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Trump’s push to exit the WHO could impact global disease control

A Good Chat on what you need to know about the potential U.S. withdrawal and its consequences.

- February 4, 2025
World Health Organization (WHO) logo
World Health Organization logo in Geneva, Switzerland (cc) US Mission Geneva via Flickr.

On the day of his second inauguration, President Trump announced his intent to withdraw the United States from the World Health Organization (WHO). His executive order justified the decision based on the organization’s alleged “mishandling of the COVID-19 pandemic” and “its failure to adopt urgently needed reforms.” The Trump administration also said it viewed WHO budget demands placed on the United States as disproportionate, arguing that WHO was asking China to contribute too little. Most observers assess the withdrawal as requiring additional congressional action before it can be completed.

To consider the consequences of the potential U.S. withdrawal from WHO, Good Authority editor Christopher Clary chatted with Catherine Worsnop, an assistant professor in the School of Public Policy at the University of Maryland-College Park. Worsnop’s work focuses on the WHO and international cooperation in global health. Their chat, lightly edited for clarity and length, is below.

Christopher Clary: Why is there a World Health Organization in the first place? What are its biggest accomplishments, in your view?

Catherine Worsnop: The World Health Organization was founded in 1948 as a specialized agency of the United Nations to “act as the directing and coordinating authority on international health work” with an objective of “the attainment by all peoples of the highest possible level of health.” WHO works in many areas and its accomplishments range from helping to eradicate smallpox to coordinating the only global agreement on tobacco control and enabling the development of the annual flu vaccine.

A core function is trying to help countries overcome collective action problems during disease outbreaks. WHO does this through activities like providing information and technical advice. WHO monitors, collects, and shares epidemiological information about ongoing outbreaks (e.g., tracking cases of Mpox across countries or classifying new variants during the covid-19 pandemic) and provides advice about how to respond as well as on-the-ground support in doing so. 

For instance, in the past week WHO has reported on a potential Ebola outbreak in the Democratic Republic of Congo, Marburg Virus in Tanzania, and Sudan Ebola Virus in Uganda. WHO is serving a key information collection and advising role in each outbreak. In the case of Marburg, WHO reported on the suspected cases before they were confirmed by Tanzania’s government, WHO staff deployed to the outbreak zone, and WHO has provided essential medical supplies such as testing kits and personal protective equipment.

Of course, WHO is not always successful in this role. WHO responded too late, many critics believe, to outbreaks of Ebola in 2014 and AIDS in the 1990s. It updated key guidance during the covid pandemic too slowly. Organizationally, the WHO took too long to respond to evidence of sexual assault perpetrated by WHO employees.

As is the case with any international organization, WHO is made up of member countries and so the organization’s successes and failures should be seen as a joint venture rather than the organization’s sole responsibility. Still, WHO remains the leading voice in global health. People listen to WHO despite its limited enforcement power and the proliferation of other powerful organizations – like the Gates Foundation. While governments do not always follow WHO guidance – and even sometimes do the opposite – no other health organization similarly commands the attention of most governments around the world.

Could the United States just work on health issues on a bilateral basis, without going through an international organization? On the other side of the coin, how well would the WHO work if the United States did withdraw?

Since the mid-19th century, countries have collaborated on health problems because they could not address them alone. A group of countries convened the first International Sanitary Conference in 1851 in response to ongoing cholera pandemics and the spread of other diseases resulting from the growing transcontinental movement of people and goods. These governments recognized that their uncoordinated responses were both economically disruptive and had not stopped cholera’s spread.

Much like today, international cooperation on health proceeded in fits and starts. The 1851 conference brought together only 12 European countries. And, countries did not formally ratify an agreement until the 1892 International Sanitary Convention. But, through the mid-20th century, countries continued to meet and update the convention, and country participation in the conferences expanded.

WHO’s founding in 1948 came after an almost 100-year history of cooperation on global health issues. Countries created WHO and its precursors because they recognized the value and necessity of working together on cross-border health issues – and the downsides of going it alone. This includes the United States, which helped to create WHO. 

The United States has been WHO’s largest funder because it benefits from the public goods that WHO provides, has seen WHO and its programs as furthering foreign policy goals, and has wanted to influence WHO policies and negotiations. The U.S. has received these benefits for a relatively cheap price – for example, in 2023 the U.S. paid about $481 million in contributions to the organization. Beyond these direct benefits to the United States, WHO has contributed to improving health for individuals globally.

While there are many regional and bilateral health agreements and organizations, they are not substitutes for a global organization. As just one example, at the outset of an outbreak – when time is of the essence – one centralized information source makes a lot more sense than having to rely on several bilateral arrangements for information. In fact, the Trump administration recognizes this since the executive order on WHO withdrawal instructs the secretary of state and the Office of Management and Budget director to “identify credible and transparent United States and international partners to assume necessary activities previously undertaken by the WHO.”

Through preexisting relationships between WHO and the Centers for Disease Control and Prevention (CDC) and elsewhere, the U.S. might have been able to maintain access to some of the public goods WHO provides – like information about potential outbreaks and pandemics – even if it did formally withdraw from WHO (in other words, by free riding). But this seems less likely now, after CDC staff were instructed on Jan. 26, 2025, to stop communicating with WHO. CDC officials would normally be working closely with WHO to understand and respond to the outbreaks of Ebola and Marburg, for instance. Now, that may not be happening and the U.S. may have less access to critical public health information.

From WHO’s perspective, U.S. withdrawal could have financial and political implications. As the largest WHO funder, U.S. withdrawal heightens the already intense financial strains on the organization. Just a few days after the executive order, WHO’s director general noted that “the announcement has made our financial situation more acute” and announced cuts to hiring and travel. More broadly, WHO has been trying to shore up its financing by encouraging member countries to shift donations away from earmarked voluntary contributions to an increase in assessed contributions (membership dues), or at least flexible voluntary contributions that could go into WHO’s core operating budget. Currently, assessed contributions, which are predictable and fully flexible, make up less than 20% of the WHO budget. Even before Trump’s executive order, WHO had only been partially successful in its efforts to strengthen its financial situation.

So, a critical question is how WHO’s other funders respond to a potential U.S. exit. Will other WHO member countries step up to fill the gap, or will a U.S. withdrawal lead other countries to shirk and reduce (or fail to increase) their contributions? WHO is worried that countries may rethink prior pledges to increase contributions. If not other member countries, would WHO’s private donors such as the Gates Foundation increase contributions? Regardless, the loss of U.S. funds will be painful for the organization. WHO will need to decide what to prioritize. Should it spend less on infectious disease and emergencies? Or maternal health and infant mortality? Or chronic disease?

There are also political ramifications. If U.S. resources are not replaced and WHO shrinks its activities, WHO’s voice could be less authoritative internationally. Alternatively, if other funders boost their support, the U.S. may have diminished influence on global health issues. Without the U.S., perhaps WHO has an opportunity to reorient towards the interests of other member countries, particularly those in the global south focused on issues of technology transfer and equitable access to vaccines and other life-saving medicines. The U.S., with the support of its biotechnology and pharmaceutical firms, has long resisted change in these areas.

Could this be just a negotiating ploy? I saw the president tell a Jan. 25 rally, “Maybe we would consider [rejoining the WHO] again, I don’t know, they have to clean it up a bit.” Relatedly, do you think the Trump administration has a point about the need for cost-saving changes?

Member countries often threaten to withdraw, withhold funds, or deny other resources to international organizations when they are displeased by an organization’s activities. This might just be a threat with an aim of pushing for changes within WHO. WHO is not perfect and ideas for changing the organization abound. But one difficulty is the lack of clarity on what steps the organization could take to change the Trump administration’s course, since Trump’s main criticisms are either vague or inaccurate. WHO would also have to consider what message appeasing the U.S. would send to its other 193 member countries.

You’re right that Trump has signaled that organizational changes could bring the U.S. back. Of course, I hope the U.S. does not leave WHO and fully reengages with the organization. But, remember that Trump has been targeting WHO since his first term, when he began withdrawing from the organization. This time, though, the halting of communication between U.S. officials and WHO increases the credibility of Trump’s executive order and reduces negotiating space.

Yet, WHO has faced organizational insecurity before, like when President Ronald Reagan withheld funds in the 1980s, when WHO was pressured to adopt neoliberal economic policies in the 1990s, accused of improper ties to pharmaceutical companies during the 2009 H1N1 pandemic, or criticized for failures during the 2014 Ebola outbreak. During these times, WHO has often found a way to navigate member country demands and reduced resources, while preserving some organizational autonomy to advance its global health goals. In the months and years ahead, WHO will be trying to figure out how to do the same thing this time.

Irrespective of how this dispute resolves, what global health issues are you watching most closely over the next few years?

In addition to watching how WHO shifts priorities and how its other donors react, I’ll be tracking several issues. First, the executive order does not legally withdraw the U.S. from WHO. To legally withdraw, the U.S. needs to provide one year’s notice and fully meet outstanding financial commitments to WHO (currently, the U.S. has not yet paid up for 2024 or 2025). Further, the president may not have the authority to unilaterally withdraw from WHO without an act of Congress. So, I’ll be watching whether the withdrawal becomes official – or whether it remains de facto through the halting of communications and failure to pay outstanding financial contributions.

Second, I’ll be watching what happens when outbreaks of concern develop.The potential outbreaks of Ebola and Marburg and the ongoing Mpox emergency are a worry, along with concerning developments around bird flu in the United States (which has not been inspiring confidence in U.S. outbreak response). How will the U.S., WHO, and the international community react to disease outbreaks given the strained relations between the U.S. and WHO? Interestingly, regardless of what happens with U.S. WHO membership, the U.S. is still a party to the International Health Regulations, which set out countries’ mutual obligations during global health emergencies. If faced with a global health emergency, will the U.S. reflect Trump’s isolationist position or not?

And a final note: Trump’s executive order on WHO is not an isolated action. Rather, it’s one of several actions with implications for global health. I’ll be watching developments related to the freeze on U.S. foreign assistance funds, which has threatened global health programs overall. This includes PEPFAR, which has prevented 26 million AIDS deaths globally since 2003. Though the administration said they granted a waiver for life-saving HIV treatment, it’s not clear this actually happened. And the freeze itself has created uncertainty and put other global health-related programs at risk. These programs not only save millions of lives around the world, but also provide many benefits to the U.S. related to health and otherwise.