stance vis-à-vis the WHO and continued to be its largest funder. But Republicans in Congress maintained their opposition, saying that the WHO wasn’t adopting needed reforms, pointing to the organization’s alleged inability to demonstrate independence from the political influence of certain WHO member states and objecting to the U.S. signing on to the world’s first pandemic treaty, a proposed legally binding agreement designed to prevent, prepare for and respond to future global pandemics.
The U.S. has traditionally been the most generous provider of health and humanitarian assistance to people in need around the world, as evidenced in part by the key role it has played as a WHO benefactor. As Trump’s second term commences, this magnanimity may be at stake. In turn, this could pose a threat to worldwide public health.
