Trump’s Plan to Leave the WHO Is a Health Disaster

In the summer of 2020, 15 recognized leaders in US public health gathered to author an article in The Lancet—one of the world’s most eminent medical journals—decrying Donald Trump’s intention to withdraw the US from the World Health Organization, a decision that was later reversed by President Biden before it took effect.

Nearly five years later, one of the opening salvos of Trump’s second term has been to again initiate the process of withdrawing the US from the WHO. The move is already drawing both controversy and the threat of legal challenges.

According to a 1948 joint resolution passed by both houses of Congress, any such withdrawal requires the US to provide the WHO with one year’s notice, but it appears that Trump’s intentions are to withdraw immediately and do so without seeking congressional approval.

“The executive order announces the immediate withdrawal from WHO, and he’s not seeking congressional authorization, and he’s also not giving the required one year’s notice,” says Lawrence Gostin, a professor in public health law at Georgetown University Law Center in Washington, DC, and one of the coauthors of the 2020 Lancet article. “In my view, this is reckless and it’s lawless, and it needs to be challenged in court.”

Trump has a long history of criticizing the WHO, previously accusing the organization of being “corrupt,” ripping off America, and “severely mismanaging and covering up” the spread of Covid-19. The US has historically been one of the WHO’s largest funders, with some estimates suggesting that it provides a fifth of the organization’s entire budget. Between 2022 and 2023, the US provided the WHO with nearly $1.3 billion.

However, Gostin and others are particularly concerned about the impacts of a US withdrawal on the country’s ability to manage the ongoing threat of infectious diseases. While the WHO has a far-reaching remit, ranging from advice on essential medicines to public policy recommendations on everything from tobacco and drug use to road safety, it is arguably most impactful when it comes to the surveillance of potentially problematic new diseases, such as bird flu, and coordinating an international response.

“Withdrawing from WHO makes us more alone, more vulnerable, and more fragile in the world,” says Gostin. “You can’t shut down a border against a pathogen. We need WHO to be on the ground to put out fires before they get to the United States. And we also need WHO’s vast network to provide us with the information about mutations and viruses that we need to develop life-saving vaccines and medical treatments.”

According to Sten Vermund, chief medical officer of the Global Virus Network and another coauthor of The Lancet article, what happens next depends on the reactions of other countries and nongovernment organizations such as the Bill and Melinda Gates Foundation, the World Bank, and Gavi, the Vaccine Alliance, which all provide the WHO with significant funding. After Trump cut US contributions to the WHO to $680 million in 2020–21, Germany responded by quadrupling its contributions to more than $1 billion. The Danish government also agreed to double its contributions, placing a strong emphasis on improving sexual and reproductive health and tackling the rise of non-communicable diseases.

“President Trump is trying to downsize the WHO, and the question is whether other high-income nations like those in Europe, Australia, Japan, and elsewhere, pick up some of the slack,” says Vermund. “Will the Gates Foundation, which has been a very generous donor, pick up some? It’s conceivable that others will tide things over until we have a new administration that might be more friendly to the WHO, but I’m dubious that they can pick up the entire chunk of the WHO budget which is paid for by the US.”

And it isn’t just money that the US provides to the WHO, but staff and expertise too. “The Centers for Disease Control and Prevention has seconded a number of staff to the WHO, and I would predict that the Trump administration, with a new CDC director, will call those folks home,” says Vermund. “That would create quite a gap, because WHO funds do not pay for those individuals. So I think you’d have an almost immediate reduction of workforce and removal of critical professionals within the WHO organization.”

According to Gostin, a lot of the money the US provides to the WHO is core mandatory funding, which all members are required to give, but some funds are particularly earmarked for causes in which the US has a vested interest, such as polio eradication, HIV/AIDS, and the process of identifying and controlling disease outbreaks before they spread and reach American shores. Without US funding, Gostin says that these programs wouldn’t completely disappear, but they would be significantly weakened.

“Polio could come surging back,” says Gostin. “Remember we had polio in the wastewater in New York just a couple of years ago, and our kids are not being immunized. And we’ve had other real health scares in the United States, not just Covid-19, which killed more than a million people. We’ve had Zika, and the next health emergency might be just a mutation or two away. Maybe it’s already here in the form of avian influenza, and we’re going to need WHO to help us with that.”

Both Gostin and Vermund fear that withdrawing from the WHO will place the US at the back of the line when it comes to receiving critical information such as pathogen samples and genomic sequencing data, which pharmaceutical companies require to generate effective vaccines. Gostin cites how the US relies on WHO data every year to effectively update the seasonal influenza vaccine, while Vermund explains that financially speaking, it is far more efficient for the US to fund the WHO to help “snuff out” diseases at their source, rather than trying to tackle them when they arrive in the country.

“We spent over $2 billion preparing for Ebola to hit US shores in 2014 and 2015, and since we only had five or six cases, that was very cost-ineffective,” says Vermund. “So that’s a typical example of how when the US goes it alone, it will be very inefficient compared with contributing to a multinational response to control a disease in the country of origin.”

Trump’s decision does have one historical precedent, with Ronald Reagan’s administration being equally critical of the WHO throughout the 1980s. By the end of 1987, the WHO was facing the worst budget crisis in its history after the US delayed sending promised payments and recalled staff, despite the emergence of HIV/AIDS as a global killer. Public health experts at Johns Hopkins Bloomberg School of Public Health have since criticized this as contributing to the AIDS crisis.

Gostin believes that instead of paying less, the US should be putting pressure on other leading global powers such as China, Russia, Brazil, and India to pay more to the WHO to help support traditionally underfunded issues, such as the need to train more doctors and nurses in Africa, address the global rise of chronic diseases, and improve measures that can make us better prepared for the next pandemic.

Because of the potential impact of Trump’s decision, Gostin told WIRED that he is currently seeking cross-party political backing to potentially file a lawsuit to the Supreme Court, challenging Trump’s executive order. “Trump believes he can do it on his own,” he says. “But I think this is too consequential and momentous a decision for the president to make unilaterally on a whim, or as a grudge against WHO. It’s important enough that we need Congress to weigh in.”

For now, Vermund says that having made the WHO withdrawal a priority at the start of his presidency, it is highly likely that Trump will ultimately be able to get it over the line. While the US is supposed to fulfil its financial obligations to the agency for 2025, he also doubts that this will happen.

“He’s initiating it very early in his presidency, on day one, and that gives him a lot of time to negotiate Congress and the courts if it should come to that,” says Vermund. “If he doesn’t pay his bills to an international agency, I’m not aware of any enforcement mechanism that is available. He may choose to ignore the agreements and go forward without formal legal authority.”