Donald Trump’s plan to withdraw the United States from the World Health Organization (WHO) has been met with dismay in the public health field. Some have called one of the US president’s first executive orders “a grave error” and “absolutely bad news”. The WHO is a United Nations agency 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 noninfectious diseases.

In fact, infectious diseases have the most pressing need for global coordination. Unlike noncommunicable diseases, infections can spread rapidly from one country to another, just as Covid spread to cause a pandemic. We have much to thank the WHO for, including the eradication of smallpox, 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 reasons for withdrawing include “mishandling of the COVID19 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 higher payments the US makes to the WHO compared to China.

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In 2024-25, the US contributed 22 per cent of the organisation’s mandatory funding from member states compared to about 15 per cent for China. President Trump initiated withdrawal from the WHO over similar concerns in 2020. But this was reversed by President Biden in 2021. The withdrawal may take a year to come into effect, and may need approval 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 faltered in 2024 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 Centers for Disease and Control (CDC) already has such international partners and could feasibly do this.

It already convenes a global network of training in outbreak response, which could provide a model. But to move in this direction needs finessing, as another objective of the new US government is to reduce or cease international aid. The WHO also convenes a range of expert committees and networks of reference laboratories. One among many network of laboratories is for influenza, comprising more than 50 labs in 41 member states. 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 become a human pandemic these global networks are critical for surveillance of pandemic threats. WHO expert committees also drive global health policy 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 per cent of the WHO budget.

The organisation relies on donations from other organisations (including private companies and philanthropic organisations), which make up the remaining 80 per cent. So the US withdrawal may increase the influence of these other organisations. The Trump administration is not alone in its criticism of how the WHO handled Covid and other infectious disease outbreaks. For example, the WHO agreed with Chinese authorities in early January 2020 there was no evidence the “mystery pneumonia” in Wuhan was contagious, while in reality it was likely already spreading for months. This was a costly mistake. There was criticism over WHO’s delay in declaring the pandemic, stating Covid was not airborne (despite evidence otherwise). There was also criticism about its investigation into the origins of Covid, including conflicts of interest in the investigating team. The WHO was also criticised for its handling of the Ebola epidemic in West Africa a decade ago. Eventually, this led to a series of reforms, but arguably not enough. US public health expert Ashish Jha 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 has asked 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.

(The writer is Professor of Global Biosecurity, NHMRC L3 Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW Sydney. This article was published on www.theconversation.com)