“Oh, that’s a big one,” grinned Donald Trump, signing an executive order in his first moments returning to office, giving notice of his intent to withdraw the United States from the World Health Organisation (WHO). He repeated long-standing grievances about the agency’s initial handling of the Covid-19 pandemic and financing imbalances. In the same order, the president paused the transfer of vital US funds, support, and resources to WHO, including pulling back US officials from Pandemic Treaty talks.
The United States was one of WHO’s founding members. But when it joined WHO, the US by joint resolution of Congress reserved the right to withdraw on the condition that it gave the UN one year's notice and paid WHO all its outstanding dues. The United States has not paid its dues for 2024 or 2025, and both arrears would have to be paid before the US could legally withdraw. But Trump’s decision has already spurred drastic cost-cutting measures and budget cut proposals at WHO, and if carried through would be devastating for global health. WHO programs cover an enormous range of health issues from cancer research, tobacco control, and mental health, to health system strengthening, pandemic preparedness, and disease eradication.
The United States is by far WHO’s largest member state donor, contributing approximately 15% of the agency’s total funding. That funding is comprised of assessed contributions (fully flexible member fees scaled primarily by GDP supplemented by other economic measures) and voluntary contributions (donations usually earmarked to specific priorities). For WHO’s 2024-25 budget, US funding comprises 22% of its assessed contributions (US$261 million) and more than 14% of its voluntary contributions (almost US$728 million). That alone funds 20% of WHO’s emergency response work, and 25% of its core program.
WHO’s budget was already spread thin, and its mandate keeps growing, with budget estimates for 2026-27 already 9% higher than the current biennium. But the loss of US funding – particularly its membership fees over which WHO has full control – makes matters more acute, jeopardising vital WHO-led health programs including polio eradication, pandemic preparedness and response, and universal health coverage. Privately, the organisation is concerned that it would face a “hand-to-mouth type situation” in early 2026 if things don’t change.
The last time Trump withheld funding from WHO, in 2020, European countries stepped up to fill the gap. Yet it is unlikely that they will do so again, as many are facing political and financial challenges of their own. Recently, WHO embarked on financing reforms that would not make it so reliant on a single donor like the United States, including committing to phased increases to countries’ assessed contributions and an investment round to broaden its donor base. But these reforms will not make up for the shortfall.
Ironically, the United States has had an outsized influence over WHO’s agenda.
Last year, the United States partnered with WHO and Rwanda to bring an outbreak of Marburg virus under control, and with WHO and Africa CDC to confront the mpox emergency on the continent, supporting capacity-building and contributing more than US$22 million and pledging 1 million vaccines to the response. Earlier, the United States had supported WHO-led emergency responses to Ebola, Covid-19, and HIV/AIDS. Without US assistance, future WHO-led emergency responses could be scaled back or delayed, leading to increased transmission, sickness, and death in the world’s most vulnerable regions.
The loss of this health emergency support in addition to WHO-US public health collaboration through the US CDC comes at a time when the world is facing overlapping outbreaks and diseases emerging with increased frequency.
It’s a raw deal for the United States, too. Without WHO, the United States will lose access to critical, accurate epidemiological data and disease information transmitted through WHO channels, including genomic sequencing, disease surveillance, and pathogen samples such as influenza used, among other things, to make vaccines. This makes Americans – and by extension, all of us – less secure.
In his executive order, Trump criticised WHO for its “inability to demonstrate independence” from member states, a seemingly impossible ask of an organisation governed by member states. Ironically, however, the United States has had an outsized influence over WHO’s agenda. US contributions to WHO are larger than China’s because the United States chooses to donate more and tightly earmarks those donations to priorities that serve its political interests – much to WHO’s frustration as it can’t direct the funds elsewhere. And the United States has held enormous sway over WHO policy.
Trump’s order pulling back US diplomats from the Pandemic Treaty talks will create new dynamics in the negotiations, for better or worse. The United States has acted as somewhat of a bridge-maker in the negotiations, though its absence may create a path for consensus on valuable equity measures that the US has opposed, such as unhindered access to pandemic-related health products in an emergency.
There is speculation on whether China, India, or others in the expanded BRICS alliance would fill the leadership vacuum the United States leaves. South Africa and Brazil may play a larger role as they respectively host the G20 and COP30 this year. And countries in the Africa Group may step up, already indicated by 14 African nations and partners pledging more than US$45 million to WHO through its investment round.
China has historically donated little to WHO on top of its fees, and recently signalled that it would oppose the latest round of increases in assessed contributions to WHO – increases that were essentially already agreed and aimed at increasing the predictability of WHO’s financing. Though even as China seems unlikely to increase its influence over WHO through funding, it seems poised to expand its influence by filling personnel vacancies at WHO and expanding support for health programs through bilateral partnerships, reshaping governance for global health in the process.
Argentina also announced that it would withdraw from WHO, stoking concerns that other like-minded countries may follow suit, diminishing WHO’s claim to universality. Thankfully, efforts are already underway in the United States to reverse Trump’s decision. And there’s a good argument Trump’s unilateral attempt to withdraw the United States from WHO is unconstitutional even if the US does pay its dues, as it lacks the support of Congress. Suggesting a possible change of heart, Trump recently hinted he would be open to negotiating with WHO, which WHO has indicated it would welcome.
Trump should keep the United States a WHO member, for America’s own national interests if not for the vast benefit of the world at large: WHO is the only global organisation with the membership, authority, expertise, and credibility to protect and promote global health in a world increasingly connected and threatened by disease. But if not, it is up to the rest of the international community, Australia included, to step up its financial and political support for WHO in this moment and for its future.
