What an American exit from the WHO for global health

For decades, the United States has had considerable power to determine the direction of global health policies and programs. President Donald Trump issued three executive orders on his First day at the office That may signal the end of that era, health policy experts said.

Trump’s order to withdraw From the World Health Organization it means the United States probably won’t be at the table in February when the WHO Executive Board meets. The WHO is made up of its members: 194 countries that set health priorities and make agreements on how to share critical data, treatments and vaccines during international emergencies. With the United States missing, he would cede power to others.

“It’s just stupid,” said Kenneth Bernard, a visiting fellow at Stanford University’s Hoover Institution who served as a senior BioDeFense official during the George W. Bush administration. “Withdrawing from the WHO leaves a gap in global health leadership that will be filled by China,” he said, “which is clearly not in the best interest of the United States.”

Executive orders to withdraw from WHO and reassess those of the United States International Assistance Approach cites the “mismanagement of the Covid-19 pandemic” and says that US aid serves “to destabilize world peace.” In action, they echo priorities established in Project 2025‘s “mandate for leadership,” a Conservative policy plan from the Heritage Foundation.

The 922-page report says the United States “must be prepared” to withdraw from the WHO, citing its “manifest failure” and advises a review of international aid at the State Department. “The Biden administration has deformed the agency by treating it as a global platform to pursue abroad a divisive political and cultural agenda that promotes abortion, climate extremism, gender radicalism, and interventions against perceived systemic racism,” it says.

As one of the world’s largest funders of global health, through international and national agencies such as the WHO and the WHO International Development Agency, the US step may reduce efforts to provide health care and combat deadly outbreaks. , especially in lower income countries without the means to do it alone.

“Not only does this make Americans less safe, it makes citizens of other nations less safe,” said Tom Bollyky, global health director at the Council on Foreign Relations.

“The United States cannot stand up to transnational health threats,” he added, referring to policies that block travelers from countries with disease outbreaks. “The majority of evidence surrounding travel bans It indicates that they provide a false sense of security and distract nations from taking the actions they need to take at the national level to ensure their security.”

less than 1%

Technically, countries cannot withdraw from the WHO until one year after official notice. But Trump’s executive order cites his 2020 termination notice. If Congress or the public push backthe administration may argue that more than a year has passed.

Trump suspended funding to the WHO in 2020, a move that does not require congressional approval. American contributions to the agency reached a minimum of $163 million During that first year of Covid, falling behind Germany and the Gates Foundation. Former President Joe Biden restored US membership and payments. In 2023, the country gave the WHO $481 million.

As for 2024, Suerie Moon, co-director of the Global Health Center at the Geneva Graduate Institute, said the Biden administration paid two year installments for early 2024-25, which will cover some of this year’s payments.

“Unfairly onerous payments” are cited in the executive order as a reason for the WHO’s withdrawal. Countries’ dues are a percentage of their gross domestic product, meaning that as the world’s richest nation, the United States has generally paid more than other countries.

Funds for WHO account for approximately 4% of the United States Budget for global healthwhich in turn is less than 0.1% of US federal spending each year. At about $3.4 billion, HHO’s entire budget is about a third of the budget for the Centers for Disease Control and Prevention, which got $9.3 billion in central funding in 2023.

He Who are funds? Support programs to prevent and treat polio, tuberculosis, HIV, malaria, measles and other diseases, especially in countries struggling to provide healthcare at the national level. The organization also responds to health emergencies in conflict zones, including places where the United States government does not operate, in parts of Gaza, Sudan, and the Democratic Republic of the Congo, among others.

In January 2020, the WHO alerted the world to the danger of the Covid outbreak by sounding its loudest alarm: a public health emergency of international concern. Over the next two years, he examined diagnostic tests and potential medications for Covid, regularly updating the public and advising countries on steps to keep citizens safe.

Experts have cited false in the agency, but Numerous analyzes show Those internal problems explain why the United States has one of the highest death rates in the world due to Covid. “All nations received WHO alert of a public health emergency of international concern on January 30,” Bollyky said. “South Korea, Taiwan and others responded aggressively to that, the United States did not.”

“It’s a red herring”

However, Trump’s executive order accuses the WHO of “mishandling” the pandemic and failing “to adopt urgently needed reforms.” In fact, the WHO has made some changes through bureaucratic processes that involve input from the countries that belong to it. Last year, for example, the organization approved several amendments to its regulations on health emergencies. These include provisions on transparent reporting and coordinated financing.

“If the Trump administration tried to push particular reforms for a year and then got frustrated, you might find the reform line credible,” Moon said. “But for me, it’s a red herring.”

“I don’t buy the explanations,” Bernard said. “This is not a money problem,” he added. “There is no justification for withdrawing from the WHO that makes sense, including our issues with China.”

Trump has accused the WHO of being complicit in China’s failure to openly investigate the origin of Covid, which he alludes to in the executive order as “inappropriate political influence.”

“The World Health Organization shamefully covered the Chinese Communist Party’s tracks every step of the way,” Trump said in a video Posted on social media in 2023.

On multiple occasions, the who has called for transparency from China. The agency does not have the legal authority to force China, or any other country, to do what it says. This fact also repudiates Trump’s warnings that a pandemic treaty under negotiation by the WHO infringes on American sovereignty. Rather, the Agreement aims to set out how countries can best cooperate in the next pandemic.

Trump’s Executive Order requires the United States to “cease negotiations” on the pandemic agreement. This means the pharmaceutical industry may lose one of its strongest advocates as discussions progress.

In the negotiations so far, the United States and the European Union have sided with the US lobby. pharmaceutical industry To maintain strict patent rights on drugs and vaccines. They have opposing efforts From middle-income countries in Asia, Africa and Latin America to include licensing agreements that allow more companies to produce drugs and vaccines when supplies are short in a crisis. TO Study published in Nature Medicine Estimated that more than a million lives would have been saved if covid vaccines had been available worldwide in 2021.

“Once the United States is absent, for better and worse, there will be less pressure on certain positions,” Moon said. “In the pandemic deal negotiations, we can see opposition to more public health-oriented approaches to intellectual property weaken.”

“This is a moment of geopolitical change because the United States is becoming less relevant,” said Ayoade Alakija, president of the African Union vaccine delivery alliance. Alakija said Asian and African countries with emerging economies could now put more money into the WHO, changing policies and setting agendas previously opposed by American and European countries dealing with the war in Ukraine. “Power is changing hands,” Alakija said. “Maybe that will give us a more equitable and just world in the long run.”

Echoes of the 2025 project

However, in the short term, the WHO is unlikely to fully recover its losses, Moon said. US funds typically make up about 15% of your budget. Along with Trump’s executive order That stops international aid for 90 days, the lack of money can prevent many people from getting life-saving treatments for HIV, malaria and other diseases.

Another loss is the scientific collaboration that occurs through the WHO and in some 70 centers it houses at American institutions such as Columbia University and Johns Hopkins University. Through these networks, scientists share findings despite political disputes between countries.

TO third executive order Commands the Secretary of State to ensure that the department’s programs are “in line with an America First foreign policy.” It follows the order to halt international aid by reviewing it for “consistency with the foreign policy of the United States.” That order says U.S. aid has served “to destabilize world peace by promoting ideas in foreign countries that are directly inverse to harmonious and stable relations.”

These and executive orders on climate policies track with policy agendas expressed by the 2025 project. Although Trump and his new administration have distanced themselves from the Heritage Foundation’s playbook, CBS News reviewed The work histories of the 38 senior authors named and found that at least 28 of them worked in the first Trump administration.

One of its main architects was Russell Voughtwho served as director of the Office of Management and Budget during Trump’s first term and has been nominated again for it. Multiple contributors to Project 2025 are from the America First Legal Foundation, a group led by Trump adviser Stephen Miller that filed complaints against “Woke Corporations.”

Project 2025 recommends cutting international aid to programs and organizations focused on climate change and reproductive health care, and directing resources to “strengthen the foundations of free markets,” reduce taxes, and deregulate companies like a path to economic stability.

Several experts said the executive orders appear to be about ideological rather than strategic positioning.

The White House did not respond to questions about its executive orders on global health. Regarding the executive order that says US Aid serves “to destabilize world peace,” a USAID spokesperson wrote in an email: “We forward it to the White House.”

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