Can the US replace the World Health Organization?

The United States is about to find out whether the World Health Organization can be easily replaced. In his executive order announcing the withdrawal of the United States from WHO, President Donald Trump instructed officials to “identify credible and transparent United States and international partners to assume necessary activities previously undertaken by the WHO.” The order does not specify exactly what constitutes a necessary activity, but experts point to a range of actions WHO takes that are a benefit to the United States. These include disease surveillance to improve health security and the agency’s role in setting global guidelines that help protect the safety of U.S. consumers. Many of those tasks, observers agree, are not easily replicated by other partners, if they can be replicated at all. “I don’t find the whole thing surprising, though,” Pete Baker, the deputy director of the global health policy program at the Center for Global Development, told Devex. “It fits with ‘America First.’ If we can solve this ourselves, we will.” The administration’s isolationism is in many ways a rejection of the ethos that guided the establishment of WHO in 1948. In its constitution, the agency lays out a vision of peace and security that is dependent on the health of all and celebrates the “achievement of any State in the promotion and protection of health” as “of value to all.” “That’s what global health is, all working together,” Krutika Kuppalli, an infectious disease specialist, told Devex. “We’re only as strong as our weakest link.” Much of WHO’s current priorities stem from that vision, including its work ensuring equitable access to health technologies and providing health services in some of the poorer corners of the world. A Trump administration intent on embracing U.S. isolationism, though, may not be interested in supporting WHO efforts that are based on a vision of interconnectedness and equity. So there might be little interest in looking for partners to replicate WHO’s work strengthening the health workforce in low- and middle-income countries, for instance. Is the United States “going to prioritize global health or aid at all?” Baker asked. “It’s not inherent as a choice.” If the administration does look to provide technical support or health aid in particular instances, it does have other mechanisms it could turn to outside of WHO, including bilateral efforts or potentially trying to partner with domestic and international nongovernmental organizations. Not everything is so easily replaced, though. Even if it views global health purely from an isolationist perspective, experts said the U.S. government cannot ignore the actual benefits it derives from WHO. Most pointed to the importance of the agency’s coordinating role in global disease surveillance, which informs and guides U.S. agencies. Dabney P. Evans, who directs the Center for Humanitarian Emergencies at Emory University, pointed to the Ebola outbreak in West Africa that was first reported in 2014 and saw cases spread to the United States later that year. “An outbreak may start somewhere else, but it can certainly reach me. And isn’t it to my benefit to know what’s coming so we can prepare our public health systems, our public health responses, and leverage all of our knowledge?” she explained. Experts struggled to identify a U.S. or international partner that could immediately replicate WHO’s global surveillance efforts, even as they warned of the expense of trying to construct an alternative. U.S. agencies have also long taken a collaborative approach with WHO officials to arrive at case definitions for diseases and establish guidelines for how to respond that the experts Devex spoke to said have benefitted all sides. “When I worked at WHO, we would have regular meetings with [the U.S. Centers for Disease Control and Prevention] and we would share what information we had and they would share what information they had,” said Kuppalli, who was involved in the global response to COVID-19 and mpox, among others. “It helps us better develop more robust recommendations, figure out how to develop the appropriate interventions, how to message to the public from different perspectives.” If the United States does withdraw from WHO, American experts would lose access to the convening power of WHO and its ability to draw authorities from around the world. That reality was underscored by a directive issued by CDC on Sunday ordering its staff to stop communicating with WHO. The U.N. agency also compiles data that can be crucial for identifying trends and emerging health risks. Baker said there are U.S. organizations known for their skills with data analysis, such as the Institute for Health Metrics and Evaluation, but they would struggle to source information from governments around the world. “One hundred ninety-four countries are not going to submit data to IHME,” he said. “That’s a unique benefit of WHO.” There are some tasks WHO performs that the Trump administration might see as necessary, which might also be replicable. The agency plays a role in establishing guidelines that also shape U.S. policy. These include the Codex Alimentarius, a collection of food-related codes that protect consumers and set fair trade practices. These standards help guide U.S. food policymaking and guarantee U.S. food safety. “There are no other partners that can be relied upon to support the United States food safety,” Scott Haskell, an expert on trade and food safety at Michigan State University, explained to Devex in an email. “Basically, much of the world is a member of the Codex. The likelihood that we can form our own partnerships with other nations outside of the confines of Codex is short-sighted and destined to fail. This move will set back our positive trade relations for decades to come.” Furthermore, as experts perceive a Trump administration seemingly intent on hollowing out scientific expertise, including policies that have interrupted research at the National Institutes of Health and elsewhere, they wonder whether that will hamstring partners that might actually have been able to fill these regulatory voids if asked to do so. “This is the paradox of trying to do it on our own,” Kuppalli said. “We’re dismantling all of the systems, so we don’t have another one in place.”