On his first day of presidency, Donald Trump signed an executive order to withdraw the United States from the World Health Organization (WHO). This decision is rooted in a combination of political, financial, and ideological motivations.[i]
Central to his rationale is his assertion that the WHO mishandled the COVID-19 pandemic and is unduly influenced by China. His critique includes the organization’s perceived delay in declaring COVID-19 a global health emergency and its initial opposition to travel bans from China, which Trump interpreted as deference to Beijing. Additionally, he has consistently decried the disproportionate financial burden on the U.S., which contributed over $450 million annually to the WHO compared to China’s $40 million.[ii]
The WHO responded to Trumps’ announcement, asking the U.S. to reconsider its withdrawal. “With the participation of the United States and other Member States, WHO has over the past 7 years implemented the largest set of reforms in its history, to transform our accountability, cost-effectiveness, and impact in countries,” the statement read. “This work continues.”[iii]
Breaking from Tradition: Trump’s Directive Diplomacy
Trump’s practice of issuing significant presidential directives,[iv] including the U.S. withdrawal from the WHO, highlights a calculated strategy to signal decisive leadership and establish immediate control over his administration’s agenda. This approach leverages the high visibility of a president’s inaugural day to amplify policy priorities, project authority, and appeal to his political base. Preannouncing these directives amplifies their symbolic weight, as it not only reaffirms campaign promises but also demonstrates a break from the previous administration’s policies.
Historically, powerful states have used withdrawal threats as leverage for institutional reform, as seen in the U.S.’s dealings with other international organizations like United Nations Educational, Scientific and Cultural Organization (UNESCO). Trump’s actions could be interpreted as a coercive strategy to compel the WHO to address perceived inefficiencies and inequities.[v] For instance, reforms related to financial contributions, transparency, and governance could potentially align the organization more closely with U.S. interests.
Trump’s approach appears less about constructive reform and more about signalling dissatisfaction. Unlike 2020, when the U.S. engaged in limited reform discussions with the WHO, the 2025 directive signals a retreat from multilateralism altogether. The 2025 executive order differs in timing and approach from Trump’s 2020 threat. While the earlier threat occurred mid-pandemic and was criticized as reckless during a global health crisis, the current decision is framed as a deliberate campaign promise, executed immediately upon taking office. Unlike in 2020, when officials within his administration delayed the withdrawal process and sought reforms, Trump’s 2025 directive is more decisive, cutting funding and recalling U.S. personnel with unprecedented speed.[vi]
His rhetoric, which paints the WHO as corrupt and politically compromised, also seeks to appeal to his populist base, sceptical of globalist institutions.
The Cost of Withdrawal: U.S. Departure Raises Questions about Legality and Global Health
The withdrawal raises significant legal challenges. The U.S. joined the WHO in 1948 through an act of Congress, and many experts argue that leaving the organization requires congressional approval. Some legal scholars have suggested that Trump’s unilateral decision could face lawsuits. Additionally, international agreements obligate the U.S. to provide a year’s notice and fulfil outstanding financial commitments, complicating the administration’s ability to expedite the process.[vii]
Under the WHO’s framework, a member state must provide one year’s notice and settle all outstanding dues to formally withdraw. This creates a built-in delay for any significant changes to occur, granting room for potential political or legal challenges. A subsequent administration could reverse the decision, as Joe Biden demonstrated in 2021 when he reinstated the U.S. as a member of the WHO following Trump’s first attempt to withdraw.
The U.S. is the largest financial contributor to the WHO, and its withdrawal would create a substantial funding gap, jeopardizing programs like polio eradication, tuberculosis treatment, and pandemic preparedness. Without U.S. support, the WHO may struggle to respond to health crises, particularly in low-income regions.[viii]
Furthermore, the simultaneous suspension of U.S. foreign aid for 90 days compounds the issue. Aid-dependent countries, particularly in sub-Saharan Africa, rely heavily on U.S.-supported programs. The abrupt cessation of funding risks destabilizing health systems, creating fertile ground for pandemics and other health crises.
The withdrawal of the U.S. from WHO raises significant health security concerns. As a member, the U.S. benefits from the WHO’s global health surveillance, early warning systems, and access to critical data on infectious diseases. These systems are instrumental in detecting and mitigating threats such as avian flu, Ebola, and COVID-19. Without these channels, the U.S. risks delayed responses to emerging global health threats, which could lead to higher mortality rates and increased strain on domestic healthcare systems.
The WHO’s role in coordinating global vaccine development is another crucial aspect. The organization facilitates the exchange of viral samples and research findings, enabling timely vaccine production. Without membership, the U.S. pharmaceutical sector might lose access to vital resources, potentially hindering the country’s ability to respond to pandemics effectively.[ix]
Close to the Bone: Will Withdrawal Make America Sick Again?
Domestically, the absence of WHO collaboration could also result in higher healthcare costs and reduced public health efficiency. The lack of access to global data on influenza strains, for example, may lead to mismatched vaccines and higher rates of hospitalizations and deaths from seasonal flu. The diminished collaboration with the WHO may also impair the U.S. Centers for Disease Control and Prevention (CDC) in combating antimicrobial resistance and preparing for future pandemics.
The withdrawal could diminish U.S. influence in global health governance, creating a power vacuum likely to be filled by countries such as China. This shift could have long-term implications for global health diplomacy, with the U.S. losing its ability to shape international policies and initiatives.
For instance, China’s financial and political support for the WHO may strengthen its leadership role, allowing Beijing to assert greater control over global health priorities. This scenario risks sidelining U.S. interests and could undermine initiatives that align with American values, such as promoting transparency and accountability in health governance.[x]
Trump’s decision to withdraw the U.S. from the WHO appears to reflect a broader trend of disengagement from multilateral institutions, driven by financial concerns, political ideologies, and skepticism of international governance. The WHO has, over the past seven years, implemented the largest set of reforms in its history, with significant improvements in accountability, cost-effectiveness, and its impact on global health outcomes. The withdrawal of the U.S. from the organization risks undermining these achievements and could hinder global health initiatives that rely on strong partnerships and coordinated responses.
Dr Kristian Alexander is a Senior Fellow and Lead Researcher at the Rabdan Security & Defense Institute (RSDI), Abu Dhabi.
[i] Klein, Betsy, ‘Trump announces US withdrawal from World Health Organization’, CNN, January 22, 2025, WHO: Trump announces US withdrawal from World Health Organization | CNN Politics
[ii] Hernandez, Javier ‘Trump Slammed the W.H.O. Over Coronavirus. He’s Not Alone.’, New York Times, April 08, 2020, Trump Slammed the W.H.O. Over Coronavirus. He’s Not Alone. - The New York Times
[iii] WHO, ‘WHO comments on United States’ announcement of intent to withdraw’, January 21, 2025, WHO comments on United States’ announcement of intent to withdraw
[iv] Treisman, Rachel ‘Trump is signing a flurry of executive orders. Here's how those work’, NPR, January 21, 2025, Executive orders and actions, explained : NPR
[v] von Borzyskowski, Inken and Felicity Vabulas, ‘When Do Withdrawal Threats Achieve Reform in International Organizations,’ Global Perspectives, January 23, 2023, Vol. 4, No.1, When Do Withdrawal Threats Achieve Reform in International Organizations? | Global Perspectives | University of California Press
[vi] Rotella, Sebastian, James Bandler, and Patricia Callahan, ‘Inside the Trump Administration’s Decision to Leave the World Health Organization,’ ProPublica, June 20, 2020, Inside the Trump Administration’s Decision to Leave the World Health Organization — ProPublica
[vii] Cullian, Kerry, ‘Trump May Face Lawsuit Over US Withdrawal from WHO,’ Health Policy Watch, January 21, 2025, Trump May Face Lawsuit Over US Withdrawal From WHO - Health Policy Watch
[viii] Gostin, Lawrence et al, ‘US withdrawal from WHO is unlawful and threatens global and US health and security,’ Lancet, July 9, 2020, 396 (10247): 293-295, US withdrawal from WHO is unlawful and threatens global and US health and security - The Lancet
[ix]Kekatos, Mary, ‘Public health experts worry about implications of Trump withdrawing US from WHO: ‘An enormous mistake’’, ABC News, January 22, 2025, Public health experts worry about implications of Trump withdrawing US from WHO: 'An enormous mistake' - ABC News
[x] Chorev, Nitsan, ‘The World Health Organization between the United States and China’, Global Social Policy, October 19, 2020, Vol. 20, Issue 3, pp.378-382, The World Health Organization between the United States and China - Nitsan Chorev, 2020
