President Trump withdraws the US from WHO — now what?

On day one, President Trump issued an Executive Order withdrawing the United States from the World Health Organization. Here is what it says:

The United States noticed its withdrawal from the World Health Organization (WHO) in 2020 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. In addition, the WHO continues to demand unfairly onerous payments from the United States, far out of proportion with other countries’ assessed payments. China, with a population of 1.4 billion, has 300 percent of the population of the United States, yet contributes nearly 90 percent less to the WHO.

In reply, WHO issued a statement expressing regret and hope that the US would reconsider, and said it “look[s] forward to engaging in constructive dialogue to maintain the partnership between the USA and WHO.” In signing the Executive Order, President Trump said, “we’ll see what happens,” implying there is room for negotiation.

Regarding the payments, only about a quarter are “assessed contributions,” so the US could itself decide to greatly reduce its funding without leaving. But what about the substantive issues (I also wrote about these last week)? And what concrete actions could be taken over the coming months that are responsive to US concerns?

First, COVID-19. There is ~ 50% chance of a COVID-scale pandemic by 2050. Pandemics require global cooperation, and leaving WHO would weaken the U.S.’s ability to shape pandemic preparedness efforts, including the Pandemic Agreement currently being negotiated. Furthermore, in contrast to commonly held belief, WHO has repeatedly pressed China for transparency on the origins of COVID-19 (see here, here, here, here, and here).

What could WHO do?

• Listen carefully to US concerns about handling of the pandemic and work with the US to address these.

• Continue to press China for transparency on origins of COVID-19.

Second, geopolitics. The nomination of Elise Stefanik as US Ambassador to the UN suggests that fighting anti-semitism will be a key issue for the Trump Administration. At her confirmation hearing she said, “Our tax dollars should not be complicit in propping up entities that are counter to American interests, antisemitic, or engaging in fraud, corruption, or terrorism." In the context of the Executive Order, Richard Goldberg, a former National Security Council staffer in the first Trump Administration, posted on X, “WHO maintains a standing agenda item castigating Israel…” In the longer term, staying in WHO would allow the U.S. to influence the 2027 director-general election, while leaving would clear the way for Chinese influence.

What could WHO do?

• At the February Executive Board meeting, suspend relations with the International Federation of Medical Students’ Associations (IFMSA), which last August suspended the Israeli medical students association, selectively waiving their own by-law requiring an investigation, until IFMSA reverses its decision.

• At the May World Health Assembly, fix the situation of having one World Health Assembly resolution and discussion on the health of people in the “Occupied Palestinian Territories” and another for all other emergencies in the world.

• Balance WHO statements between attacks on health facilities (by Israel) and militarization of those facilities (by Hamas).

Third, accountability for results. Saving lives garners bipartisan US support, and historically has been strongly advanced by compassionate conservatives including evangelical groups. WHO’s investment case aims to save 40 million lives between 2025-2028. By staying the US could provide a much-needed focus on accountability and innovation.

What could WHO do?

• Reintroduce a proposed programme budget for the February Executive Board meeting which contains a prototype one-page dashboard so Member States can easily track progress on outputs and outcomes, providing greater accountability for results.

These steps will no doubt be insufficient for the US at this moment. The day one decision seems primarily political: a reversal of the Biden Administration’s day one decision reversing the former Trump Administration’s position. They may also be a bridge too far for WHO. Several require action not only by the WHO Secretariat (i.e. the Director-General and his staff) but also by member countries. However, these concrete steps — that WHO, the US, and other countries could work on together — represent a rational middle ground and could serve as a roadmap for dialogue in the coming months.

A crisis is a terrible thing to waste.