Whither the WHO?
Introduction
President Donald Trump signed an executive order (EO) on Inauguration Day initiating the withdrawal of the United States from the World Health Organization (WHO).[1] This action quickly provoked consternation among some public health experts; one was quoted in The New York Times claiming it “will undermine the nation’s standing as a global health leader and make it harder to fight the next pandemic.”[2] This brief offers some background on both the EO and the WHO itself, outlines the order’s likely implications, and offers some tentative suggestions for next steps.
I. Reasons the Executive Order Was Issued
President Trump’s EO offered several reasons for his decision to withdraw from the WHO, including:[3]
- The WHO’s mishandling of the COVID-19 pandemic and other global health crises;
- its failure to adopt urgently needed reforms;
- its inability to demonstrate independence from certain WHO member states; and
- its demands for payments from the United States that are disproportionate to the size of the U.S. population
The first three of these reasons are the very same ones President Trump used to justify his notification to withdraw the United States from the WHO on July 6, 2020—an order that was later revoked by President Joe Biden on his Inauguration Day in 2021.
Of note, the EO also seeks to:[4]
- pause U.S. funding for the WHO;
- withdraw U.S. government personnel and contractors working for the WHO;
- “identify credible and transparent United States and international partners to assume necessary activities previously undertaken by the WHO”; and
- cease negotiation on the WHO Pandemic Agreement and amendments to the International Health Regulations.
In other words, the EO is motivated by the WHO’s poor performance during the COVID pandemic, including, especially, its promotion of economically and socially disastrous lockdowns; a fear that this failure would be repeated through the development of a new pandemic treaty modeled, at least in part, on the response to COVID; a concern that the WHO is beholden to certain foreign powers; and a view that the U.S. funds spent on the WHO could better be deployed elsewhere.[5]
II. What Is the WHO?
Founded in 1948, the WHO comprises a permanent United Nations secretariat based in Geneva, Switzerland, which oversees public-health projects around the globe. The WHO’s constitution defines its objective as “the attainment by all peoples of the highest possible level of health.”[6] Initially, it sought to achieve this objective by combatting such widespread infectious diseases as cholera, plague, and smallpox.
In 1951, the WHO introduced the International Sanitary Regulations, which subsequently evolved into the International Health Regulations (IHR), to standardize disease reporting globally. Through standardized reporting and coordination of responses, the WHO played an important role in containing numerous pandemics, including the 1957 Asian Flu, the 1968 Hong Kong Flu, and the 2003 severe acute respiratory syndrome (SARS) outbreak. Similar techniques were used in its successful campaign to eradicate smallpox.
Over time, however, the WHO has sought to address a wider range of health problems. To do so, it changed its funding model. Originally funded by core donations from member nations, the WHO began to develop “Special Programmes,” starting in the 1970s, that would attract specific funding from donors. Over time, these grew in importance and now comprise the vast majority of the WHO’s funding and expenditure.[7]
In 2022-23, only about 13% of the WHO’s total $7.8 billion budget came from assessed contributions.[8] The remainder—fully 87%, or $6.8 billion—came from “voluntary contributions,” often given to support special programs. This increasingly heavy reliance on voluntary contributions has cast doubt on whether the WHO is setting global health priorities or reflecting the interests of private agendas, especially in light of some of the WHO’s recent activities.
Of equal concern, whereas the WHO’s funding originally came entirely from individual governments, this has been increasingly replaced over time by intergovernmental bodies and private philanthropy. In 2023, the four largest contributors, responsible for around 45% of WHO’s funding, were the United States (15.6%), the Gates Foundation (12.7%), Germany (11%), and the Global Alliance for Vaccines (7.4%).
III. What Would a United States Exit from the WHO Mean?
A U.S. exit from the WHO would have many ramifications. Here, we adumbrate a few of the most significant: the effects on pandemic management, the effects of funding cuts on the WHO, the effects on WHO reform, and the implications for the currently stalled pandemic treaty.
A. Implications for Pandemic Management
Pandemics do not respect the often-arbitrary geographical borders established by nation states. It is almost impossible for a large nation with many border-crossing points, such as the United States, to isolate itself completely from a pandemic. As such, some degree of coordination will inevitably be required if nations are to limit the harm of future pandemics.
Pandemic prevention and management have been core functions of the WHO since the body’s inception. While there are other organizations that perform some important related activities, the WHO plays a dominant role, especially with regard to the standardization of disease reporting through the International Health Regulations (IHR) and international coordination of responses.
The recent White House EO called on the secretary of state to “identify credible and transparent United States and international partners to assume necessary activities previously undertaken by the WHO.” It also called for an end to negotiations on the WHO Pandemic Treaty.
It is possible that a new group of likeminded nations working collaboratively would be considerably more effective at preventing, identifying, and responding to future pandemics than the WHO has shown itself to be. There is, however, a risk that the United States choosing to leave the WHO before such a group is established could mean that most, if not all, of the organization’s other 193 nations remain members and negotiate a pandemic treaty (however ineffectual, or even counterproductive) on which the United States will have no input. Worse still, the United States may be excluded from access to important information about disease outbreaks, making it more difficult to respond to future pandemics.
B. Loss of US Funding Is Unlikely to Kill the WHO
As noted above, while the United States has been the largest single funder of the WHO, it still only represents about 16% of total funds.[9] While the loss of such a large sum may require WHO to cut some activities, it would not likely end the organization. Indeed, the withdrawal of the United States from WHO and the termination of U.S. government funding might lead nations like China or nonprofit organizations like the Gates Foundation to increase funding, both to continue programs they favor and to curry favor with WHO leadership, possibly worsening the very outcomes that motivate the U.S. withdrawal.
C. Hindering Needed WHO Reforms
The WHO’s failures during the COVID-19 pandemic are increasingly apparent. The organization promoted deeply harmful lockdown policies that were contrary to its own guidelines, and that will arguably exacerbate global inequality and ill health for generations. It then compounded these harms by colluding with the Chinese government to obscure the disease’s origins.[10] These failures were underpinned by malignant political leadership. Under the leadership of Tedros Adhanom Ghebreyesus, the organization has consistently misled nations about the risk of future pandemics.[11]
But the WHO also employs many excellent and honorable physicians and scientists who would probably welcome change, including change in leadership. Since the WHO is unlikely to vanish, the solution must be to reform.
Exiting the WHO would prevent the United States from using its funding and participation as leverage to force through that reform. While it is difficult to change large organizations, it is possible. The WHO previously was revitalized under the leadership of former Norwegian Prime Minister Gro Harlem Brundtland from 1998 to 2003. Under new leadership—which the United States could push for if it were to remain a member—a similar beneficial change could occur.
President Trump will leave office in January 2029 and the new president could seek to rejoin the WHO. This could mean financing an organization perhaps even more beholden to corrupting private and geopolitical interests than it is today.
D. Likelihood of a Misguided Pandemic Treaty
Given the WHO’s recent history of project failure and capture by vested interests, it should not be in charge of a pandemic treaty for the entire world. Its only previous treaty—the Framework Convention on Tobacco Control—has been an expensive mess that has likely delayed the transition away from smoking.[12]
Perhaps a reformed WHO could oversee the development and implementation of an effective pandemic treaty, but today’s WHO cannot. Treaty negotiations have stalled because of opposition, including from U.S. interests. But the continued desire of WHO leadership to push for a treaty is not an argument in favor of a U.S. withdrawal from WHO. The opposite is more nearly the case: U.S. membership of the WHO is far more likely to ensure that the WHO does not pursue its pandemic-treaty fantasy.
IV. Where to Next?
Whether or not the United States exits the WHO, there is an urgent need to address the issues raised in the White House EO—including, but not limited to, the failures of the U.S. and other health-care systems to address the threat of COVID in a reasonable manner; reforming the WHO; and building a “coalition of the willing” to address future pandemic threats (with or without the WHO).
A. Understanding the Real COVID Failures and Rebuilding Trust
It is easy to blame the WHO for the policy disasters that led to and were enacted during the COVID-19 pandemic. And while the WHO certainly deserves some blame, many of those policies would have looked much the same had WHO not been involved.
The WHO did not initiate the gain-of-function research at the Wuhan Institute of Virology or the lab’s lack of appropriate biosafety controls—which in combination probably led to the pandemic.[13] Nor did the WHO claim that vaccines completely prevent transmission of COVID. Nor, for that matter, was it the WHO that first suggested lockdowns and other mandates.
In the United States, many state governments and the federal government made mistakes. In the case of the federal government, this was in no small part the result of state actors funding dangerous research, knowingly giving bad advice, and repeatedly lying to Congress about the mistakes and prior lies.[14]
But governments had willing allies in other members of the “pandemic industrial complex,” including companies that manufacture COVID tests and personal protective equipment (PPE), as well as those pharmaceutical firms that have profited from vaccine drives that have continued long after the end of the pandemic—at great expense, but little to no benefit.[15] While the WHO was a useful tool in these efforts, supported by the vested interests that funded it, it was not an essential one, nor was it the root of the problem.
Unfortunately, these mistakes have had serious consequences, including a loss of trust in governments’ advice regarding vaccines and health care more generally. Distrust of the public-health establishment is at an all-time high: a recent academic survey found that two-thirds of Americans do not trust their health-care system.[16] My own research has demonstrated massive increases in vaccine hesitancy.[17]
To earn back the trust of the American people, the Trump administration should commission a full, independent analysis of COVID, from its origins to the many policy failures, including those that came under his first administration.
B. The WHO Must Be Reformed
The White House EO does not immediately withdraw the United States from the WHO. Rather, it begins the process. It is still possible that other members of the WHO could persuade its leadership to offer concessions sufficient to keep the United States in the fold. But regardless of what drives it, the WHO urgently requires radical reform so that it can operate effectively as a coordinating body to address global health challenges.
At a minimum, the WHO should be required to refocus on activities that genuinely require global coordination. This might be achieved, in part, by changing the organization’s governance structure so that it is more directly accountable to member states. Currently, WHO programs are agreed to an annual basis at the World Health Assembly, and then implementation is left mostly in the hands of the appointed secretariat. Giving those member states more regular and direct say in the WHO’s actions could potentially reduce the influence of a few powerful multilateral and non-state donors.
Secondly, the WHO’s members could cap or prohibit contributions from non-members. While partnerships can be valuable, these should be expressly approved by members and funds should not flow via the WHO secretariat. They should instead be structured through separate, transparent, and accountable entities. Such caps would have the effect of significantly reducing the WHO’s budget, forcing it to focus on areas of critical global importance.
A reformed WHO could be an important agency. It is, after all, the only international health agency constitutionally governed by member states alone.[18] While it has been corrupted by vested interests and the inevitable self-serving decay that afflicts large unaccountable bureaucracies, a substantially reformed WHO could be useful. It would need to be less than half its current size and focused on what it is uniquely positioned to deliver, free from private influence. It can then go back to shaping the coordination standards for management of diseases like tuberculosis and malaria, and exposing the deadly international criminal industry of fake drugs. Focused on building technical capacity within countries that request such help, it could remove the need for such aid (and therefore the WHO itself) in the years to come.
C. A Coalition of the Willing
If the United States does exit WHO, one hopes it will have identified “credible and transparent … international partners to assume necessary activities previously undertaken by the WHO.” Such a coalition of the willing is sorely needed, especially to share information about new outbreaks and other emergent threats; to coordinate access to virus (and other pathogen) information (including rapid dissemination of genetic sequences); and to provide appropriate incentives for the development and delivery of suitable vaccines and treatments.[19]
[1] See Withdrawing the United States from the World Health Organization, White House (Jan. 20, 2025), https://www.whitehouse.gov/presidential-actions/2025/01/withdrawing-the-united-states-from-the-worldhealth-organization.
[2] Sheryl Gay Stolberg, Trump Withdraws U.S. from World Health Organization, N.Y. Times (Jan. 20, 2025), https://www.nytimes.com/2025/01/20/us/politics/trump-world-health-organization.html.
[3] White House, supra note 1, § 1.
[4] Id. at 2(d), 4.
[5] See Roger Bate, A Pandemic Treaty Will Double Down on all the Bad Ideas from COVID-19, Int’l Ctr. L. Econ. (Feb. 2, 2024), https://laweconcenter.org/resources/a-pandemic-treaty-will-double-down-on-all-the-bad-ideas-from-covid-19; Kevin Bardosh & Jay Bhattarcharya, The World Health Organization’s Pandemic Treaty Ignores Covid Policy Mistakes, RealClear Policy (Apr. 30, 2024), https://www.realclearpolicy.com/articles/2024/04/30/the_world_health_organizations_pandemic_treaty_ignores_covid_policy_mistakes_1028504.html; David Bell, Pandemic Preparedness and the Road to International Fascism, 82(5) Am. J. Econ. & Socio. 395 (2023), https://onlinelibrary.wiley.com/doi/10.1111/ajes.12531?msockid=3815d67b9a696639042fc67b9b0b6713.
[6] Constitution of the World Health Organization, 1 U.N.T.S. 9, (Jul. 22, 1946), available at https://treaties.un.org/doc/Treaties/1948/04/19480407%2010-51%20PM/Ch_IX_01p.pdf.
[7] See Contributor, World Health Org., https://open.who.int/2022-23/contributors/contributor (last visited Jan. 27, 2025).
[8] Id.
[9] World Health Organization, supra note 7.
[10] After Action Review of the COVID-19 Pandemic: The Lessons Learned and a Path Forward, U.S. House of Representatives, Select Subcommittee on the Coronavirus Pandemic, 118th Cong. (Dec. 4, 2024), available at https://oversight.house.gov/wp-content/uploads/2024/12/12.04.2024-SSCP-FINAL-REPORT.pdf.
[11] See Rational Policy Over Panic: Re-evaluating Pandemic Risk Within the Global Pandemic Prevention, Preparedness and Response Agenda, U. Leeds, https://essl.leeds.ac.uk/downloads/download/228/rational-policy-over-panic (last visited Jan. 27, 2025).
[12] See Martin Cullip & Roger Bate, Lessons from the WHO Framework Convention on Tobacco Control for the WHO Pandemic Treaty, Int’l Ctr. L. & Econ. (Nov. 26, 2024), https://laweconcenter.org/resources/lessons-from-the-who-framework-convention-on-tobacco-control-for-the-who-pandemic-treaty.
[13] See Jocelyn Kaiser, NIH Says Grantee Failed to Report Experiment in Wuhan that Created a Bat Virus that Made Mice Sicker, Science (Oct. 21, 2021), https://www.science.org/content/article/nih-says-grantee-failed-report-experiment-wuhan-created-bat-virus-made-mice-sicker; Ed Browne, Fauci Was ‘Untruthful’ to Congress About Wuhan Lab Research, New Documents Appear to Show, Newsweek (Dec. 1, 2021), available at https://www.congress.gov/117/meeting/house/114270/documents/HHRG-117-GO24-20211201-SD004.pdf.
[14] See Executive Grant of Clemency: Joseph R. Biden, JR. President of the United States of America, U.S. Dep’t of Just., Off of the Pardon Att’y (Jan. 19, 2025), https://www.justice.gov/pardon/media/1385746/dl?inline.
[15] See What Next for China’s Covid-industrial Complex?, The Economist (Dec. 8, 2022), https://www.economist.com/business/2022/12/08/what-next-for-chinas-covid-industrial-complex; Bell supra note 5.
[16] See Do You Trust the American Health Care System? Can Policymakers Help you Trust It More?, Johns Hopkins Carey Bus. Sch. (Sep. 12, 2024), https://carey.jhu.edu/articles/american-health-care-policymakers-help-trust.
[17] See Roger Bate, Vaccine Hesitancy and the Pandemic: Physician Survey Responses, Int’l Ctr. L. & Econ. (Feb. 23, 2024), https://laweconcenter.org/resources/vaccine-hesitancy-and-the-pandemic-physician-survey-responses.
[18] See World Health Org., supra note 6.
[19] In addition, it may be necessary to use other methods to persuade undemocratic nations to share data and warn of impending disaster—e.g., by agreeing to send them money and vaccines quickly when problems hit.