What Does the US Withdrawal from the WHO Mean for Global Health Security?

Donald Trump’s decision to withdraw US funding from the WHO has been described as a ‘global health crisis in the making’ by the British Medical Journal. He began the same process during his previous administration, only to have the decision reversed by Biden once the preferred candidate of the scientific community took power. This time, however, Trump is starting the process with plenty of time to complete it within his term of office. 

Trump’s key issue with the WHO seems to be a determination to continue to blame China for the Covid-19 pandemic (against such strong scientific evidence to the contrary that even the Chairman of the US Joint Chiefs of Staff could not support the position that a bioweapon origin was plausible). Accusations that China mishandled or withheld information on the initial discovery of a novel virus fail to acknowledge that while that information was passed to the WHO on 31 December 2019, and cascaded immediately from there to all member states immediately, the US took another three months to instigate lockdowns (so too did the UK), instead focusing on China’s ‘brutality’ towards its citizens. Trump himself did not wear a facemask until 10 October 2020, by which time US states’ responses to the pandemic were deeply divided along political lines. But as Trump begins his second term of office, his continued narrative of China being untrustworthy, of ‘inappropriate political influence’ in the WHO, and of a need for urgent reform continues unabated. 

The US is major donator to the WHO, contributing $950 million, or 14.53% of the WHO’s total budget in 2024, considerably more than the next largest national contributor (Germany, at $215 million) and certainly more than China’s paltry 0.35%. In 1948, China – then an Allied nation, having fought on the same side as the US in the Second World War – was one of the original members of the WHO; in fact, it was China’s delegation to the 1945 conference to set up the UN, along with Brazil, who first proposed the idea of a World Health Organization. But since then, China has not been a major financial donor, which begs the question of why the WHO would bend to its influence against other countries on which it is much more dependent?

Trump is not the WHO’s only detractor: the European Parliament asked if it was fit for purpose following the Covid-19 pandemic, and academic journals are awash with critiques. The WHO acts slowly and is over-careful not to upset anyone; even its response to the US’s withdrawal has been typically bland and apolitical, simply thanking the US for its investment so far. It has no powers to impose actions or policies on member states, but works best as a coordinator, enabling rapid dissemination of information once it receives it, with the International Health Regulations 2005 imposing a legal duty on member states to report cases of certain diseases following similar criticism of China’s laxity during the first SARS pandemic. 

It is unlikely, however, that financially crippling the WHO will improve its efficiency or effectiveness. It may, ironically, create space for China to step in to fill the gap, as it promised to do when Trump last turned his back on the WHO. After all, money has to come from somewhere. 

The WHO gets its funding from three main sources: member states paying ACs (assessed contributions – membership dues determined by the UN as a percentage of GDP; this accounts for less than 20% of the WHO’s annual income); voluntary contributions from member states above and beyond the ACs; and donations from other UN organisations, intergovernmental organisations, philanthropic foundations and the private sector. 

It is worth noting that the WHO annual programme budget for 2024-25 of $6.83 billion is a drop in the ocean against the $1.5 trillion US Department of Defense budget (15.5% of the total federal budget). The US is the largest donor to NATO (15% of the total $430 billion) and will continue to spend on Global Health Security even if not through the WHO. Programmes such as the Biomedical Advanced Research and Development Authority’s Project Bioshield, ostensibly a counter-CBRN (chemical, biological, radiological and nuclear) programme, extensively fund medical research to protect US personnel in regions of the globe where they operate, for example in supporting Ebola virus development, while US Navy ships such as USNS Mercy will continue to patrol parts of the world where it is in the US’s interests to win hearts and minds campaigns (not to mention maintaining a naval presence).

Other than the US, nation-states are not the main donors to WHO. The Bill and Melinda Gates Foundation (which has a total annual budget of $8.6 billion) contributed 13.67% of the WHO’s budget in 2024; the public-private-partnership vaccine alliance GAVI contributed 10.49%; and the World Bank contributed 4.02%. The Chinese philanthropic Jack Ma Foundation works alongside the WHO, rather than donating to it, but has been effective in donating medical supplies to low- and middle-income countries, and Covid-19 supplies across the world. Some of this is undoubtedly health diplomacy, but so, arguably, is the US’s previous involvement. 

The WHO will, ultimately, find ways to survive without the US, and the US will continue to spend on global health security, even if more on its own terms. Infectious disease does not respect international borders, and needs coordinated international effort to address it. Trump’s protectionism will not be able to ignore this for long. 

© Jennifer Cole, 2025, published by RUSI with permission of the author

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