On 29 May 2020 the US President Donald Trump announced he would withdraw the United States from the World Health Organization (WHO). After initially stating he would halt funding for up to 90 days while an investigation was conducted into whether the WHO was complicit with China in hiding information about covid-19, Trump delivered an ultimatum to Dr Tedros, the WHO’s Director-General, on 18 May stating the organization had 30 days in which to make a series of unspecified reforms. Just 11 days later, Trump announced he was not only halting funding, but would withdraw the United States from the WHO. 

Under the WHO Constitution, no provision exists for governments to withdraw from the organization after they join. The very idea was rejected in 1946 on the basis it was deemed incompatible with the objective of building a universal health organisation (Burci and Vignes 2004). The only government to assert it reserved the right to withdraw from the newly formed WHO was the United States, at the insistence of an isolationist US Congress (Cueto, Brown and Fee 2019). Importantly, however, under the terms of the reservation lodged by the United States on 21 June 1948, withdrawal requires one year’s notice to take effect. 

Trump’s announcement on 29 May effectively serves as the United States formal notification of withdrawal, although this too has been queried. Doubts remain whether Trump has the legal authority to enact his threat, with Democrats in Congress accusing the President of breaching the same laws that resulted in his impeachment by the House over the Ukraine scandal. Even if Trump’s threat is realised though, the earliest it will take effect is May 2021; and given there’s a presidential election scheduled for November this year, it remains possible the decision will be reversed. 

Trump’s announcement must therefore be seen for what it is: a blatant attempt to divert attention away from his administration’s failings at controlling the spread of SARS-CoV-2 throughout the United States. With over 105,000 covid-19 related fatalities, the United States has currently recorded more deaths than the United Kingdom, Italy and Brazil combined. It is a fact that has not escaped the American population, who have become increasingly disillusioned with the President’s handling of the pandemic. 

Sensing his approval ratings under threat, Trump followed his standard playbook: attack and deflect. When in mid-April his condemnation of the media failed to resonate, Trump refocused on the WHO, accusing the health agency of mismanaging the crisis. The media storm that ensued with various public health experts, politicians and world leaders defending the WHO confirmed it was an effective distraction strategy. Since then, every time the President has come under pressure he escalated attacks on the WHO, which arguably explains why Trump dispensed with his original timetable and plans for an investigation before making a final decision on withdrawing from the United Nations health agency.

Unfortunately, even if Trump loses in November, the damage he has inflicted on the United States, the WHO, and global health has already been done. The great irony is that in threatening to withdraw from the WHO on account it is purportedly “controlled” by China, the President effectively signalled the United States’ willingness to vacate its leadership role in global health, paving the way for China and others to exert more influence. Even if the decision is later reversed, Trump has created the very conditions he was reportedly worried about and the reputational damage to the United States’ leadership credentials will persist for decades to come.

The President’s threat to the WHO is also a serious one, given it currently provides around 15% of the organization’s funding. Aside from the direct impact to the WHO’s financial position, which has been precarious for years, the WHO coordinates a number of global health initiatives ranging from chronic and infectious disease control programmes to providing technical assistance during disease outbreaks. On this point even Republicans have expressed concerns over the President’s decision, noting the US’ withdrawal may interfere with vital clinical trials and make it working with countries to prevent the spread of disease more difficult.

Indeed, it is arguably the broader impacts to global health that are the most worrying aspect of Trump’s decision. US health experts currently fill a number of WHO positions while the US Centers for Disease Control and Prevention has been a strong WHO partner for decades in the fight against disease. The future of this collaboration is now under a cloud. In addition, various initiatives from polio eradication to HIV/AIDS are now under threat—work that could be forced to stop or scaled back unless alternative funding sources are found. And as the oft-cited maxim makes clear, diseases know no borders. 

Trump’s decision to withdraw the United States from the WHO is not only unwise; it is dangerous and harmful, ultimately only perpetrated in an attempt to shore up his electoral prospects for November. We live in dangerous times when the whims of one man can so severely impact global health, so it is now up to governments all over the world to step up and build the health systems and capacities needed to mitigate Trump and his policies.

Adam Kamradt-Scott, associate professor/reader in international security studies at the University of Sydney. Twitter: @adamkams

Competing interests: None declared. 

References:

Burci GL and Vignes CH (2004) World Health Organization. Kluwer Law International, The Hague.

Cueto M, Brown TM and Fee E (2019) The World Health Organization: A History. Cambridge University Press, Cambridge.