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U.S. President Donald Trump announced his intention to withdraw the United States from the World Health Organization (WHO), renewing an effort begun in 2020 but blocked after the election of Joe Biden. Trump’s decision invites two questions: First, has the United States actually, legally quit the WHO? And second, are other actors powerless to prevent the country’s withdrawal or, if it occurs, shape how it affects global cooperation on health? On both fronts, the answer is no. Trump’s executive order is only the beginning of a complex legal and geopolitical struggle that could have unanticipated global effects.
The United States helped create the WHO in 1948, not out of altruism but because it understood the overwhelming benefit the WHO could provide to the country. Upon joining, President Harry Truman declared it was in hopes international cooperation “spares us the haunting fear of devastating epidemics.” Since that time, the WHO has had both significant successes, such as smallpox eradication, as well as failures, like the early response to AIDS in the 1990s, learning from each.
U.S. President Donald Trump announced his intention to withdraw the United States from the World Health Organization (WHO), renewing an effort begun in 2020 but blocked after the election of Joe Biden. Trump’s decision invites two questions: First, has the United States actually, legally quit the WHO? And second, are other actors powerless to prevent the country’s withdrawal or, if it occurs, shape how it affects global cooperation on health? On both fronts, the answer is no. Trump’s executive order is only the beginning of a complex legal and geopolitical struggle that could have unanticipated global effects.
The United States helped create the WHO in 1948, not out of altruism but because it understood the overwhelming benefit the WHO could provide to the country. Upon joining, President Harry Truman declared it was in hopes international cooperation “spares us the haunting fear of devastating epidemics.” Since that time, the WHO has had both significant successes, such as smallpox eradication, as well as failures, like the early response to AIDS in the 1990s, learning from each.
But it has unquestionably provided a range of public goods the United States and other countries depend on—from information on transnational spread of dangerous viruses, to the scientific collaboration needed for each year’s seasonal flu vaccine, to space to negotiate with allies and adversaries alike over key health issues. While Trump’s executive order seems designed to pick fights with China on territory that is far less perilous than other areas of security policy, the WHO has ironically created a conduit for collaboration. The United States leverages data from China’s contributions to WHO influenza centers for its vaccine development, while the WHO supported U.S.-China collaboration on HIV and AIDS.
The executive order instructs the secretary of state and the director of the Office of Management and Budget to somehow replace the WHO with “credible and transparent United States and international partners.” They will likely find this to be an impossible task—not least because everyone else is already an active member of the WHO.
After all, it was only as part of a WHO mission that U.S. scientists got even limited access to information on the COVID-19 epidemic in Wuhan, China. Substituting bilateral efforts may work with close allies, but in a multipolar world, rivals and competitors around the world are unlikely to share virus samples, open their pharmaceutical markets, or announce outbreaks to a U.S. agency directly. The very point of the WHO is that it reduces transaction costs and enables trust-building for difficult relationships.
And the cost to the United States is minimal—the assessed contribution of $260 million is only around 0.07 percent of the U.S. federal health and human services budget for 2024-25, in line with U.S. GDP despite the Trump administration’s complaints. The United States, however, voluntarily contributes far more than its assessed contribution because it sees value in a wide variety of WHO programs—from polio eradication and pandemic response to pharmaceutical regulatory capacity-building and mental health services for victims of torture.
But has the United States actually withdrawn from the WHO? Not yet, despite Trump’s order. And it will not be simple to do so. In 1948, a joint resolution from Congress (Public Law 643) authorized Truman to accept membership in the world’s new multilateral health organization. Since the WHO’s constitution made no provision for withdrawal, Congress made it a condition of U.S. entry that it could withdraw but also required a one-year notice and that the United States’ financial obligations to the organization must be met in full. The World Health Assembly recognized the decision and accepted the conditions unanimously.
So, to start, the United States must pay its dues, which it has not done yet for 2024 or 2025. But Trump’s executive order explicitly orders that the U.S. government pause all funding transfers to the WHO. Unless rescinded, this prevents the United States from legally withdrawing. It also may quickly run afoul of U.S. law on impoundment.
While the original act of Congress made no mention of which branch of government would have the authority to withdraw from the WHO, legal scholar Harold Hongju Koh has argued that the president does not have the power to unilaterally withdraw the United States from international legal agreements, like the one through which it joined the WHO. Having entered through a joint resolution from Congress, his analysis suggests it must be on Congress to effect withdrawal.
Politically, there is little chance the Republican-led U.S. Congress will challenge on this. Indeed, last year, the House Appropriations Committee sought to enact its own ban on WHO funding. But the GOP margin is razor-thin, and there are many U.S. political actors with standing—members of Congress, private entities, and perhaps states or localities negatively affected—who could challenge this withdrawal over the next year and potentially drag the process out far longer.
Would U.S. withdrawal be a disaster for the WHO?
On the surface level, of course, losing the funding and political support from the world’s most powerful country is an unequivocal blow. The WHO’s ability to support the fight against AIDS and polio, for instance, will be badly undermined, as will its emergency response capacity, where the United States provides an outsized portion of the funding available. The legitimacy of the organization would also take a hit. If the United States sought to invest in parallel efforts or organizations, this could threaten the WHO’s authority and power within an increasingly complex global health governance ecosystem. The Biden administration often led within the WHO; according to one report, two-thirds of recommended U.S. reforms have been adopted.
But there could also be upsides, at least compared to alternatives.
Trump has assailed the WHO for being unable to “demonstrate independence from the inappropriate political influence of WHO member states”—a unattainable hope for an organization governed by member states. Ironically, though, the United States exercises the most political influence among member states by far. This is not without challenges for the organization.
Case in point: the Pandemic Treaty. For the last two and a half years, governments have been meeting through the WHO’s Intergovernmental Negotiating Body to hammer out an international agreement on countries’ obligations to prevent and respond to pandemics. The basic political tension has been clear from the outset: high-income countries prioritize more information-sharing, but low- and middle-income countries want sharing of technology, vaccines, medicines, and funding. A meaningful agreement could be possible if all sides could agree on a compromise on both these fronts.
But as of last December, a deal still seemed far off. The United States, after initial skepticism, has been deeply involved in many areas of the negotiations, and it reportedly advanced agreements on key issues such as data-sharing.
On the other hand, the United States’ positions on more equitable access to pandemic technologies like vaccines has been a major barrier to agreement. The United States has reportedly taken hard lines and watered down text, seeking to protect the interests of its massive domestic pharmaceutical industry.
Meanwhile, major uncertainty over the form of the Pandemic Treaty has been driven by concerns over U.S. law and politics. Originally, the treaty was intended to fall under article 19 of the WHO’s constitution—allowing for legally binding measures on a wide range of issues affecting health. However, the U.S. government opposed, concerned its political hurdles would prevent ratification.
Negotiators on all sides have been highly attuned to how U.S. politics could torpedo the effort. Indeed, the U.S. opposition to calling it a treaty have led to two years of draft text that have labeled it vaguely as a “convention, agreement or other international instrument.” Through last month, it was still not clear if the treaty would revert to being regulations under article 21, which would require a narrower scope but allow an “opt out” approach. In the context of consensus-based negotiations, the prospect of a Trump administration-led U.S. WHO delegation appeared likely to kill the treaty.
But now, Trump’s executive order has put speculation to bed, declaring “The Secretary of State will cease negotiations on the WHO Pandemic Agreement … and actions taken to effectuate such agreement and amendments will have no binding force on the United States.”
In this context, perhaps negotiators can get more ambitious. Of course, the United States is not the only opponent of key equity-focused measures favored by the global south, which have also been blocked by the European Union and others. But perhaps moving a major player with strong red lines off the board will strengthen the hand of the Africa Group; the Group for Equity, composed of countries from Latin America, Africa, and South and Southeast Asia; and other negotiating blocs—meaning a breakthrough can be found.
If Washington’s absence creates space for more democratic governance, particularly with greater power for historically less powerful regions like Africa and the Caribbean, it could create a better WHO. It is possible that U.S. opposition could actually spark a commitment to shoring up the WHO, and maybe even a consolidation behind the WHO’s political leadership amid a famously fractured global health governance ecosystem, in which the organization has often struggled.
But U.S. absence could also have the opposite effect—maybe strengthening the disruption and a breakdown of cooperation in the absence of semi-hegemonic power, a state that Russia has seemingly embraced in recent years. It will almost certainly strengthen Beijing’s power within the WHO. And it could lead to an even greater splintering of health governance globally, if alternatives to the WHO gain traction and private actors become even more powerful.
The impact of WHO withdrawal is not clear yet, nor is it certain that the United States will actually leave. Supporters of effective global health would be wise in this rapidly evolving context to both pay close attention and to build toward the possible best-case scenarios by bolstering the WHO’s position in the face of a coming power vacuum.
