On his first day in office, President Donald Trump signed an executive order withdrawing the U.S. from the World Health Organization (WHO)—a move that experts say makes the U.S. and other countries less safe from infectious diseases and other public-health threats.
“For Americans it may not be obvious immediately what the impact will be, but given the world we live in and all of the factors that are driving more disease outbreaks, America cannot fight them alone,” says Dr. Ashish Jha, dean of the school of public health at Brown University and former White House COVID-19 Response Coordinator. “We need an effective WHO to not just keep the world safe from these diseases, but to keep Americans safe from these diseases.”
“The bottom line is that withdrawing from the WHO makes Americans and the world less safe,” says Dr. Tom Frieden, president and CEO of the nonprofit health organization Resolve to Save Lives and former director of the U.S. Centers for Disease Control and Prevention (CDC).
In a statement responding to Trump’s order, the WHO says it “regrets” the U.S.’s decision. “We hope the United States will reconsider and we look forward to engaging in constructive dialogue to maintain the partnership between the USA and WHO, for the benefit of the health and well-being of millions of people around the globe.”
Here’s what to know about the U.S.’s withdrawal from the global health organization and what it might mean for the health of Americans and people around the world.
The background
This is the second time Trump has attempted to withdraw from the WHO. In 2020, during the pandemic and toward the end of his first term, Trump submitted a letter to the Secretary-General of the United Nations stating the U.S.’s intention to withdraw. Though U.S. funding stopped, a withdrawal didn’t happen: About six months later, then-President Biden in his first day in office wrote back to the Secretary General saying that the U.S. would remain a member of the WHO.
In the new executive order, Trump cites 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.” Trump, along with other public-health experts, have previously criticized the agency for not holding China more accountable for its slow response to the WHO’s investigation of COVID-19’s origins.
The order also says that the U.S.’s member dues—which ranged from $100 to $122 million over the past decade, the highest that any member pays—are “unfairly onerous” and “far out of proportion with other countries’ assessed payments.” (By comparison, while China has a similar assessment, its population is four times the size of the U.S.) The U.S. also contributed far more in voluntary funding in recent years; in 2022-2023, for example, it provided a total of nearly $1.3 billion to the health agency.
What happens next?
In the WHO’s agreement with the U.S., the U.S. would provide one year’s advance notice and pay any remaining balance to the organization in order to leave. But that agreement, made in 1948 when the WHO had just been created, was made through a joint act of Congress. It’s not clear whether Congress would have to act to implement the withdrawal.
Lawrence Gostin, professor and chair of global health law at Georgetown University and director of the O’Neill Institute, says Trump’s decision may open him up to legal action. “Trump made a unilateral decision to pull out of WHO,” Gostin wrote on X. “But we joined WHO in 1948 by an act of Congress. Trump needs Congress’ approval to withdraw. As director of a WHO Center, I am considering a lawsuit.”
Gostin also points out that the executive order calls for immediate cessation of payments, although the terms of the U.S.’s agreement with the WHO allows for a year to implement the withdrawal.
What public-health experts are saying
Experts are raising concerns about the short- and long-term implications for public health in the U.S. and abroad. “The WHO continues to serve as a very critical air traffic control and public health response organization for the world,” says Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “We in the U.S. don’t experience many of the infectious diseases we see around the world in large part because they are stopped in these countries, oftentimes through the support and coordination of the WHO. Funding the WHO is about investing in our own health here in this country.”
The WHO is not without controversy. Some of its biggest supporters have also criticized the bureaucracy and inefficiencies of the organization. However, health experts largely don’t see withdrawing funding as an effective catalyst for change. “The WHO can be improved; there are inefficiencies, like with all organizations,” says Paul Spiegel, professor in the department of international health and director of the Center for Humanitarian Health at the Johns Hopkins Bloomberg School of Public Health. “But by pulling out, and removing the huge amount of money that the U.S. gives, you’re not allowing the WHO to make reforms. You’re hobbling it.”
What does the WHO do?
With 194 member countries, the WHO is responsible for a number of important public health programs—particularly vaccines. Each year, scientists there, working with health officials around the world, determine which influenza and COVID-19 strains to include in updated versions of the respective shots. As a member, the U.S. has access to samples of these strains, which help vaccine-makers develop and produce enough doses of matched flu vaccines in time for flu season for the public each year. The WHO was instrumental in coordinating the eradication of smallpox and is now working to eliminate polio.
Being part of the international network becomes critical when a new threat like COVID-19 emerges, Jha says. “When there are outbreaks, countries usually report them first to the WHO and share samples with the WHO,” he says. As a member, “the U.S. has access to that information”—but if the U.S. withdraws, “our ability to access all of that will substantially be worse.”
The WHO also provides health guidance for a number of countries that don’t have the resources to create health recommendations for their populations, such as advice on breastfeeding, diabetes, and giving up smoking.
While other non-government organizations and philanthropies exist, like the Global Fund and GAVI, “none has the same level of trusted relationships with the ministries of health in different countries that WHO has,” Jha says. Frieden agrees. “The executive order says the U.S. is looking for alternatives. But what alternative do we have that works with 194 countries and is trusted by them? If you look at the reach, the relationships, and infrastructure of the WHO, it’s unparalleled.”
Have countries withdrawn from the WHO before?
In 1949, a year after the WHO’s creation, the then Soviet Union and a number of satellite states in Eastern Europe withdrew as Cold War tensions mounted. However, they returned in 1956.
Liechtenstein is the only country that is a member of the United Nations but not a member of the WHO.
Are there signs that the WHO is reforming and changing in response to criticisms?
“If I were giving a grade, I would say their reform efforts get a solid ‘C’,” says Jha. While he says the agency’s emergency preparedness response to outbreaks has improved, in his opinion the WHO still must address under-performing personnel and what he sees as a culture that isn’t responsive enough to fast-moving pathogens.
Jha and other public-health experts argue, for example, that the WHO acted too slowly in allowing the U.S.’s mpox vaccine to be made available to African countries during the recent mpox outbreak.
“There is an arrogance there that even though the vaccine was approved by the FDA and EMA [European Medicines Agency], they wanted their own review because they don’t trust our regulators,” says Jha. “I’m sorry, but if both the FDA and EMA have approved it, then you can do a pretty rapid review and don’t need an independent year-and-a-half review.”
“But that’s classic WHO: they think they are better than everybody else when they actually are not,” Jha says. “I think there are deep cultural issues that need addressing inside the WHO.”
How a withdrawal could endanger the U.S.
The most immediate domestic consequence may be that if the U.S. is not privy to the WHO’s database of changing influenza strains, more Americans could be hospitalized and die from flu infections, says Jha. “Right now 30,000 elderly people at high risk for influenza complications die every year from the flu,” he says. “If we are not making vaccines, or our vaccines are not as good or effective, then we are going to see those numbers go up.”
By not being a WHO member, the U.S. would also lose access to the global database of health information that includes surveillance for new and existing infectious diseases, which could make the country more vulnerable to microbial threats from around the world. “It means we are going to see a lot more disease outbreaks become regional and global, and we will see more disease outbreaks from other countries coming into the U.S.,” says Jha.
If the U.S. withdraws, there will also be implications beyond health. The U.S. would lose its major role as an influencer in global health policy; currently, it shapes how the world responds to and maintains people’s health, Osterholm says, in what he calls “public health diplomacy.” By supporting the WHO, the U.S. supports programs that bring clean water, food, and vaccines to children around the world, and in turn creates valuable relationships with countries that otherwise would be out of reach. “If we are not supporting or doing those things, wait to see how the Russians and the Chinese will,” he says. “They will fill in behind us, and we will absolutely lose the connections to some countries that have been valuable to us over recent decades.”
The U.S.’s withdrawal would leave a sizable financial hole for the agency. “I don’t see other countries stepping up and filling the gap,” says Jha. “Except maybe one country that could do this, and that’s China. That alone would not be great for U.S. interests.” Soon after Trump stopped U.S. funding to WHO in 2020, China pledged $30 million to the organization.
What the rest of the world risks
Without U.S. membership, the WHO would lose its close ties to the CDC, which is regarded as one of the world’s leading public-health agencies. Several dozen CDC researchers are currently assigned to the WHO and would likely be recalled, experts say. Those scientists form critical bridges between the U.S. and other countries, allowing for the exchange of information on new and emerging threats as well as policies that promote health and prevent chronic diseases.
For Frieden, that possibility hits close to home. Early in his career, while working for the CDC, he was assigned to work at WHO in India on its programs to control tuberculosis. “I couldn’t have done what I did as a CDC employee,” he says, noting that the non-political rubric of the WHO enabled him to travel throughout India, meet with high-level local officials, and implement programs to reduce the spread of drug-resistant tuberculosis that continues today. “There are a lot of places where as Americans we can’t be—for safety reasons, for political reasons. And WHO provides that space where countries that may not agree on anything else can have a discussion.” Smallpox, which required the U.S. and Soviet Union to work together through the WHO, was eradicated during the Cold War, he adds.
Health threats around the world—not just from infectious diseases, but also urbanization and deforestation—are forecasted to increase due to climate change and other factors, says Spiegel. “Our interactions with animals are increasing, so the chances of some novel disease like COVID-19 probably increase compared to 100 years ago,” he says. That makes global collaboration on health “more important now than ever.”
The WHO makes such collaboration possible, Frieden says, with the common goal of improving health. “What weakens WHO makes us all less safe,” he says. “What strengthens WHO makes us more safe.”
TIME
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