Donald Trump’s plan to the United States from the World Health Organization (WHO) has been in the public health field.
Author
- C Raina MacIntyre
Professor of Global Biosecurity, NHMRC L3 Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW Sydney
Some have called one of the US president’s first executive orders ” ” and ” “.
What does the WHO do?
The WHO is a that aims to expand universal health coverage, coordinates responses to health emergencies such as pandemics, and has a broad focus on healthy lives. It does not have the power to enforce health policy, but influences policy worldwide, especially in low-income countries.
The WHO plays an essential coordinating role in surveillance, response and policy for infectious and non-infectious diseases. In fact, infectious diseases have the most pressing need for global coordination. Unlike non-communicable diseases, infections can spread rapidly from one country to another, to cause a pandemic.
We have much to thank the WHO for, including the , a feat which could not have been achieved without global coordination and leadership. It has also played a leading role in control of polio and HIV.
Why does the US want to withdraw?
The include:
mishandling of the COVID-19 pandemic … 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.
The executive order also cites the disproportionately the US makes to the WHO . , the US contributed 22% of the organisation’s mandatory funding from member states compared to about 15% for China.
President Trump initiated withdrawal from the WHO over similar concerns in 2020. But this was reversed by President Biden in 2021.
What happens next?
The withdrawal may take a year to come into effect, and by the US Congress.
How this will play out is unclear, but it seems likely the WHO will lose US funding.
The US withdrawal may also be the final nail in the coffin for the WHO Pandemic Agreement, which when member states could not agree on the final draft.
Trump’s executive order states all negotiations around the pandemic agreement will cease. However, the order hints that the US will look at working with international partners to tackle global health.
The US (CDC) already has such international partners and could feasibly do this. It already convenes a , which could provide a model. But to move in this direction needs finessing, as another objective of the new US government is to .
The WHO also convenes a range of expert committees and networks of reference laboratories. One among many network of laboratories is for influenza, comprising . This includes five “super labs”, one of which is at the CDC. It’s unclear what would happen to such networks, many of which have major US components.
With the threat of bird flu mutating to these global networks are critical for surveillance of pandemic threats.
WHO expert committees also on a range of issues. It is possible for the WHO to accredit labs in non-member countries, or for experts from non-member countries to be on WHO expert committees. But how this will unfold, especially for US government-funded labs or experts who are US government employees, is unclear.
Another potential impact of a US withdrawal is the opportunity for other powerful member nations to become more influential once the US leaves. This may lead to restrictions on US experts sitting on WHO committees or working with the organisation in other ways.
While the US withdrawal will see the WHO lose funding, member states contribute about 20% of the WHO budget. The organisation relies on donations from other organisations (including private companies and philanthropic organisations), which make up the remaining . So the US withdrawal may increase the influence of these other organisations.
A chance for reform
The Trump administration is not alone in its criticism of how the WHO handled COVID and other infectious disease outbreaks.
For example, the in early January 2020 there was no evidence the “mystery pneumonia” in Wuhan was contagious, while in reality it was for months. This was a costly mistake.
There was criticism over WHO’s , stating ( ). There was also criticism about its investigation into the , including in the investigating team.
The WHO was for its handling of the a decade ago. , this led to a , but arguably not enough.
More changes needed
US public health expert argues for reform at WHO. Jha, who is the dean of the Brown University School of Public Health and former White House COVID response coordinator, argues the organisation has an unclear mission, too broad a remit, poor governance and often prioritises political sensitivities of member states.
He proposes the WHO should narrow its focus to fewer areas, with outbreak response key. This would allow reduced funding to be used more efficiently.
Rather than the US withdrawing from the WHO, he argues the US would be better to remain a member and leverage such reform.
Without reform, there is a possibility other countries may follow the US, especially if governments are pressured by their electorates to increase spending on domestic needs.
The WHO the US to reconsider withdrawing. But the organisation may need to look at further reforms for any possibility of future negotiations. This is the best path toward a solution.
