Implications Of A U.S. Withdrawal From The WHO, From A Public Health Physician

On January 27, a CDC official instructed senior leaders at the agency to discontinue further collaborations with the World Health Organization, pending further instruction. This includes participating in-person or virtually in working groups, coordinating centers and advisory boards, as well as any travel for meetings. This action follows an executive order signed by President Trump on his first day in office to withdraw the United States from the WHO. Based on a 1948 Congressional resolution for U.S. participation, a one-year notice and Congressional approval is required before exiting the WHO, which includes shoring up existing financial obligations. President Trump’s previous administration provided notice of a planned WHO withdrawal, but this was reversed by the Biden administration before it took effect.

Reasons For The Withdrawal

There are two reasons given for the executive order. The first is “Due to the organization’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.”

The second reason given was that the payments required of the United States are “far out of proportion” compared with other countries. In particular, China is cited as an example with three times the population of the United States, “yet contributes nearly 90 percent less” that what the United States pays. Upon review of the 2024-25 period assessments for WHO member funders, the U.S. is listed as the largest contributor, at approximately $261 million (22.0%) of the overall $1.1 billion in assessments. China’s contribution is listed as approximately $181 million (15.25%). Other funding for the WHO comes through voluntary contributions.

The Mission Of The WHO

The WHO is an agency of the United Nations, with its headquarters in Geneva, Switzerland. Its stated activities include health promotion through connecting nations, partners and people, including to “Keep the world safe and serve the vulnerable – so everyone, everywhere can attain the highest level of health.”

Past WHO Successes

The WHO led the successful worldwide effort to eliminate smallpox from humans, which was declared eradicated in 1980. Efforts by Pan American Health Organization, PAHO, the WHO’s regional office for the Americas, in conjunction with the WHO have eliminated wild type polio virus infection in the Americas and has reduced endemic spread to just two countries. The WHO has also collaborated with the Carter Center on elimination of Guinea worm disease, which has been reduced by 99.9%. Providing medications to treat HIV under the President’s Emergency Plan for Aids Relief (PEPFAR), which was started by former President George W. Bush, in Africa is credited with saving 25 million lives. There are numerous ongoing efforts in health promotion, disease surveillance and response to outbreaks around the world, such as Marburg virus, which just resurfaced in Tanzania.

What Does The U.S. Gain From Participating?

Key aspects of participation include input to regulations such as the International Health Regulations, which provide requirements for reporting and responding to outbreaks. There are numerous ongoing activities where U.S. representatives provide critical input and gain insight on ongoing operations and policies that affect the U.S.

In addition, having a seat at the table provides opportunities for two-way dialogue, information sharing on disease surveillance, treatments, vaccines, diagnostics, data sharing and scientific planning and preparation for future outbreak and pandemic response. Moreover, relationships with international collaborators built across the table and in the field yield intangible, but significant results when a crisis occurs.

The Potential Repercussions Of Withdrawing

Multilateral organizations are imperfect by their nature. In order to get anything done, they require consensus building across the representatives. In the case of the WHO, there are 196 members and associate members. Negotiations to reach consensus can be slow and painstaking, but having a seat at the table provides an opportunity for input and ability to shape the final product, whether for regulations or myriad other consensus documents. If the U.S. walks away from the WHO table, it guarantees that the U.S. will have no input.

Infectious diseases don’t respect national borders. In the twenty-first century alone, we have experienced this challenge with Chikungunya, Dengue and Zika virus pandemics, the 2014-16 West Africa Ebola virus outbreak, the Covid-19 pandemic and annual influenza virus spread. More recently, we have seen it with mpox and bird flu. Even when flights were shut down during the early stages of the Covid-19 pandemic, we found that the virus circumvented our attempts to reduce international spread and was already within our borders and amplified through European channels.

Potential repercussions of withdrawal include: the risk of diseases that occur elsewhere affecting the U.S. population; efforts to eliminate polio and Guinea worm could be set back; childhood diseases preventable with vaccines could surge; and during the next pandemic, we may find ourselves on our own and have additional challenges responding and receiving credible information. Furthermore, by the U.S. deliberately yielding its seat at the table, it may provide a wider opening for China to influence WHO policy and activity. That would seem counterproductive to U.S. interests.

I often cite the John Donne poem, “For Whom The Bell Tolls,” which states that “No man is an island.” Nowhere is this more prescient than when dealing with infectious diseases across the globe, where what happens elsewhere presents risks to the population of the United States. It’s not a situation where we can build a wall to prevent importation of diseases, nor put our heads in the sand and hope diseases go away. Donne’s poem goes on to state, “Ask not for whom the bell tolls, it tolls for thee.” Identifying “credible and transparent United States and international partners to assume necessary activities previously undertaken by the WHO,” as the recent executive order directs, may not be so simple and will take time, resources and good will, potentially leaving the U.S. vulnerable for when the bell tolls.