Brigit C.A. Toebes and Benjamin Mason Meier

The World Health Organization (WHO) was established in 1948 as a specialized agency of the United Nations – to promote health in a world torn apart by war.  Following from the devastation of World War II, the Constitution of the WHO recognized that “the health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest co-operation of…States.” Governed by the cooperative leadership of 194 WHO member states, the World Health Assembly has provided a global platform for addressing health worldwide through WHO governance.

Infectious disease control is thus a core function of the WHO, as such diseases can spread quickly and threaten all countries. During the World Health Assembly this week, the question will be raised whether member states will adopt a new “pandemic agreement”. This new treaty seeks to guarantee fairer access to vaccines worldwide and provide new regulations for the control of emerging diseases, such as Ebola, Covid-19, and bird flu. Yet this multilateral milestone – addressing common health threats through global health law – comes at a moment of increasing international division.

On January 20, US President Donald Trump announced that the United States would withdraw from the WHO. He stated that the organization was not functioning well and had shown poor leadership during the Covid-19 crisis. The United States has a one-year notice period for withdrawal from the WHO, and in principle, the US Congress must still approve the withdrawal and pay its assessed contributions. However, as Trump has shown strong control over the Congress, it seems likely that the withdrawal will become a reality soon – without any required financial contributions during this final year.

The US has long been WHO’s most significant donor, responsible for about 18% of the WHO’s regular budget from its member states. Beyond these financial contributions, the US has long served as a central leader in the World Health Assembly, setting the direction for WHO governance to promote global health. This US withdrawal will therefore represent a significant loss for the organization, as it is unlikely that other member states will rapidly make up for the loss of financial support or global leadership.

With WHO now seeing a dramatic reduction of funding, staff, and programming, low- and middle-income countries will be disproportionately impacted, as they will receive less financial and technical support for strengthening their health systems and health programs. This WHO support is desperately needed as health inequities rise across nations – in the control of infectious diseases and beyond. Many low- and middle-income countries are now facing an increase in chronic diseases, many of which are lifestyle-related, such as cardiovascular diseases, respiratory diseases, and cancer. Addressing these challenges requires knowledge, expertise, and resources to ensure the highest attainable standard of health for all. WHO has long sought to support all countries as a matter of global solidarity, and the loss of WHO capacity to address these threats will impact all nations. 

The US itself will also feel this impact. The WHO has an enormous network of agencies, laboratories, and scientists that constantly monitor infectious diseases worldwide. Not only does the US government need this information to protect public health, but so does the US pharmaceutical industry, which benefits every year from up-to-date information on, for example, the ever-changing seasonal flu vaccine. Consider also the looming bird flu outbreak in the US, where global knowledge and coordination will be urgently needed to quickly develop a vaccine. With the US withdrawal from the WHO, it will lose its authoritative voice in addressing common health challenges through coordinated international responses. This US abandonment of health leadership is a loss for its international influence in a rapidly changing world.

The decline of US leadership in global health is ultimately bad for the entire world. Less support for the WHO means less focus on global infectious disease control. This means, for example, less funding and support for pandemic preparedness—preparing a country for the outbreak of an infectious disease. The disease preparedness system is only as strong as its weakest link: if any national health system is unprepared for a pandemic, it can have significant consequences for everyone. We know that viruses know no borders, and a pandemic can completely disrupt our society. Without the US in WHO, the world will be less healthy and more insecure.

Yet this existential crossroads for WHO governance can shape new foundations for global collaboration. We should ask ourselves what we – as the Netherlands, the EU, and other countries around the world – can do to strengthen global governance to prepare for future challenges. The WHO is all of us, as member states of this organization. To strengthen global health, we need more WHO, not less. More support is needed from the rest of the world – China, India, the EU. Only then can have a conversation about a better-equipped WHO, one that is strong enough to prepare for the enormous global challenges ahead. 

Brigit Toebes is professor of health law in a global context at the Faculty of Law of the University of Groningen, and Member of the Groningen Centre for Health Law.

Benjamin Mason Meier is a Professor of Global Health Policy at the University of North Carolina at Chapel Hill.