The United States’ withdrawal from the World Health Organization became official Thursday, formalizing a fissure between the Trump administration and the Geneva-based global health agency that dates back to the early days of the Covid-19 pandemic.
Thursday marks the one-year anniversary of the date on which the WHO was informed that President Trump had decreed that the U.S. would terminate its membership in the organization, something he tried to do during his first term in office. According to a joint congressional resolution passed in 1948 to allow the United States to join the WHO, the country had to give a year’s notice before withdrawing. (The joint resolution also stipulated that the country had to pay outstanding bills before leaving, a condition that has not been met.)
The executive order Trump signed on his first day back in the White House cited the WHO’s “mishandling of the Covid-19 pandemic that arose out of Wuhan, China, and other global health crises, its failure to adopt urgently needed reforms, and its inability to demonstrate independence from the inappropriate political influence of WHO member states” as its rationale for leaving the organization. It also complained about the country’s assessed contributions, the highest of any member country. (Assessed contributions are set based on a country’s GDP.)
The WHO has yet to officially acknowledge that the U.S. is leaving, insisting that member states will have to determine the country’s status in the organization going forward. Director-General Tedros Adhanom Ghebreyesus said last week he hoped the U.S. will reconsider. But on this side of the Atlantic, the question is settled.
“We are definitely walking away from organizations like the WHO,” a senior official at the Department of Health and Human Services said during a press conference about the withdrawal on Thursday, claiming that the organization merely takes credit for work done on the ground by staff at the Centers for Disease Control and Prevention. HHS told reporters taking part in the briefing that officials could not be identified by name.
The officials disputed the fact that the joint resolution of Congress authorizing the U.S. to join the WHO stipulated that the country should pay outstanding bills before leaving. But the wording of the document states that the U.S. could withdraw from the agency after giving one-year’s notice and providing “the financial obligations of the United States to the Organization shall be met in full for the Organization’s current fiscal year.”
Lawrence Gostin, a professor at Georgetown University and director of the WHO Collaborating Center on National and Global Health Law, said that “for all intents and purposes,” the United States hasn’t been a member of the WHO since Trump’s inauguration.
“I feel like this is a real turning point in American history,” said Gostin, who tried without success to broker a rapprochement between the Trump administration and the WHO. “Over 75 years, we’ve been its most influential member and biggest funder. And I think that there’s now a break that’s beyond political and that will endure for the foreseeable future. I don’t think that’s good for the world, but I think it’s worse for America.”
During the press conference, officials said the U.S. is not “walking away from being a leader in global health,” and is aware of the need to “have data and a world presence and interact with global health leaders from around the world.”
Yet plans on precisely what that means, and how the U.S. can maintain consistent and strong monitoring of global health data, remain vague. “There are thousands of existing agreements… everything from data sharing to laboratory specimen sharing to funding opportunities and relationships that are already in place that we will continue to leverage and then further augment,” said another senior HHS official during the press conference.
Despite those plans, global health experts in the U.S. and abroad warned that the U.S. withdrawal meant the world will be a less secure place going forward — more poorly equipped to respond to health emergencies such as the West African Ebola outbreak of 2014-2016 or the Covid pandemic.
“We’re taking risks without realizing it, or we’re graduating risk without realizing it,” said Jeremy Konyndyk, president of Refugees International, who in a previous job led the U.S. Agency for International Development’s responses to Ebola, Covid, and other health crises.
Konyndyk was also a member of an international panel that reviewed the WHO’s handling of the West African Ebola outbreak; its findings led to the creation of the WHO’s Health Emergencies Program. The agency and global health in general made some headway after the Ebola outbreak, but since the Covid pandemic, some of those gains have eroded.
“When that will bite us in the ass, it’s impossible to predict. But there is a 100% certainty that it will bite us in the ass,” Konyndyk said.
The withdrawal of the U.S. has already weakened the organization. It started cutting positions and leaving vacancies unfilled last January. By midway through this year, the organization will have cut 22% of its staff in a move aimed at dealing with a vastly different economic reality.
But the withdrawal also weakens the U.S., experts said, limiting the country’s access to key infectious disease intelligence from around the globe and denying it influence over the way outbreak responses are structured and run.
“The effect of that withdrawal will be less information that we will be able to get during outbreaks. More difficulty asserting our influence in how those outbreaks are managed. Less information about what kind of an outbreak we’re dealing with, no matter how it’s caused,” said Beth Cameron, a professor and senior adviser to the Pandemic Center at the Brown University School of Public Health. Cameron served as senior director for global health security and biodefense in the Biden administration.
Nikki Romanik, a senior fellow in global health security at Brown who served as deputy director of the Office of Pandemic Preparedness and Response Policy in the Biden White House, agreed, suggesting that if a new infectious diseases crisis is brewing, the U.S. may be the last to know. Romanik also noted this withdrawal is coming at a time when the Trump administration has subjected the Centers for Disease Control and Prevention to successive rounds of job cuts and has left her former office in the White House virtually vacant.
“So we would be starting from a very dusty Day 1. There’s probably cobwebs in half of the systems that we normally had going all the time. It would be awful. If we thought Covid went badly in the United States, we have no idea what we’re in for,” she said.
A former WHO official, who spoke on condition of anonymity, said the U.S. cannot replicate through bilateral agreements the disease surveillance intel it received through the WHO.
“Obviously we never know when the next outbreak is going to hit or where it’s going to come from, but there’s a lot of ways that the U.S. is going to be put at risk by the divorce and not actually harmed until something happens, and that’s why there’s no political pressure or less political pressure to not do that now,” the former official said.
In the press conference, HHS officials said that the U.S. intends to ensure the CDC has a presence in every country where it has a mission, without fully explaining what might happen if an outbreak was playing out in a country that does not have diplomatic relations with the U.S.
“The point of the WHO is that stopping outbreaks requires collaboration with countries even if they are not close allies,” said Matthew Kavanagh, the director of Georgetown University Center for Global Health Policy and Politics. “During Covid-19, it was through the WHO that the United States got early access to the Covid-19 viral sequence from China,” he said.
When the U.S. served notice it was withdrawing from WHO in Trump’s first term — a move rescinded by President Biden on his first day in office — other countries stepped into the void to increase funding for the organization. But that hasn’t happened this time. The protracted war in Ukraine, the abrupt cancellation of U.S. international assistance with the dismantling of USAID, and decisions by a number of countries to increase their defense spending have led to funding challenges across the board in global health, and particularly at WHO.
“I think for WHO it’s been a very, very tough year,” said Suerie Moon, a professor of international relations and co-director of the global Health Center at the Geneva-based Graduate Institute of International and Development Studies. “The mood in Geneva is definitely doom and gloom.”
At a press conference last week, Tedros noted that the agency had secured about 75% of the funding it needs for its next biennium, 2026 through 2027. (The WHO budgets over a two-year period.) Finding the remaining 25% could be tough, he said.
Experts also noted that the U.S. withdrawal comes at a time when the WHO is readying itself for the campaign to replace the director-general, whose second term concludes in the summer of 2027. Candidates intending to vie for the position will begin to make their interest known this year.
While some experts expect the U.S. to try to influence the process from the outside, the country will not have a vote. And being seen to have strong support in Washington could work for — or against — someone running to be the next director-general. Romanik called it “a huge missed opportunity” that the country cannot be involved in the process.
Stephanie Psaki, who is also a global health fellow at Brown and was coordinator for global health security in the Biden White House, suggested the U.S. has squandered an opportunity to influence global health security.
“Stepping away, giving up our seat at the table is a gift to China, to Russia, to other countries who would like to have a more active voice and also be seen as being constructive participants in the multilateral system,” she said. “So I don’t know how that achieves any kind of national security or diplomatic objective for the U.S. government.”
The former WHO official and others told STAT that there are efforts — on the down low — to maintain some communications between the WHO and the U.S. government. But for the foreseeable future, it appears unlikely that any significant interactions between the U.S. government and the WHO will be allowed to take place.
Tom Bollyky, director of the global health program at the Council on Foreign Relations, can see a day when that may change. But he doesn’t expect it to come about any time soon.
“I can envision a world where the U.S. finds its way back into the WHO,” he said. “What WHO looks like and what the global health system looks like by the time that happens, I don’t know.”
