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The U.S.
withdrawal from the WHO
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Author:
Katelyn Jetelina, PhD, MPH One day, I stumbled upon something shocking: one country was overcharging its citizens three times the regular price for pediatric HIV medications. I rushed to my boss; it was our moment to change the world! We informed the country, but they already knew it was happening. In fact, the Ministry of Health was pocketing the surplus, ultimately taking advantage of helpless parents for wanting to save their child’s life. Then I learned a hard truth: We could do nothing about it. WHO works with countries, not the other way around. The WHO’s structure prevents it from holding member states accountable or acting decisively, even in situations where lives are at stake. This story came rushing back to me this week when President Trump announced the U.S. would withdraw from the WHO, blaming the organization’s handling of the Covid-19 pandemic, systemic inefficiencies, and overpaying in dues. This was a headline-grabbing move, but the implications are far more nuanced—and important—than the politics. The decision raises important questions about the organization’s value and effectiveness, but it also underscores its irreplaceable role in global health—despite its flaws. Let’s not sugarcoat it: The WHO has real challengesThe WHO is a specialized agency to the United Nations. Its mission? To promote health, keep people safe, and serve vulnerable populations worldwide. This means everything from coordinating pandemic responses to setting international health guidelines to approving vaccines. But, the WHO isn’t a typical organization. It’s made up of member states (i.e., 194 countries) represented by their Ministries of Health. While this structure allows for global representation, it also exposes a major weakness—health ministries are often underfunded and underpowered, especially in low-income countries. And then there’s the authority challenge. The WHO Director-General might sound powerful, but they have zero authority to enforce compliance or take decisive action without the consent of member states. It’s like trying to steer a massive ship with a tiny paddle. Then, there is a scope problem. Its scope is huge—everything from disease surveillance to mental health to non-communicable diseases. But when you try to do everything, you end up struggling to do anything really well. The result? A gap between what the WHO says it can do and what it can actually deliver. Another major challenge is funding. The WHO runs on a shoestring budget (just over $6.5 billion in 2022-2023, less than some U.S. hospital systems). About 20% of the funding comes from “dues” determined by a standard formula that considers the country’s economy. (China does pay less than the U.S. in dues, but not by much.) However, most (80%) of WHO’s budget comes from voluntary contributions by member countries that are often earmarked for specific projects. This means the WHO isn’t fully in control of its own priorities—it’s dependent on what donor countries want to fund.
Case example: COVID-19 and the WHOCovid-19 put the WHO under a microscope. Critics argue the organization was too slow to declare a public health emergency and too deferential to China in the early days of the pandemic. China got away with a lot. Also the WHO committee on the origin of Covid-19 waffled, ultimately not making a conclusion. Covid-19 also highlighted the gap between the WHO’s ambition and its capacity. The organization has a big voice on the global stage, but it often lacks the resources and technical expertise to back it up. This disconnect has fueled calls for reform, particularly around focusing on core capabilities. What the withdrawal means for the U.S.We will be “okay.” The U.S. has robust health infrastructure, its own vaccine and diagnostic certification systems, and disease surveillance capabilities through agencies like CDC. Most of what the WHO provides—certifying vaccines, technical assistance, and capacity building—doesn’t apply to the U.S. So why does this matter to the U.S.? Three main reasons: 1. Self-Interest: Infectious diseases don’t respect borders. Covid-19, flu, Ebola—you name it. Even if the U.S. is well-equipped to handle its own health challenges, our safety depends on the rest of the world being equipped, too.
3. Being a good neighbor: As a wealthy nation, it’s our responsibility to lift others. So, is this the end of the world?No, but this will make things a lot harder. The U.S. is the single biggest donor to WHO, giving $1.3 billion annually and beating Germany, the second-place donor, by hundreds of millions of dollars. Most U.S. money goes to WHO Africa, Headquarters, and Eastern Mediterranean, but no region is untouched.
The WHO, for all its flaws, is the backbone of global health coordination. Without it, we’d have no centralized system to manage cross-border health threats. And |
