Trump issues order to withdraw US from WHO

In a move that could have a significant impact on US and global efforts to monitor and respond to infectious diseases, the Trump administration yesterday said it will withdraw from the World Health Organization (WHO).

In an executive order issued within hours of his inauguration, President Donald Trump cited the WHO’s mishandling of the COVID-19 pandemic and failure to implement reforms as among the reasons for withdrawal. He also faulted the organization’s “inability to demonstrate independence from the inappropriate political influence of WHO member states.”

The order is the second attempt by President Trump to withdraw from WHO, an organization he has been highly critical since the COVID-19 pandemic. The first Trump administration announced it would leave the WHO in July 2020. That executive order was blocked by the incoming Biden administration in January 2021.

In a statement, the WHO said it regretted the announcement, noting that American institutions have “contributed to and benefited from” WHO membership.

“WHO plays a crucial role in protecting the health and security of the world’s people, including Americans, by addressing the root causes of disease, building stronger health systems, and detecting, preventing and responding to health emergencies, including disease outbreaks, often in dangerous places where others cannot go,” the WHO said.

A key funder and partner for decades

A member state since the WHO was founded by the United Nations in 1948 to promote health around the world, the United States has for decades been a top donor and partner to the agency. In the 2022-23 biennium, the US government was the leading donor, contributing $1.28 billion. The United States has been a key partner in WHO efforts to eradicate smallpox and polio, strengthen global health security, and deliver humanitarian assistance to communities devastated by conflict, natural disasters, and disease outbreaks.

“US funding has been instrumental in supporting the WHO’s pandemic response,” Michele Goodwin, SJB, and Lawrence Gostin, JD, co-directors of  Georgetown University’s O’Neill Institute National and Global Health Law, said in a statement. “Without it, the organization’s ability to address global health emergencies will be significantly weakened, endangering health everywhere.”

In addition, US agencies including the Centers for Disease Control and Prevention (CDC), collaborate with the WHO on infectious disease surveillance efforts, such as the Global Influenza Surveillance and Response System, which monitors seasonal flu viruses and makes recommendations on which viruses to include in flu vaccines for the northern and southern hemispheres. The CDC has also partnered with the WHO on efforts to monitor antimicrobial resistance. 

Infectious disease and public health experts warn that US withdrawal from the WHO could negatively impact these and other surveillance efforts, leaving the United States less prepared for future outbreaks. 

“This represents one of the darkest days of public health that I can recall,” said Michael Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy, which publishes CIDRAP News. “Withdrawing from the World Health Organization will make the entire world less safe, and in particular the United States.”

“Leaving the WHO will put the US in a position where it will be without full situational awareness of infectious disease outbreaks that are occurring globally, it will hamper the ability of the CDC to be most effective in global health, and will likely only increase Chinese influence on the organization,” Amesh Adalja, MD, a senior scholar with the Johns Hopkins University Center for Health Security, told CIDRAP News. 

Withdrawing from the World Health Organization will make the entire world less safe, and in particular the United States.

Osterholm said the loss of US funding will undercut the WHO activities that help keep the United States and other high-income countries protected from many of the life-threatening infectious disease that circulate in low- and middle-income countries. At the same time, he noted that the relationship has benefited the United States by giving scientists from agencies like the CDC opportunities to work in countries experiencing outbreaks and help inform the global response.

“Those are opportunities that we would not have had if we had not been part of the WHO team,” he said.

Accusations of Chinese influence

President Trump’s anger toward the WHO stems back to the early days of the COVID-19 pandemic. He and congressional Republicans contend the WHO delayed naming COVID-19 a Public Health Emergency of International Concern and other measures to counter the global spread of COVID-19 because of pressure from the Chinese government. They also believe the WHO helped China cover up the origins of the pandemic.

The criticism of the WHO has also been bipartisan, with members of the Biden administration agreeing that the agency needs reform. But Adalja said that efforts to reform the WHO will likely be less prioritized without US influence. Osterholm agrees.

“I have, for some time, urged an evaluation of how the WHO can do its job much better,” he said. “But we are actually going to make ourselves less able to shape a better public health response in the future by bowing out.”

The executive order says the US Secretary of State will also cease US participation in negotiations on the WHO Pandemic Agreement and amendments to the International Health Regulations, which are aimed at addressing some of the weaknesses in international COVID-19 response and bolstering the world’s capacity to quickly identify and respond to future pandemic threats. The president also ordered the administration to find “credible and transparent” US and international partners to assume some of the duties of the WHO after US withdrawal.

The withdrawal does not take effect immediately, however. According to the joint resolution on WHO membership adopted by Congress in June 1948, withdrawal requires a 1-year notice, with the country needing to meet its financial obligations to the WHO for the current fiscal year.