The U.S. Can Support Global Health Without Backing the WHO

Of all of the United Nations’ activities—peacekeeping, refugee management, protecting human rights—the least controversial should be cooperative efforts to improve and protect public health. Reducing infant and maternal mortality, promoting and facilitating immunization, bolstering health capabilities in developing nations, and detecting and preventing new pandemics are indisputable goods. Nonetheless President Donald Trump withdrew from the World Health Organization on the very first day of his second term. His executive order halted U.S. funding, recalled government personnel and ended U.S. participation in negotiations for a new WHO Pandemic Agreement ostensibly intended to better prepare the international community for a future pandemic. 

To understand the necessity of Trump’s scorched earth approach, it is critical to review how we arrived here. An organization that grew out of the world’s response to the Spanish flu pandemic utterly failed in handling the COVID pandemic a century later, and it has yet to reckon with the damage it did or the structural problems that resulted in that failure.

While the purpose of the WHO is to facilitate “the attainment by all peoples of the highest possible level of health,” the legacy of the Spanish flu loomed large in its first few decades: The organization focused on promoting immunization, sanitation, nutrition, as well as eradicating diseases that caused enormous suffering. The pinnacle of its achievements was the eradication of smallpox in 1979. Although the WHO has helped curtail other diseases, polio in particular, this achievement has proven difficult to replicate.  

In the 1970s and 1980s, the WHO began to expand its focus to include banning tobacco, climate change, addressing lifestyle diseases like diabetes and obesity, and myriad other more health topics unrelated to contagious disease. And with that mission creep, donors noticed a growing politicization, duplication of mission with other organizations like the World Bank, and bureaucratic bloat. The U.S. and other governments responded by withholding mandatory funding and increasing voluntary contributions over which they had more direct control. When governments sought to directly address AIDS, tuberculosis, and malaria in the 1990s and early 2000s, they did not trust the WHO, but created new entities like the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Global Fund. 

This pressure spurred limited reforms, but the WHO couldn’t steer fully clear of controversy.  As with other U.N. specialized agencies under Chinese management and influence, China used its political influence to limit Taiwan’s engagement with the WHO. The organization also bent to the funding whims of government and non-government donors to support health concerns that pose no threat of contagion, like road safety and obesity, or were aimed at encouraging national action to change behavior, such as regulating unhealthy diets or alcohol use. And then there were the scandals: sexual harassment and financial mismanagement. 

As the WHO wandered further afield from its core mission, the less capable it became of meeting its original purpose.  

The 2003 outbreak of a coronavirus causing severe acute respiratory syndrome (SARS) in China laid bare the inadequacy of the WHO pandemic framework. China’s lack of cooperation and transparency during the outbreak, including censoring doctors and withholding information from the WHO and the international community, led the World Health Assembly, the governing body of the WHO, to update and strengthen international health regulations (IHRs) in 2005. But the WHO still made a mess of the swine flu in 2009—leading to the unnecessary culling of pigs and unwarranted trade bans—and it was criticized heavily for its slow response to the 2014 Ebola outbreak. 

The COVID pandemic was the international health crisis for which the WHO was nominally built. Instead, it unveiled its weaknesses for all to see. From the very beginning, the WHO leadership appeared more concerned with kowtowing to Beijing than acting quickly and decisively to contain the pandemic and minimize its damage. It was Taiwan, not China, that first alerted the WHO about potential human-to-human transmission of COVID-19, only to have the WHO stick to China’s line that such transmission was unlikely. 

WHO Director-General Tedros Adhanom Ghebreyesus echoed Chinese representations of the nature of the threat from COVID-19, tweeting on January 14, 2020: “Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel #coronavirus.” The WHO failed to condemn Beijing’s obfuscation and delays in allowing international experts into Wuhan in the early stages of the pandemic. To the contrary, Tedros lavished praise on his Communist friends, praising their willingness to “immediately” share genetic sequencing information about the virus (they did not). Later, the WHO actively downplayed the possibility that COVID-19 originated from a laboratory in Wuhan, China. 

To this day, the Chinese government has failed to disclose the most basic information about the provenance of the COVID virus, and the WHO has never formally condemned Beijing for its lack of cooperation. 

All told, the COVID-19 pandemic is estimated to have resulted in more than 7 million deaths worldwide and over $10 trillion in economic losses. There is plenty of blame to go around for the pandemic, not least U.S. funding through the National Institutes of Health for gain-of-function research in China. But the WHO was supposed to prevent what happened. Abject failure is too kind a characterization of the WHO response. 

But that is not the only problem at the global health body. This is where Donald Trump comes in. 

At the outset of COVID-19, President Trump and his team worked with the WHO and China. However, he became more critical as the pandemic progressed. His April 2020 call for more accountability for the WHO mentioned that the U.S.’s funding of the organization was 10 times that of China, criticized China’s excessive influence within the organization, and called out the organization’s missteps in responding to the pandemic. Ultimately, the U.S. suspended funding to the WHO and later informed the organization that the U.S. would withdraw. 

Formal withdrawal takes a year and, before it could be completed, newly elected President Joe Biden reversed course. Unfortunately, Biden failed to use the leverage Trump had bequeathed him to seek reforms and changes as a condition of U.S. reengagement. Rather, Biden sought to pay all arrears in funding with no strings attached. Worse yet, Biden failed to oppose or propose an alternative candidate to Chinese-backed Tedros when he ran for reelection in 2022. 

As a result, the WHO is little changed from the organization Trump decided to leave in 2020. In some ways, it is worse. In 2022, to counter the increased tendency of governments to use voluntary funding to direct resources to preferred programs, the WHO increased mandatory contributions owed by member states. And a multiyear effort to negotiate a Pandemic Agreement resulted in a text that fails to address the key problems exposed by COVID-19, including China’s lack of transparency and cooperation. 

No wonder Trump has decided to withdraw again. But this time he is going further, recalling U.S. government personnel working in the WHO and terminating U.S. participation in the negotiations for the Pandemic Agreement. 

The real mystery is why the WHO leadership and the other member states have not spent the last three months drafting serious reform proposals and changes to convince the U.S. to remain engaged instead of trimming costs at the margins like restricting travel. Prudence dictates that the WHO should proactively offer reforms to retain its largest financier and source of expertise. In fact, it should seize the openness Trump signaled in his executive order: “They [the WHO and its member governments] wanted us back so badly; so, we’ll see what happens.”

What might such reforms be? 

First, Trump is correct to complain about the disproportionate financial burden on the U.S. versus China. The U.S. was charged 22 percent of the two-year regular budget in 2024-2025. China was assessed 15.255 percent. This could be addressed by capping the level of assessments at 15 percent or, in anticipation of China’s higher rate in the newly adopted U.N. scale of assessments for 2025 that the WHO uses as the base for its assessments, at 20 percent. To lessen the burden on other member states who would have to fill the gap, the organization should reduce the assessed portion of its budget and, ideally, shift non-core activities to voluntary funding and refocus the organization on its core mission.

Second, COVID demonstrated that the WHO’s mission should be to detect and combat the spread of communicable diseases, especially those whose impact is broad, transboundary, and pose a threat of pandemic. Non-communicable diseases and other health issues are more appropriately handled at the national or sub-national level. If governments wish the WHO to play a role in these matters, funding should come from voluntary contributions and only to the extent that it does not divert resources, attention, or capacity from the primary mission.   

Third, member states need to formally condemn China for its likely role in creating the COVID-19 pandemic. It is increasingly clear that the virus was the result of a lab leak from the Wuhan Institute of Virology. China’s negligence cost millions of lives and trillions in economic costs. Its lack of transparency and cooperation made the pandemic worse. Failing to condemn Beijing rewards the same behavior that the WHO claims to oppose and the Pandemic Agreement claims to remedy. 

Finally, the negotiations for a Pandemic Agreement have been a fiasco that has focused on a number of tangential issues like weakening intellectual property rights and mandating technology and resource transfers that, for the most part, would have done little to prevent the COVID-19 pandemic had it been in place prior to 2019, and will do little to prevent a future pandemic. The effort should be scrapped and restarted. 

The WHO has been a troubled organization for too long—troubles that were only highlighted by the pandemic. As Roger Bate noted in 2009, “WHO has a role to play, but it should be smaller and more focused. Its current condition is the end product of an ambitious mandate and a half-century of mission creep.” 

The U.S. will not cease supporting international health under Trump. But those efforts need not involve the WHO. As Trump instructed in the executive order, the U.S. will seek “credible and transparent” alternatives to assume necessary activities previously undertaken by the WHO. The threat of withdrawal should be a wake up jolt to the WHO and its more responsible members. While the loss of U.S. membership and funding might not be terminal, it will be crippling. 

Member states who believe the WHO remains vital need to ask themselves what reforms they should propose to convince the U.S. to reverse course. Done well, such reforms could be about more than just placating the U.S., they could usher in a revolution in international health. The only real question is: Why is anyone opposed?