MANILA — U.S. President Donald Trump’s announcement last Friday that the United States would terminate its relationship with the World Health Organization has raised multiple questions. Experts are asking whether he can unilaterally do that, what exactly is the procedure for severing membership with the U.N. health aid agency, and what that means for the U.S.’s position in global health governance.
But first, the U.S. government needs to clarify what it meant by the statement of “terminating” its relationship with WHO.
Gian Luca Burci, WHO’s former legal counsel and adjunct professor at the Graduate Institute of International and Development Studies in Geneva, told Devex that Trump did not specifically say the U.S. will be withdrawing from WHO.
“He said we are terminating today, any relationship with WHO. So that's a usual bombastic statement. But what does it mean? It can mean two things. First, it can actually mean that the U.S. intends to withdraw. But it can also mean, for example, that the U.S. will continue ... its funding freeze of WHO and will somehow disengage, would be less active, but short of a withdrawal,” he said.
“A statement, in Trump's style in the Rose Garden, I think is not enough to jump to conclusion[s],” he added.
But if the intention is to withdraw membership from the U.N. health body, the procedure is full of questions and uncertainty.
Unique US conditions
There are no provisions in WHO’s constitution on member state withdrawal, Burci said. The U.S. Congress laid out its own conditions for withdrawal when the government signed on to become a member of WHO in 1948. The conditions state that “the United States reserves its right to withdraw from the organization on a one-year notice: Provided, however, that the financial obligations of the United States to the organization shall be met in full for the organization’s current fiscal year.”
These conditions are unique to the United States. So far they have not yet been fulfilled. On Monday, during WHO’s virtual press briefing, Director-General Tedros Adhanom Ghebreyesus indicated that the organization had not yet received any formal notice from Washington, saying “the only communication we have — or announcement — was actually that Friday's media announcement from the U.S.”
The United Nations has not received any letter from the U.S. government on the matter, United Nations Secretary-General Spokesperson Stéphane Dujarric told Devex.
The U.S. has an outstanding balance of close to $100 million in assessed contributions as of April 30.
In addition to uncertainty over the year’s notice and payment of dues, it’s also unclear who has the final authority on the withdrawal.
Harold Hongju Koh, the State Department’s legal adviser during the presidency of Barack Obama who is now a professor of international law at Yale Law School, said that since the U.S. became a member of the organization through an agreement approved by a joint congressional resolution, the same should apply for its withdrawal.
“...the United States entered the organization through an executive agreement subsequently approved by a joint resolution of Congress. The mirror principle would dictate that it could constitutionally leave only with the enactment and approval of a subsequent, mirroring joint resolution authorizing withdrawal,” he wrote.
“There's been dissatisfaction with WHO over the years, but this is a radical departure in calling for defunding and terminating [relationship with] WHO,” J. Stephen Morrison, senior vice president and director of the Global Health Policy Center at the Center for Strategic and International Studies told Devex. The administration has “considerable authority,” but he also expects consultations to be taken with Congress on the matter, he added.
Trump’s statements on WHO have drawn mixed reactions in Congress and his announcement of a WHO funding freeze in April was met with support and criticism. Nancy Pelosi, speaker of the House of Representatives, said at the time the decision “will be swiftly challenged,” but no legislation has been passed to date that would address the funding freeze.
The U.S. has a history of withdrawing from international organizations. It withdrew from the International Labour Organization in 1977, but rejoined three years later. It withdrew twice from UNESCO, first under then-President Ronald Reagan in 1983, and then in 2017 under Trump. In 2018, it withdrew from the United Nations Human Rights Council.
The U.S. would not be the first nation to withdraw its WHO membership. In 1949, the Soviet Union and several other Eastern European countries including Albania, Bulgaria, Byelorussia, Czechoslovakia, Hungary, Romania, and Ukraine, sent WHO notifications of withdrawal, expressing dissatisfaction over the agency’s work and U.S. influence on WHO.
“It was the Cold War and WHO was very dominated by the United States, ironically, seeing what's happening today,” Burci said.
At that time, George Brock Chisholm, WHO’s first director-general, argued that the WHO’s constitution did not include any provisions for a withdrawal, and proposed that the World Health Assembly list those countries requesting withdrawal as non-active members instead. This allowed the countries to easily resume their membership to WHO in 1955, with WHO allowing them to pay only a percentage of their back dues.
Another question to ask, if the U.S. does withdraw, is what does it mean to be a nonmember of WHO. Burci said even if the U.S. withdraws, nothing prevents it from using WHO’s guidelines, which are designed as global public goods and therefore can be used by anybody.
But the U.S. could lose part of its influence in shaping global health governance. Amanda Glassman, executive vice president at the Center for Global Development, wrote in a commentary days before Trump’s announcement, that U.S. withdrawing funding from WHO could lead to an “incoherence in US global health programs, less efficiency and effectiveness.”
Reporters Amy Lieberman in New York and Sara Jerving in Nairobi contributed reporting.