US threat may spark WHO reform

The World Health Organisation headquarters in Geneva. PHOTO: REUTERS
The World Health Organisation headquarters in Geneva. PHOTO: REUTERS
The United States intends to leave the World Health Organisation. What happens next, C Raina MacIntyre asks.

Donald Trump's plan to withdraw the United States from the World Health Organisation (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, co-ordinates 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 co-ordinating role in surveillance, response and policy for infectious and non-infectious diseases. In fact, infectious diseases have the most pressing need for global co-ordination.

Unlike non-communicable diseases, infections can spread rapidly from one country to another, just as Covid-19 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 co-ordination and leadership.

It has also played a leading role in the control of polio and HIV.

Reasons the US gives for wanting to withdraw 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 higher payments the US makes to the WHO compared  with China. In 2024-25, the US contributed 22% of the organisation's mandatory funding from member states compared to about 15% for China.

Trump initiated withdrawal from the WHO over similar concerns in 2020, but this was reversed by president Biden in 2021.

Withdrawal may take a year to come into effect, and may need approval by the US Congress.

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 Centres 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 networks 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 is 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% of the WHO budget.

The organisation relies on donations from other organisations (including private companies and philanthropic organisations), which make up the remaining 80%.

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 the 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.

Without reform, there is a possibility other countries may follow the US, especially if governments are pressured  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 towards a solution. - theconversation.com

C Raina MacIntyre is professor of global biosecurity, UNSW Sydney.