Trump orders US exit from WHO. Can it survive the financial hit?

U.S. President Donald Trump ordered the withdrawal of the United States from the World Health Organization on Monday, citing the agency’s mishandling of the COVID-19 pandemic and other global health crises, as well as its failure to “demonstrate independence from the inappropriate political influence of WHO member states.” Trump has a history of strained relations with WHO. He previously froze funding and initiated the formal withdrawal of the U.S. from the organization during his first term but former President Joe Biden reversed the move on his first day in office. In an executive order on his first day in office, Trump revoked the retraction. He also asked his secretary of state and the Office of Management and Budget director to pause future transfers of U.S. funding to WHO, recall and reassign U.S. government personnel or contractors working with WHO, and cease negotiations on the pandemic agreement. Trump also accused WHO of being controlled by China, despite the U.S. contributing significantly more funding to the agency. In his executive order, he stated that WHO “continues to demand unfairly onerous payments from the United States, far out of proportion with other countries’ assessed payments”, pointing specifically to China, which has a substantially larger population than the U.S. Assessed contributions — membership dues paid to WHO — are calculated as a percentage of a country's gross domestic product agreed upon by the United Nations. The U.S. withdrawal will have significant implications for WHO’s finances. U.S. contributions cover about 15% of WHO’s budget, and a large chunk of these funds go to important health programs, such as emergency preparedness and response, HIV and tuberculosis, and childhood vaccinations. Some WHO staffers are also paid for by U.S. contributions. When Trump froze funding to WHO back in 2020, other donors such as Germany stepped in. However, all experts Devex spoke to in recent weeks aren’t so sure the same scenario will play out again. Lawrence Gostin, distinguished university professor and founding O'Neill chair in global health law at Georgetown University, said that political crises in Europe mean the region “is unlikely to come to WHO's rescue, either economically or politically.” In response to the withdrawal, WHO said it “regrets the announcement,” noting that the U.S. was a founding member of WHO and that together WHO and the U.S. “have saved countless lives and protected Americans and all people from health threats,” including eradicating smallpox and bringing polio “to the brink of eradication.” WHO has implemented “the largest set of reforms in its history” over the past seven years, and that this work continues. “We hope the United States will reconsider and we look forward to engaging in constructive dialogue to maintain the partnership between the USA and WHO, for the benefit of the health and well-being of millions of people around the globe,” it stated in a statement shared on X by WHO Director-General Tedros Adhanom Ghebreyesus. 12 months’ notice Under U.S. legislation, the government has the right to withdraw from WHO, following a one-year notice period. However, the U.S. government should pay all its financial obligations to the agency during the notice period — meaning the impact of a withdrawal should not be immediate. However, Trump didn’t follow this rule back in 2020 — when he halted funding to WHO, and then announced his intention to withdraw from the agency about a month later. Additionally, the U.S. government pays its dues late, usually toward the end of a fiscal year. So WHO could be waiting for funding that may never arrive. At the time of publication WHO had not responded to questions on what it plans to do about the expected loss of funding, however, officials and health experts Devex has spoken to say it is a huge concern within the agency, and it has been under discussion since the election. “I think a lot of people around the world were in denial that Trump would come back, so they weren't necessarily prepared for again this worst-case scenario,” one health official told Devex. No money to lose WHO’s financial troubles aren’t new. As most of its funding is earmarked, programs that receive little donor interest are often underfunded. In a recent interview, Catharina Boehme, assistant director-general for external relations and governance at WHO, said their work on neglected tropical diseases and health emergency preparedness and response face significant funding gaps. On top of that, their mandate and deliverables continue to expand. Fixing this has been the priority of WHO Director-General Tedros Adhanom Ghebreyesus. When he took over WHO’s leadership, one of his goals was to expand the agency’s donor base. During his first press conference in 2017 after being elected to the position, he said this would help in cases when traditional sources of health financing become unreliable and unpredictable. At the time, Trump was serving his first term as U.S. president, and his budget included proposed cuts to global health programs. “We have to learn from this and do something to really address, so we prevent any future shocks because of surprise,” Tedros said at that time. In the years since, Tedros announced the launch of the WHO Foundation, which facilitates contributions from different donors, including from companies and the general public to WHO. The World Health Assembly, WHO’s ultimate decision-making body, also agreed in 2022 to provide more flexible funding to the agency through gradual increases in assessed contributions, or the dues member states pay the agency. The aim is for dues to represent 50% of WHO’s base budget by at least 2028-2029. The WHA approved the first 20% increase in 2023 as part of the 2024-2025 program budget. In 2024, the WHA also agreed for WHO to launch an investment round — a new fundraising effort by the agency to raise predictable and flexible funding for its work for the next four years. Their goal for the investment round is to raise at least $7 billion. To date, it has generated some $1.7 billion in pledges. The U.S. did not pledge as the timing of the investment round coincided with its elections, and WHO said they didn’t take U.S. contributions into account when calculating the success of the investment round. However, the U.S. provides WHO with $130 million in assessed contributions annually, as well as millions in voluntary contributions that go to specific health programs, including health preparedness and response, HIV and tuberculosis, and childhood vaccinations. This adds up to roughly 15% of the agency’s budget. “Money that we would not get from the U.S. would have to be compensated for. Either that or we look for cuts and efficiencies in the organization,” Boeme said at the time. The health official privy to WHO’s budget issues said the agency is already underfunded. So while 15% may not seem like a lot, “it's significant because they don't have any to lose.” “They're already working to the bone, and they're already stretching the dollars as much as they can,” the official added. While WHO’s efforts to diversify income have expanded its donors and generated some more predictable funding for the agency, much of its funding is still reliant on a few donors. For 2024-2025, 62% of its funding still comes from just 10 donors, with a significant amount from the U.S. followed by the Gates Foundation. In addition, a big portion of its funding is still reliant on specific voluntary contributions — those that are tied to certain projects, programs, or geography. In a December episode of the “Pandemic Proof” podcast by the Center for Global Development, Boehme said while WHO has made progress in its sustainable financing journey, “that journey is far from over,” and the agency still has more room to broaden its donor base through philanthropy and the private sector. Pete Baker, deputy director of the global health policy program at CGD, told Devex that with the U.S. contributing about 15% of WHO’s budget, or roughly $600 million a year, “big philanthropy could easily cover this if it wanted to.” That amount, for example, is only about 7% of the Gates Foundation’s $8.74 billion budget for 2025. However, Baker said that “as a member state organization this isn’t ideal,” and that WHO should look to its member states for its main funding. Baker argued back in September that WHO member states should not stop increasing their flexible contributions via their assessed contributions, but also by pledging more flexible voluntary contributions. But at the same time, WHO should clearly communicate its aims, implementation plans, and timelines for organizational reform “to instill confidence in donors that their flexible funds will return a more agile and effective WHO.” Following the U.S. announcement, Baker said that with the U.S. being highly restrictive on how WHO can use its money, “If other member states or philanthropists step up and provide more flexible funding—even if it’s less than the US provides—this could help WHO be more agile and focused in delivering its mandate.”