Pulling the plug: America’s WHO departure is a death sentence for global health

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During the fight against the COVID-19 epidemic, Donald Trump accused the World Health Organization (WHO) of taking a pro-China position. Then, one year ago, after his return to the White House, Trump began the procedure for the United States to withdraw from the WHO.

Representatives of the WHO deny Trump’s claims, saying that the decision has harmed the United States itself in addition to hampering health care efforts around the world. Now, instead of a global system of collective protection against epidemics, each side will determine how to respond to threats according to its own resources and views. Poor countries will suffer the most, as they have already borne greater losses during infectious disease outbreaks when compared with wealthier states.

The WHO

The World Health Organization was founded in 1948 as a specialized agency of the United Nations. Its mission is to coordinate international action in the field of health care, formulating global standards and guidelines, collecting and publishing scientific data, supporting countries’ efforts to build domestic health systems, and serving as a platform for multilateral scientific cooperation. At present, it has 194 member countries.

Among the WHO’s key practical functions are coordinating epidemiological surveillance and epidemic alerts, standardizing clinical and laboratory protocols, issuing recommendations on vaccination and outbreak management, and running programs to eradicate and control diseases including measles, polio, and malaria. Many countries rely on WHO guidelines and protocols when developing their own national strategies to combat diseases.

WHO funding consists of mandatory contributions from member states and a significant share of voluntary earmarked contributions (allocated for specific purposes) from governments, foundations, and private partners. When countries delay contributions or limit their size for domestic political reasons, the organization must redistribute funds, delaying infrastructure upgrades and the hiring of specialists, among other processes.

Before Trump’s return to the White House, the United States covered about 18% of the WHO’s annual budget. However, since Jan. 20, 2025 — the date the decree announcing America’s withdrawal from the organization was published — the United States has halted payments and contributions and withdrawn all personnel. At the same time, a significant sum of membership dues for 2024–2025 has remained unpaid — about $280 million. This amounts to roughly 40% of the Polio Eradication program in the WHO’s approved 2024–2025 budget ($694 million).

Breakdown of the global epidemic surveillance network

One of the WHO’s key tasks is coordinating global alert systems and data exchange when outbreaks of infection occur anywhere in the world. To prevent infections from spreading, danger spots must be identified as quickly as possible.

For example, the National Influenza Centers (GISRS) provide a continuous flow of information about these viruses and regulate the selection of strains for vaccines. It is precisely on the basis of GISRS data that the WHO twice a year issues recommendations on the strain composition of the seasonal vaccine (in February for the Northern Hemisphere and in September for the Southern Hemisphere). Centers within the network compare circulating variants of the virus, assess their antigenic and genetic similarity to candidate vaccine viruses, and select those expected to provide the closest match for the upcoming season.

In cases where an emergency has already occurred, the WHO deploys an Early Warning, Alert and Response System (EWARS) to the affected region. EWARS detects infections at an early stage, assists national services in combating disease, and transmits and structures epidemiological data from the regions. The system has demonstrated high effectiveness: since 2015, more than 100 million people have received assistance.

EWARS, for example, played a significant role during the 2017–2022 cholera outbreak in Yemen, one of the largest in modern history. Nearly one million people were infected, and despite conditions of destroyed infrastructure, the system made it possible to quickly identify clusters of the disease and direct resources to priority areas. In the Democratic Republic of the Congo, during outbreaks of disease caused by the Ebola virus in 2018–2020, the system ensured the rapid transmission of field data and accelerated the response of mobile teams.

Another illustrative case is the Rohingya humanitarian crisis in Bangladesh, ongoing since 2017. There, EWARS has helped detect and contain outbreaks of measles, diphtheria, and acute diarrhea in overcrowded refugee camps.

Epidemiological surveillance requires constant investment in laboratory services in low-income countries. Global infectious disease alert systems depend on a network of national and regional laboratories that receive equipment, reagents, and training through WHO programs. At the same time, the Lancet Commission on diagnostics notes that 47% of the world’s population has limited or no access to diagnostic services.

With the U.S. departure, laboratory services will not be able to operate as effectively as before. Laboratories involved in epidemiological surveillance are facing disruptions in reagent supplies, reduced diagnostic coverage, and declining readiness of response services. This directly weakens the ability of health services to quickly detect and contain infectious disease outbreaks. In addition, the U.S. withdrawal from the WHO “reduces access to real-time disease surveillance systems, technical guidance, and early warning networks — resources that proved vital during COVID-19,” according to the country’s National Library of Medicine.

Vulnerability to future pandemics

The WHO continuously publishes and updates recommendations on surveillance of major infections and coordinates the exchange of information about them among national epidemiological services. The U.S. refusal to participate in the global network for such exchanges will lead to increased vulnerability to pandemics, since the detection of threats previously relied on collective monitoring: the faster countries share signals, the sooner quarantine, laboratory, and vaccination measures are launched.

After the U.S. withdrawal, data on infection hotspots reach WHO structures in incomplete form and with delays. During pandemics, when infections spread rapidly, such gaps in information exchange are especially critical, as even the slightest delay in transmitting data can trigger a sharp rise in disease incidence.

Breaks in the data-sharing chain will also negatively affect health care in the United States itself. For example, leaving the GISRS network, which tracks circulating strains and monitors their evolution, will mean that American doctors will once again work in isolation from the global health mechanism.

Declining support for low-income countries

The WHO has created a system of programs to support low- and middle-income countries in order to help them combat infections and crisis situations:

• WHO Health Emergencies Programme – assistance in various emergency situations, from infectious disease outbreaks to humanitarian crises, including epidemiological surveillance in emergencies (war, natural disasters, mass displacement of people);

• EWARS/emergency surveillance – early warning and response in emergency situations, mentioned above;

• Global Malaria Programme – coordination of the WHO’s global efforts to combat and eliminate malaria;

• End TB Strategy – a global program to reduce the incidence of and mortality from tuberculosis;

• Global HIV, Hepatitis and STIs Programmes – development of international recommendations and strategies for the prevention, diagnosis, and treatment of HIV, viral hepatitis, and sexually transmitted infections, as well as support for countries in implementing these standards and monitoring results;

• Essential Programme on Immunization – the development of international standards and support for countries in routine immunization, from vaccination schedules and vaccine assessment to training, supply planning, and coverage monitoring;

• WHO Prequalification – a WHO mechanism that evaluates the quality, safety, and effectiveness of medicines, vaccines, and diagnostic tests; it also maintains a list of approved products used as a reference for international procurement and assistance programs in low- and middle-income countries.

WHO programs have worked quite successfully, and in order to judge their effect it is enough to assess changes in mortality observed in poor countries receiving “official development assistance” (ODA) from 2002-2021. A recent study in The Lancet Global Health covering 93 low- and middle-income countries over the period in question shows that ODA significantly improved the global mortality situation:

• overall child mortality (under five years old) fell by about 39%;

• mortality from HIV/AIDS dropped by about 70%;

• mortality from malaria and malnutrition declined by about 56%.

OECD statistics for 2023 show that the world’s poorest countries survive largely thanks to high levels of external assistance — on average $71 per person. The population of these countries totals 736 million people, the U.S. share of total ODA is 22%, and the share contributed by USAID is 19%. With the U.S. withdrawal, the estimated assistance gap for the poorest countries now amounts to $71 × 22% ≈ $15.6 per person, or about $11.5 billion per year for the entire group ($15.6 × 736 million).

After the reduction of the overall financial resources directed to poor countries, programs addressing tuberculosis, HIV, malaria, and child health in Africa and Asia have already begun experiencing problems with the procurement and delivery of medicines and medical supplies.

Health care as a tool of political manipulation

With the U.S. withdrawal from the WHO, health care is increasingly becoming a political instrument of influence for individual players. Previously, countries coordinated among themselves on standards for epidemiological surveillance, data exchange, vaccination recommendations, and responses to emergencies, with all participants relying on unified guidelines and a single coordination network. Now the U.S. administration intends to shift to a strategy of long-term bilateral agreements with individual countries.

Such arrangements could create “alternative networks” in health care (with data exchange, medicine supplies, and joint programs). However, when it comes to actual coverage they fall short of the WHO, whose system has effectively served as the legal and operational framework of global health assistance.

As the number of parallel funding channels grows, health policy becomes fragmented: different donors set different priorities, timelines, metrics, and conditions, reducing coordination and, in parallel, the effectiveness of programs for recipient countries. Experts believe that in the long term this will lead to a global deterioration in public health, meaning higher costs for crisis response.

The U.S. will also suffer. American researchers and organizations will lose access to data important for national health care and will fall out of cooperation with other WHO countries.

What comes next

After the United States announced its full withdrawal from the system, the WHO stated that the specific withdrawal mechanism would be discussed by the WHO Executive Board at its regular session, then by the World Health Assembly at its annual session in May 2026.

The following issues will need to be resolved:

• what financial obligations remain for the United States (contributions, arrears, closing out budget cycles);

• what to do with U.S. participation in programs and working mechanisms (which projects are halted, which are transferred, and which continue through other formats);

• how further interaction will be formalized (for example, cooperation in specific areas in partnership status or through other arrangements).

The WHO says it will try to find optimal ways to resolve the situation in order to preserve cooperation with the United States on key issues, but Washington has its own plans. According to The Washington Post, America plans to create its own structure to replace the functions of the WHO when it comes to global epidemiological surveillance, data-sharing networks, and rapid response systems. The initiative was put forward by the U.S. Department of Health and Human Services, which has requested about $2 billion per year for these purposes.

Experts are highly skeptical that such an initiative can succeed. Atul Gawande, a professor at Harvard Medical School who served as Assistant Administrator for Global Health at USAID from 2022-2025, said that “this idea means spending that exceeds our costs for the WHO in order to create a structure whose sustainability is questionable and which in any case will accomplish only part of what was possible when the work was done together with the whole world.”

In any case, major damage to global health caused by the United States has already been done: the dismantling of U.S. foreign health assistance worldwide, including the effective withdrawal of USAID, has already claimed the lives of more than 750,000 people. This is primarily due to shortages in supplies of HIV medications, antimalarial drugs, and vaccines, reductions in field epidemiological surveillance, and the closure of some clinics in low-income countries. According to estimates by international agencies, if U.S. participation continues to decline, additional mortality by 2030 will reach roughly 23 million deaths, primarily due to the resulting rise in HIV/AIDS, tuberculosis, malaria, and preventable child mortality.