The Trump administration’s decision to begin a formal withdrawal from the World Health Organization (WHO) will forfeit substantial power and leverage at the leading global public agency at exactly the moment when the United States held its greatest strength.
At the same time, public health experts and officials warned, America’s exit will put more people around the world at risk of disease and death, and it could even put Americans at a disadvantage at a time when a pandemic is raging.
“We give up a lot. The World Health Organization has been around for a little over 70 years, and it plays a critical role globally in assuring that the approach to protecting people’s health around the globe doesn’t leave some countries out,” said Richard Besser, a former acting director of the Centers for Disease Control and Prevention who now heads the Robert Wood Johnson Foundation.
“The World Health Organization is a recognition that the health of people everywhere is the responsibility of us all, and that a health crisis in one part of the world can have a profound impact on the health of people in other countries,” he said.
The Trump administration submitted a formal notification of withdrawal to the United Nations on Tuesday. That begins a yearlong process that would sever ties by July 6, 2021 — if President Trump wins reelection in November. Former Vice President Joe Biden has already said he would keep the United States in the WHO if he wins.
Trump had pledged to withhold funding from the WHO and to revoke U.S. membership earlier this year, blaming the international agency for failing to hold China to account for the spread of the coronavirus.
Trump’s allegations ignore that the WHO was the first global agency to raise alarms about the novel virus, now known formally as SARS-CoV-2. WHO pressure led the Chinese government to publish the first genetic sequence of the disease in early January, code that enabled both American and international laboratories to develop diagnostic tests and to begin development of vaccine candidates.
“The administration’s accusations against WHO do not stand up to scrutiny, and certainly do not rise to the level of abandoning the organization as the worst pandemic in a century sweeps around the world and hammers the United States,” said Jeremy Konyndyk, a senior fellow at the Center for Global Development and a former director of the U.S. Agency for International Development.
In leaving the WHO, the administration would give up the U.S. seat at important global health tables.
The WHO convenes experts who decide which influenza vaccines will be developed in any given year. It runs research and development roadmaps for vaccine candidates for other diseases, from far-off threats like Ebola and Nipah to those that are increasingly dangerous to Americans, like the Zika virus. American government scientists would no longer be a part of those deliberations.
“We are designing the trials for vaccines. WHO is involved with what we call the R&D roadmaps for all the new vaccines, diagnostics and therapeutics well beyond flu. We’re deeply involved with those things. We won’t be anymore,” said Michael Osterholm, director of the Center for Infectious Disease Research and Prevention at the University of Minnesota, who heads several of those roadmap committees.
The WHO had already pledged to begin an introspective process to reform itself based on its response to the coronavirus, similar to a reflective period that led to major reforms after an Ebola outbreak in West Africa in 2014 and 2015 exposed deep deficiencies in the global health security network. Americans led some of those reform panels; they would surrender that influence if the United States goes through with its exit.
“The best way to rectify weaknesses in WHO and in wider global health governance is by remaining engaged and outlining a constructive vision for reform,” said Konyndyk, who headed one of the reform panels after the Ebola epidemic.
Perhaps most importantly, the WHO’s surveillance network is a key source of health intelligence, one that gives governments around the world the access to information necessary to combat the coronavirus and whatever other disease emerges as the next global threat.
“We get tremendous information back to the United States on a routine basis, just by the very nature of our U.S.-based, often government workers stationed at WHO,” Osterholm said. “Just the loss of intelligence on a routine basis is going to be profound.”
One function of that access to intelligence came in January, when American officials were part of the WHO delegation that visited the Chinese city of Wuhan to gather information about the coronavirus. The WHO effectively shamed China into allowing those experts in; it is almost unthinkable that China would allow American experts in to conduct the same sort of investigation without the international body’s imprimatur.
“If we abandon the World Health Organization we abandon a seat at the table, and we suffer from that because it decreases our ability to work in some parts of the world to help control disease there, diseases that could spread to our own borders,” Besser said. “For us to desert the global community at a time when our participation is needed more than ever is a sad commentary on where we are. This is the time to say what can we do to ensure that the World Health Organization is successful, and that means not stepping away, but stepping up and doing more.”
Public health experts say the consequences of an America-alone approach to global public health are evident in the Trump administration’s approach to the coronavirus, which has been described as catastrophic, scattershot or simply nonexistent.
COVID-19, the disease caused by the coronavirus, has killed far more people in the United States than any other nation in the world.
“WHO’s handling of the pandemic has not been perfect, but has been more than good enough to provide ample early warning and actionable guidance to countries that were paying attention,” Konyndyk said. “The disastrous state of the outbreak in the United States is not the result of following WHO guidance but rather is the result of ignoring the agency’s increasingly urgent warnings from late January onward. Had the U.S. followed WHO’s advice on early preparedness, aggressive testing, contact tracing, and other response measures, we would be in a far better place today than we are.”
In the future, the WHO will play a role in determining how any successful vaccine candidates are distributed around the world. Director-General Tedros Adhanom Ghebreyesus has said repeatedly that developing a vaccine is an insufficient solution to the pandemic until that vaccine is fairly and equitably distributed.
There is no guarantee that an American firm will be the first to develop a vaccine, and therefore no guarantee that Americans would be first in line to receive it.
Trump’s move to leave the WHO drew bipartisan criticism. Sen. Bob Menendez (N.J.), the ranking Democrat on the Senate Foreign Relations Committee, said in a tweet the decision “leaves Americans sick & America alone.” Sen. Lamar Alexander (R-Tenn.), who heads the Senate Health, Education, Labor and Pensions Committee, said he disagreed with the decision.
Public health experts said the consequences of America’s exit cannot yet be known, but that they would be severe.
“That old adage, you don’t know what you have until you lose it,” Osterholm said. “I think now people are taking an inventory of all the things that we are involved in through the WHO that surely helps the world, but also helps us.”