President Trump signaled his intention to withdraw from the World Health Organization on Monday, a move global health experts fear will both cripple the agency and substantially weaken international health security — in the United States and abroad.
A U.S. withdrawal from the WHO would deprive the Geneva-based institution of its biggest funder and a major contributor of scientific expertise, likely necessitating a massive reorganization and a curtailment of the functions the WHO is able to perform.
During the previous Trump administration, in the first summer of the Covid-19 pandemic, the U.S. filed notice of its intent to withdraw from the WHO, saying it was doing so because the agency had protected China in the early days of the pandemic, when it was slow to share details of the spread of the new coronavirus.
But the Biden administration rescinded the withdrawal notice on its first day in office.
In a move seen as a rebuke of former President Biden’s quick dismissal of the WHO withdrawal, the incoming administration announced its intention to take the U.S. out of the global health agency on a busy first day of its tenure, in which Trump also pardoned more than 1,000 people who rioted at the U.S. Capitol on Jan. 6, 2021, and called for an end to birthright citizenship.
In his executive order calling for the U.S. to withdraw from the WHO, Trump reiterated the same issues he raised in 2020: the WHO’s “mishandling” of the Covid-19 pandemic, “its failure to adopt urgently needed reforms, and its inability to demonstrate independence from the inappropriate political influence of WHO member states.”
He also said the WHO demands an unfair level of payments from the U.S., relative to other nations’ contributions.
Tom Bollyky, director of global health for the Council on Foreign Relations, called the move “an enormous mistake,” in an interview ahead of Trump’s inauguration.
“Americans have been made less safe by the president’s action today,” said Bollyky. He said the WHO plays “an irreplaceable role” in global outbreak response, and its ability to carry through with that role in future crises will be undermined by the U.S. move.
Bollyky and others hope the move to withdraw may turn out to be a bargaining chip aimed at forcing reform of the WHO — reforms that would rebalance the financial contributions made by member states, institute more transparency in how monies are spent, and put pressure on China to divulge what it knows about the origins of the Covid-19 pandemic.
Should the United States follow through on the threat to withdraw, it would mark the first time since the WHO came into being in 1948 that a member state has left the United Nation’s health organization. The WHO’s constitution does not even anticipate such an eventuality; there is no provision in it for countries to revoke their membership in the organization.
But the joint resolution of Congress that allowed the U.S. to join the WHO at its founding does spell out the terms by which it can leave. The country must give a one-year notice and pay any outstanding bills before it can quit the organization.
Lawrence Gostin, a professor of global health law at the O’Neill Institute, part of the Georgetown University Law Center, told STAT a U.S. withdrawal from the WHO would be “a grave strategic mistake.”
“We’ll be out on the outside looking in” when the pandemic treaty, a pact that is meant to better prepare the world for pandemics and that is still a subject of negotiations, is agreed to in May, he said. Trump’s order also calls for the U.S. to stop negotiations on that agreement.
“When major issues come up before the World Health Assembly, we’re not going to be at the table. When China is trying … to assert its influence in Africa, in Latin America, and other countries where the United States has very strong strategic interests in minerals and trade, we won’t be there,” said Gostin, who has been involved in drafting and negotiating the pandemic treaty.
“It’ll feed the narrative that the United States doesn’t respect and partner with the Global South. There are a lot of negatives for the United States,” Gostin continued.
The order calls for the U.S. to find “credible and transparent” partners to take up needed work that the WHO previously handled.
When the first Trump administration announced its intention to pull the U.S. out of the WHO, Gostin and others argued that as the country’s entry into the international organization had been effected by an act of Congress, its withdrawal would also need congressional approval. Others are uncertain if that is the case.
Bollyky noted that President Jimmy Carter unilaterally withdrew the country from a mutual defense treaty with Taiwan in 1978 when the U.S. recognized China. The Supreme Court refused to hear a challenge to the Carter administration move, Bollyky said, adding he thinks that precedent will hold here.
Though Trump and others have accused the WHO of covering for China, in reality the agency has repeatedly called for the release of more information on how the pandemic started. In an editorial published last week in the journal Science, Maria Van Kerkhove, director of the WHO’s department of epidemic and pandemic threat management, reiterated the call.
“Sadly, the world still lacks the data and access needed to fully understand the origins of Covid-19,” Van Kerkhove wrote. “WHO has repeatedly asked China to share all available information on the earliest cases, animals sold in Wuhan markets, labs working with coronaviruses, and more, but to date it has not received this information.”
A U.S. withdrawal from the WHO would throw into doubt the organization’s capacity to do the myriad things it is tasked with, from developing the disease coding system used by health systems around the world to organizing responses to health emergencies like the West African Ebola outbreak in 2014-2016 or the Zika outbreak of 2015-2016.
The organization also serves as a de facto drug and vaccine regulatory agency, doing for countries without the capacity to rigorously assess the evidence supporting new drugs and vaccines what the Food and Drug Administration does for the U.S. or the European Medicines Agency does for countries in the European Union. WHO prequalification, as the process is called, assures countries that the data supporting a new drug, vaccine, or diagnostic test have been thoroughly studied, expediting the work of national regulators.
The organization also runs the process through which the strains that annual flu shots and Covid vaccines should target are selected. As part of that process, experts from around the world meet at the WHO to analyze the versions of these viruses that are circulating and predict which are in the ascendancy. It also created and oversees the Pandemic Influenza Preparedness or PIP Framework, through which flu vaccines and diagnostics manufacturers get access to viruses with pandemic potential in exchange for assurances that a portion of any of the products that they make will be shared with participating countries in the event of a pandemic.
“WHO is in many ways the eyes and the ears for the U.S. and other countries on health emergencies,” Bollyky said. “But also … it really is a prerequisite for getting low- and middle- income countries’ cooperation in arrangements that otherwise might be seen as exploitative or not in their interests.”
“The PIP Framework doesn’t happen without WHO,” he said.
The new administration focused on what the WHO costs the U.S. The U.S. assessed dues — which cover only a portion of the WHO’s costs — are the highest of any nation. The U.S. dues for 2025 are roughly $130 million; China will pay $87.6 million.
In addition to assessed dues, the U.S. and other donors — both member countries and philanthropic organizations such as the Bill and Melinda Gates Foundation — make voluntary contributions to the WHO.
During the two-year budget cycle covering 2022-2023, the United States contributed $1.284 billion (dues and voluntary payments combined) to the WHO.
For context, the 2024 budget of the Centers for Disease Control and Prevention was $9.2 billion; NASA’s budget for the same year was $27.2 billion.
In addition to funding, the U.S. provides the WHO with technical expertise. Thirty CDC staff who remain on the agency’s payroll are currently assigned to the WHO. Those staff will be called back if the U.S. carries through on its plans.
Many other Americans — including Van Kerkhove — are on the WHO’s payroll. While technically a U.S. withdrawal would not immediately threaten their position at the agency, it is conceivable that countries that continue to fund the WHO might demand fewer Americans and more of their own nationals at the WHO going forward.
“What I’ve been saying to the Trump folks is if you think WHO is too close to China now, wait till you withdraw,” Ashish Jha, dean of Brown University’s School of Public Health who served as the Covid response coordinator in the Biden White House in 2022-2023, said in an interview.
Jha doesn’t believe a U.S. withdrawal will doom the WHO. But he does believe the agency will be profoundly weakened. “I think it limps along, but it has less legitimacy, less credibility, and less impact. And I think the world is worse off for it, no question,” he said.
Gostin said it won’t just be the world that is weakened by a U.S. withdrawal. “Even if we would reduce our funding, we still have access to all [the WHO] programs,” he said. “So it’s literally shooting ourselves in the foot. I would say shooting ourselves in the heart.”