There will be fallout from Trump’s WHO withdrawal

This isn't the first time Trump has attempted to disassociate the USA from the WHO, having initiated the process in 2020 as well, citing the same complaints. While the legalities of that withdrawal were still being debated, the incoming presidency of Joe Biden halted the process and reaffirmed the US’s commitment to global health.

This newest declaration of withdrawal will not be reversed by an incoming administration. Thus, the global public health community is bracing for impact. This will be most obviously felt through the sudden evaporation of the more than $220 million of mandatory contributions, and more than $200 of additional voluntary contributions traditionally made by the U.S. per budget cycle. This contribution comprises about 15 per cent of the WHO’s total budget.

The money is used by the WHO to run a host of programs, including polio eradication, outbreak investigation, health education, and data sharing. For many low-income countries, the WHO is the primary source of public health information, guidance, and resources. 

For example, the DOTS (Directly Observed Therapy, Short Course) system was developed in large part by the WHO, championed and funded by the organization to tackle Tuberculosis (TB) in all corners of the world. Although usually treatable with a course of inexpensive drugs, TB kills about 1.25 million people every year, making it probably the most deadly curable infectious disease in the world. 

DOTS is credited for curing more than 36 million people and preventing over 8 million TB-related deaths. It is among our best strategies for preventing the spread of drug-resistant TB, which is nightmare fuel for public health specialists.

The WHO's polio-eradication program, initiated in 1988, focuses on administering oral polio vaccines to all children under five, monitoring and responding to reported cases, and strengthening public health systems to sustain polio-free status once achieved. It’s thought that the program has successfully reduced polio incidence by over 99% since its inception.

The WHO reduced the number of polio-endemic countries from 125 to just 2.

Wealthier countries depend on the WHO’s global health intelligence to alert us to oncoming threats, on research and development into everything from vaccine science to the social determinants of health, and on the WHO’s contribution to poorer countries’ political and economic stability through health systems strengthening, lest instability bring crises to our doorsteps in the form of refugees, war, and epidemics.

The WHO also plays a key role in the development of the seasonal flu vaccine each year, collecting samples from over 100 countries, then striking committees to select the influenza strains that will comprise the upcoming season’s vaccine. Manufacturers depend on this to ensure the best possible fit of vaccines to circulating strains. If this process were to become absent, the effectiveness of seasonal flu vaccines would plummet.

Frankly, there is no alternative to the WHO. Its creation of standards, management of data apparati, acumen for striking special task forces, and commitment to low income populations cannot be readily duplicated by national groups, like the U.S. Centers for Disease Control. 

While it does suffer from the same maladies as all other large bureaucratic organizations — namely politicization and inefficiency — the WHO is nevertheless an essential global good, whose sustained funding is necessary to keep the worst of the world’s maladies at bay.

While President Trump’s withdrawal represents an existential threat to many of WHO’s critical programs, it might also offer something of an opportunity for other nations, like Canada, to establish global leadership on several fronts. 

This moment is a sign for us to strengthen our own domestic public health infrastructure, reinitiate our own vaccine manufacturing platforms, augment global disease surveillance, house databases for global access, and to fund and promote our own experts to serve on international task forces, which we can initiate and lead.

It would be preferable, though, to have the world’s wealthiest and most powerful nation join us in the never-ending fight against those maladies that threaten our very species.

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Dr. Raywat Deonandan is a Global Health Epidemiologist and Professor at the University of Ottawa. He is a former Chief Scientist with the Canadian federal government, and an award-winning writer. Contrary to accusations from bots on X, he doesn't receive cheques from Klaus Schwab, Pfizer, or Bill Gates. Though that would be nice.