United States Finalizes Withdrawal from World Health Organization Amidst Dues Dispute

The United States has officially completed its withdrawal from the World Health Organization (WHO), a process initiated one year prior by the Trump administration. This action follows the U.S. government's stated concerns regarding the WHO's management of the COVID-19 pandemic and its perceived effectiveness in global health governance.

The withdrawal has brought to light an ongoing dispute over outstanding financial contributions and has prompted discussions among public health experts regarding its potential impacts on global health cooperation.

Official Withdrawal and Rationale

The finalization of the U.S. withdrawal was confirmed by federal officials on Thursday, exactly one year after the initial notification. The Departments of Health and Human Services (HHS) and State confirmed the move, noting that the U.S. health and state departments would engage with the WHO only in a limited fashion to process the withdrawal.

U.S. Criticisms of WHO

The U.S. government attributed its decision to several factors, including what it described as perceived failures in the UN health agency's management of the COVID-19 pandemic. Specific criticisms from the HHS and Trump administration included:

• Alleged delays in declaring COVID-19 a global health emergency.
• Perceived failures in timely information sharing and alleged concealment of failures during the pandemic.
• Allegations that the WHO "strayed from its core mission" and acted "contrary to U.S. interests" in protecting the U.S. public.
• Concerns that the organization failed to implement reforms and demonstrate independence from political influence.
• References to the WHO's initial advice recommending against mask-wearing and its stance that COVID-19 was not airborne until 2024.
• Observations that the U.S. contributed significantly more financially than some other countries, such as China, and that no American has served as WHO chief executive since its inception in 1948.

WHO's Response

The WHO responded to these criticisms by stating it consistently engaged with the United States in good faith and respecting its sovereignty. The organization affirmed its pandemic response, stating it acted swiftly, shared available information transparently, and advised Member States based on the best evidence. It detailed actions following initial reports from Wuhan, China, in late December 2019, including activating its emergency system, alerting the world by January 11, 2020, and declaring COVID-19 a Public Health Emergency of International Concern on January 30, 2020. The WHO also refuted claims of political bias, stating that as a specialized agency governed by 194 Member States, it remains impartial and serves all countries.

Withdrawal Process and Financial Obligations

Under U.S. law and the terms of the U.S. agreement with the WHO, a one-year notice is a condition for withdrawal, which the U.S. fulfilled. However, a dispute remains regarding outstanding financial contributions.

The Dues Dispute

• WHO officials and the U.N. state that all owed dues must be paid for a withdrawal to be finalized.
• The U.S. currently owes varying amounts in outstanding dues. Sources reported figures ranging from $260 million to $380 million, with more specific figures indicating over $270 million, $278 million, $130 million, or $133 million for the 2024-2025 period.
• U.S. State Department and HHS officials have indicated that the U.S. is not obligated to pay these dues before withdrawal, asserting that the relevant statute does not contain such a condition. The U.S. government has ceased its funding contributions to the agency.

Legal Perspectives

Legal perspectives on the withdrawal also differ. Lawrence Gostin, a professor of global health law, described the situation as a "public and messy divorce" due to the dues dispute and stated that leaving without paying owed dues is "unlawful." He also argued that an act of Congress should be required for withdrawal, as the U.S. initially joined the WHO through congressional action. Steven Solomon, WHO's principal legal officer, noted that the WHO's constitution generally does not include a clause allowing for withdrawal, with the U.S. being an exception through a 1948 arrangement. The U.S. State Department has indicated that the WHO's opinions do not constrain U.S. actions.

Financial Impact and Historical Context

The United States has historically been the WHO's largest financial backer and a founding member. Annually, the U.S. contributed approximately 18 percent of the agency's overall funding, including an average of $111 million in member dues and approximately $570 million in additional voluntary contributions. The WHO acknowledged the United States' significant contributions to major public health achievements, such as smallpox eradication and progress against polio, HIV, and other diseases.

The U.S. departure poses a significant financial challenge for the WHO. Consequently, the organization has reduced its management team by half, scaled back its work, and plans to cut roughly a quarter of its staff by mid-year. The U.S. flag was removed from outside the WHO headquarters in Geneva.

Future Engagement and Potential Consequences

A senior U.S. government health official stated that the U.S. does not plan to participate as an observer or rejoin the organization. The U.S. government intends to work directly with other countries on disease surveillance and public health priorities, rather than through international organizations, citing over 2,000 HHS staff members in 63 countries and numerous bilateral agreements. The State Department also indicated that the United States will not participate in regular WHO-led or managed events beyond functions related to the withdrawal effort.

Concerns from Global Health Experts

Global health experts have expressed concerns regarding the withdrawal's potential consequences:

• Weakening international systems and collaborations vital for detecting, preventing, and responding to health threats worldwide.
• Disadvantaging the U.S. in responding to health crises.
• Potential loss of access to critical global health networks, such as the WHO Influenza Surveillance Network, which is essential for vaccine development and pandemic preparedness.
• Impacts on measles surveillance, timely notification of disease outbreaks, and broader global health initiatives, including polio eradication, maternal and child health programs, and viral threat research.

Ronald Nahass, president of the Infectious Diseases Society of America, characterized the withdrawal as a "shortsighted and misguided abandonment of our global health commitments," emphasizing the necessity of global cooperation.

Lawrence Gostin noted that such disease intelligence has historically benefited the U.S. in responding to outbreaks and expressed skepticism regarding the feasibility of establishing broad direct agreements for data sharing with all nations.

Alternative Views

Conversely, Brett Schaefer of the American Enterprise Institute suggested that the U.S. could continue engaging in global health through other United Nations bodies like UNICEF and UNAIDS. He also hoped for continued informal cooperation with the WHO on initiatives such as the Epidemic Intelligence from Open Sources platform.

The WHO has expressed regret over the U.S. decision, stating it may reduce safety for both the United States and the world. WHO Director-General Tedros Adhanom Ghebreyesus expressed hope for the U.S. to reconsider its decision, emphasizing the importance of international cooperation. The WHO Executive Board is scheduled to consider issues related to the withdrawal at its meeting in early February, and the World Health Assembly will address them in May.

The WHO's Role and Post-Pandemic Initiatives

The WHO functions as the United Nations' specialized health agency, tasked with coordinating global responses to health threats such as mpox, Ebola, and polio. Its responsibilities include providing technical assistance to developing nations, distributing vaccines and treatments, and establishing health guidelines.

Following reviews of the COVID-19 pandemic, the WHO has taken steps to strengthen its work and support countries in enhancing their pandemic preparedness. Member States have adopted the WHO Pandemic Agreement, an international instrument aimed at improving global safety from future pandemics, and are negotiating an annex for pathogen access and benefit sharing. The organization reaffirmed its commitment to its core mission: achieving the highest attainable standard of health as a fundamental right for all people.