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The U.S. and the WHO: An Imperfect but Essential Relationship

Leaving the global institution would have broad impacts. 

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Public Health On Call
Photography by Robert Hradil / Stringer

Editor’s note: This conversation was recorded on January 24. Since then, the Trump administration has ordered the CDC to stop working and communicating with the WHO(link is external), effective immediately, and to await further guidance.

Note: Please note that the opinions expressed in this episode belong solely to those interviewed and do not represent Johns Hopkins University. 

On the first day of his second term, President Trump signed an executive order withdrawing the United States from the World Health Organization(link is external) (WHO).

The order was expected, as he attempted this during his first term, in July 2020. However, because WHO withdrawal requires a one-year notice, the decision did not take effect and was reversed by President Biden when he took office in 2021.

In this Q&A, adapted from the January 28 episode of Public Health On Call, Judd Walson, MD, MPH, Robert E. Black Chair in International Health, talks to host Stephanie Desmon about the essential roles WHO plays in monitoring and responding to health issues around the world and the consequences this decision could have on health and security in the U.S. and worldwide.

What is the WHO and what does it do?

The WHO plays many roles—the visible, apparent roles that many people are familiar with, and the roles that are less visible. This includes:

  • Detecting, monitoring, and responding to emerging health threats, pandemics, and diseases of importance; we saw that during the COVID-19 crisis.
  • Gathering and evaluating data and information from all over the world in order to understand the status of health globally and detect emerging problems. This includes acute crises as well as larger trends in health—which issues are causing a higher burden of disease and which ones we’re making progress on and should sustain efforts to address.
  • Setting standards and developing guidelines that help people around the world, including here in the U.S., deal with various health threats and crises—not only infectious diseases, but all sorts of health issues.
  • Providing commodities and goods to improve health around the world, including vaccines and drugs for many diseases. The U.S.’s withdrawal from WHO impacts not only the people who receive those goods, but also the supply chain for them, which includes many people in corporate America.
  • Assisting with humanitarian response, which has important implications both for the populations who are affected by those crises and for global diplomacy and the role of our humanitarian responses in improving global diplomacy around the world.
  • Providing very important technical assistance to governments and partners around the world to be able to respond to health challenges. The U.S. plays a very important role in providing this technical assistance.

What is the U.S.'s relationship with the WHO? How do we benefit as a member and what do we lose by leaving?

Without the U.S., there will be important impacts to WHO both in terms of the funding we provide and the broader impacts.

From a financial standpoint, we are the largest contributor to the WHO(link is external)—somewhere between 12%–15% in 2022–2023. The WHO is already struggling financially, and the U.S.’s withdrawal will likely lead to a loss of jobs, reduction of work, and less ability to do the functions we just talked about.

But if we think it’s expensive to be part of the WHO, just wait until we aren’t part of the WHO. That's where we're going to see the true costs. This withdrawal will be incredibly costly for both the American people and the global community, and not just in the pure economic terms of our contributions to WHO.

Since World War II the U.S. has developed a reputation around the world as a country that supports others, and that has important consequences for global diplomacy. We are known in the health space as a country that provides assistance to many countries. In fact, many countries with whom we have very poor diplomatic relations, and that we don't see eye-to-eye with politically, still reach out to us for support around health.

Health provides an entryway for us to engage with countries, many of whom we may not agree with, and to have diplomatic conversations and other conversations. If that is lost, it will have tremendous consequences for the U.S.’s security and long-term economic and political outlook.

The Trump administration cites the WHO’s response to COVID as a reason for the U.S.’s withdrawal. What role did the WHO play in response to the COVID pandemic?

The COVID response globally can be classified in some ways as a technical success. We had many technical breakthroughs, including the development of vaccines at a pace that had never been seen before, the deployment of drugs and vaccines to places that previously were hard to access, and in some circumstances very quickly.

If we think it’s expensive to be part of the WHO, just wait until we aren’t part of the WHO. That's where we're going to see the true costs.

Early on, there was some consensus around how to approach the problem globally, but it was a tremendous diplomatic failure. We saw that with the hoarding of vaccines by some countries and not delivering to other countries. We saw it with failure to access data from China and other places around the origin of the virus. 

Now, those diplomatic failures were not only at WHO; they were broader. But there are valid concerns about the way that WHO operates when handling large crises.

There are also concerns about the failure to reform and concerns about lack of independence from political pressures. The WHO is a consortium of many member states, all of whom have a voice, and managing that is challenging. Lastly, there’s a feeling that there's a disproportionate level of investment by the U.S.

It's important to acknowledge that those are all real problems that need to be resolved. But rarely does walking away from a problem fix the problem. We should work to resolve them so that these functions can be performed. 

How will the U.S.’s withdrawal from the WHO impact the health of people globally and in the U.S.?

It is likely to cause enormous strain on the global community. Ultimately the global community, including Americans, will suffer and have poorer health. 

Take, for example, my colleagues around the world, including people at the WHO, working to reduce childhood deaths. That's important for people living in low-income settings, but it's important here, too. Many of us have relatives or friends who have had a baby born premature—that's a high risk period for a baby. Where do the guidelines come from [for premature births]? How do we know what the best interventions are for preterm babies? That comes from data collected from around the world and interventions that have been tried to improve survival or reduce the level of morbidity in children who do survive.

We benefit in real ways here at home from the work of the WHO. This is not only about what we do for others; it's also about what we do for ourselves.

What is the timeline for the withdrawal?

My understanding is that the withdrawal happens immediately, but the financial commitments remain for one year. I and many of my colleagues hope that over the next year, work can be done diplomatically to try to work with the administration, to come up with concrete plans for addressing some of the real concerns that have been raised—and to do so in a way that strengthens the WHO.

Do we really want a system in which whether or not we like you and you like us determines our ability to collaborate on something of global importance like a potential pandemic?

How could the U.S.’s withdrawal from the WHO impact disease surveillance?

Let's talk through a hypothetical scenario: A new disease emerges in a small country in Asia. The WHO is strong, and the U.S. is a part of it.

In this scenario, data suggest a spike in new fevers and a respiratory illness within a couple of hospitals in one area of that country. That country-level WHO office would be alerted, then the regional office. There would be an assessment of whether this seems out of the ordinary. If so, the country would receive advice about what sort of diagnostics to employ to identify the cause of that outbreak.

Depending on the need, some support might be sent to the country, whether it's people to advise or equipment to make diagnoses. And hopefully pretty quickly, we would be able to identify: Is this caused by a virus or a bacteria? If it’s a virus, is it a common virus that’s just changed? If it hasn’t changed, is it just a seasonal abnormality or pattern that we haven't seen before? Or is this something new? Is it a threat or an emerging disease?

That would all happen and those data would be shared up the chain, all the way to the central WHO, and then shared with the member states. There'd also be a discussion involving those member states about whether there’s a threat, what kind of threat it is, and what sort of response there should be.

Currently the U.S. plays a critical role in all stages of that, from assessing the threat and evaluating whether a response is warranted, to what the response should be and helping to organize that.

Now let's take the same hypothetical scenario but in which the U.S. is no longer part of the WHO.

This disease emerges, the same things happen. Meanwhile, we in the U.S. have no idea. There's no communication that anything is happening. The U.S. has no visibility. We have no access to the data. Maybe others in the system decide the disease is not a threat, but we in the U.S. have had no voice to say whether we agree. We don’t hear anything about it until suddenly it poses a huge threat, and it’s too late.

Or, let’s say that WHO members decide it is a threat and they start mobilizing all sorts of resources. The U.S. wouldn’t be a part of that decision. We also wouldn’t have a voice in what the response to the threat should be: how containment should happen, what sorts of air travel restrictions might be needed, what sorts of treatment strategies might be employed. Now, we’re not part of that discussion. We have no access to the data. We don't have access to the sequences of the actual pathogen to help us develop a response in terms of vaccines or other treatments. All of that now becomes a black box.

Could there still be country-to-country engagement with the U.S.?

That would depend: Is that a friendly country or not? Is that a country in which we have active collaborations or not?

Do we really want a system in which whether or not we like you and you like us determines our ability to collaborate on something of global importance like a potential pandemic? That's really what we're talking about: the potential inability to understand what’s happening in the world around us and be part of that decision-making process.
 

This interview was edited for length and clarity by Aliza Rosen.

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