Global health without America: What is at stake for WHO and the world?

THIS YEAR’S WORLD HEALTH DAY falls against the backdrop of strained multilateralism and a crisis in global health funding. World Health Day serves as a stark reminder that good governance, sustained financing, and collective action are essential to safeguard public health worldwide. It is crucial, at this juncture, to reflect on the United States planned withdrawal from the World Health Organization (‘WHO’) and dismantling of the US Agency for International Development (‘USAID’). 

WHO at the centre of global health governance 

The WHO was established in 1948 as a major arm of the United Nations. Its constitutional mandate is to serve as the leading international health agency responsible for tracking disease outbreaks, coordinating global efforts to combat diseases, and strengthening health systems. It plays a crucial role in pandemic preparedness and response. The WHO led the eradication of smallpox and is on the verge of polio eradication. Its Expanded Immunisation Program (‘EIP’) has protected children against vaccine preventable diseases like measles. It was born with constitutional powers to negotiate health treaties and regulations, such as the Framework Convention on Tobacco Control and the ongoing Pandemic Treaty negotiations, and it continues to update International Health Regulations (‘IHR’), as seen with the recent major amendments adopted on June 1, 2024. The agency's primary job is norm-setting, scientific standards, and technical assistance. It plays a leading role in disease classification and synthesis of the best evidence around treatments. WHO also plays a unique coordinating role in responding to health emergencies such as novel outbreaks of Ebola, Marburg, and Mpox. 

There has been, at least seemingly, a strong norm regarding the importance of international cooperation in health since WHO’s creation. That is, until now. 

President Donald Trump has notified the WHO of the US’s intent to withdraw from the WHO within a year. His administration has also severely cut international development assistance for health, while dismantling USAID. As the United States has effectively withdrawn from global health engagement, the future of international solidarity led by the WHO is at risk. 

Historical global health leadership of the US 

For over 75 years, the US has sustained this status through its commitment to driving programs that tackle pressing global health issues. It has been a principal funder and a major driver of the WHO’s agenda. Notably, in the 2022-2023 biennium, the U.S. contributed $1.284 billion to WHO, which was 20 percent of its budget, surpassing contributions from other major global health stakeholders including the Gates Foundation, Gavi, and the European Union. This funding supports emergency response, childhood vaccinations, and disease eradication, among many others. 

The US has spearheaded the fight against Ebola outbreaks in West Africa, been the major funder for HIV/AIDS prevention and treatment through the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund. In 2023 alone, US’s global funding constituted nearly three-quarters of international development assistance for HIV/AIDS, 40 per cent for malaria, and more than a third of the funding to combat tuberculosis. Since its formation in 1961, USAID has been instrumental in saving lives during various global crises. USAID has provided life-saving prevention and treatment for diseases like HIV and polio in the world's poorest countries.