In May 2020, the first-term Trump administration began its process of withdrawing the United States from the World Health Organization, the international public health entity the US played the lead role creating in 1948. Because WHO member states can only withdraw one year after notifying the UN Secretary General of this intent, America’s withdrawal never materialized because the notification was revoked by the incoming Biden administration in January 2021. Donald Trump’s return to office now makes it all but inevitable the US will soon restart its official withdrawal process.
As a supporter of and past expert advisor to the WHO, I believe America is overwhelmingly best served by remaining inside the WHO and working from within to make that organization more effective, not least because the health and well-being of Americans is inexplicably tied to that of those outside our borders. To my regret, that fight now appears to have been lost.
But even if the US is planning to withdraw from the WHO, we can still leverage that process strategically to help improve the WHO in ways that advance both international public health and America’s interests.
Although President Trump is not a strong supporter of the United Nations in general, his past critiques of the WHO, a UN body, are not entirely off base. The organization has been overly manipulated and undermined by China and the WHO’s failure to respond adequately to the COVID-19 pandemic is well documented. Even though the Trump administration itself failed spectacularly in much of its COVID-19 response, there can be little doubt that the WHO, as currently configured, is not able to sufficiently realize its mission to “promote health, protect people from health emergencies, and provide better health and well-being.”
But it’s hard to fully blame the WHO secretariat for the organization’s shortcomings when the WHO’s leaders have been so significantly constrained by WHO member states for decades. The WHO secretariat, for example, has a very limited ability to independently investigate and challenge the types of outright lies it was being fed by the Chinese government in the early days of the COVID-19 pandemic – at the same time that WHO investigators were being denied access to Wuhan. The organization has a budget smaller than that of an average-size US teaching hospital and is only able to directly control a fifth of these funds, with the rest earmarked by states. Even the strong leadership by WHO Director General Tedros Adhanom Ghebreyesus calling for a full investigation into COVID-19 origins has been overshadowed by the Chinese’ government’s unchecked ability to prevent this type of critical examination. In fact, the leadership of the WHO itself and expert panels organized by the WHO have been among the most impassioned champions for enhancing the mandate, funding, and capacity of that international body.
But while immediately notifying the UN Secretary General of America’s official withdrawal would highlight these challenges, it would do little to help address them or America’s vital national interest in working to prevent future pandemics and other public health catastrophes. If the WHO did not exist, America would need to very rapidly replicate many of its functions through some other mechanism. Worse, an abrupt withdrawal would alienate the allies and partners America would need to protect the health of its citizens while giving America’s greatest adversary, China, a free hand to further colonize the WHO for its own narrow purposes.
Rather than beginning the official withdrawal process right away, it would therefore make more sense for the President to instead issue an executive order announcing an intent to notify the Secretary General six months from now unless clearly articulated conditions for substantial reform can be met.
Key US demands might include requiring:
- proportional funding based on GDP figures per nation;
a full audit of WHO finances; - a commitment that all WHO staffing decisions be made on the basis of merit;
- that the WHO carry out a full review of its early failures in responding to the outbreak and develop a comprehensive plan for enhancing emergency response capabilities to address these shortcomings; and
- that the WHO leadership unequivocally call on Beijing to allow a comprehensive and unfettered investigation into COVID-19 origins in China.
At the same time that these demands would be articulated, the United States could both work with allies to help coordinate pressure supporting the desired changes and begin a process of planning an alternative structure should these changes not be realized within six months.
This strategy could potentially be a win-win for the United States. Either we would help fix the WHO or we would (unfortunately, in my view) lay the foundation for some type of alternative. Although an alternative pathogen surveillance system could be set up in coordination with our allies, replicating the beneficial functions of the WHO through some other type of framework would be extremely challenging. By following both paths simultaneously, the US could maintain maximum leverage while ensuring the greatest possible support from our allies for whichever path we ultimately take.
Even people like me who strongly believe it would be an historic mistake for America to withdraw from the WHO must now recognize the inescapable reality the election of Donald Trump has established. Rather than fight a losing battle to completely alter the Trump administration’s plan, better to try to make lemonade from the available few lemons by recognizing this opportunity to drive meaningful and necessary reform of the WHO, including in coordination with our allies.
The United States played the essential role in establishing the WHO and has been its lead funder and champion for 77 years. Better for us to fix and retake leadership of the WHO than to prematurely cede that body, at our own expense, to China.