On January 20, 2025, the same day he was sworn into office for his second term, U.S. President Donald Trump signed an executive order initiating the United States’ withdrawal from the World Health Organization (WHO). This decision has profound implications for global health, as the U.S. has historically been the largest donor to the WHO, contributing over $10 billion in the past fiscal year alone, and contributing approximately 18% of the WHO’s budget.
The withdrawal means the WHO will lose both a significant percentage of its funding but also the expertise of U.S. health professionals. Experts like Michael Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy, emphasize that the WHO plays an irreplaceable role in coordinating responses to infectious diseases and supporting countries during health emergencies. Osterholm said, “This represents one of the darkest days of public health that I can recall.” The loss of U.S. support could disrupt WHO operations, affecting their efficiency and timeliness, particularly in managing outbreaks like the Avian flu or Marburg virus disease.
Moreover, this move creates a political vacuum that other nations, notably China, may fill, thereby increasing their influence in global health governance. Health experts warn that this shift could alter the balance of power in international health policy and sideline U.S. interests and priorities. Ashish Jha, MD, MPH, the White House pandemic response coordinator during the Biden administration, calls the decision a “strategic error” in an interview with CNN on Monday, further adding that “WHO is a pretty essential organization — and with America’s withdrawal, it creates a political vacuum that only one country can fill — and that is China.”
The decision also raises concerns about the U.S.’s ability to access critical data on emerging health threats. Without participation in the WHO, the U.S. may find itself isolated from vital information networks, leaving the nation more vulnerable. Lawrence Gostin, a law professor of public health at Georgetown University, describes the withdrawal as “cataclysmic,” highlighting the risks of losing access to essential health data and collaboration.
Financially, the withdrawal could jeopardize various global health initiatives. Programs such as the Global Fund and Gavi, which rely on U.S. funding, may face significant shortfalls, hindering efforts to control infectious diseases and conduct essential research. This alone can impact hundreds of millions of lives. By the end of 2023, the Global Fund partnership had saved an estimated 65 million lives, and Gavi had facilitated the vaccination of over 1.1 billion children in 78 lower-income countries, averting more than 18.8 million future deaths.
President Donald Trump’s administration has already signed an executive order to suspend all U.S. foreign assistance programs for 90 days, pending a comprehensive review to ensure alignment with the administration’s policy objectives. This suspension directly affects the United States Agency for International Development (USAID), which plays a crucial role in funding local partners worldwide. The pause in assistance raises concerns about the continuity of essential health programs, including those targeting HIV/AIDS, malaria and tuberculosis, and maternal and child health. The review process may lead to a reallocation of funds, potentially prioritizing programs that align more closely with the administration’s foreign policy goals, thereby affecting the support available to local health initiatives.
The potential re-enactment of policies like the Mexico City Policy, also known as the “global gag rule,” could impact millions worldwide by restricting NGOs providing reproductive services. This policy prohibits U.S. federal funding to foreign non-governmental organizations that provide abortion counseling or referrals, advocate for the decriminalization of abortion, or expand abortion services. Reinstating this policy could significantly impact organizations that offer comprehensive reproductive health services, leading to reduced access to contraception and increased rates of unintended pregnancies and unsafe abortions.
Furthermore, the administration’s stance on multilateral health initiatives, such as the President’s Emergency Plan for AIDS Relief (PEPFAR), remains uncertain. During the previous administration, there were attempts to reduce funding for such programs, which faced resistance from Congress. However, the current political climate may influence the level of support these initiatives receive, potentially affecting millions who rely on them for essential health services.
In summary, President Trump’s decision to withdraw the U.S. from the WHO and other actions threaten to weaken international health security, disrupt critical health programs, and diminish the U.S.’s role in shaping global health policies. As the world continues to face complex health challenges, the absence of U.S. leadership in the WHO could have far-reaching consequences for global health initiatives and pandemic preparedness.
The American legacy of combating threats to global health security — including at home in the United States — is at risk. This will demand greater engagement and advocacy with local organizations to provide solutions at the community level. Moreover, there is an opportunity for the private sector to bridge the gap by investing more creatively and aggressively in healthcare solutions globally, particularly as private health spending is growing faster than GDP in many emerging economies.
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