A Negotiated Settlement with the Trump Administration & WHO, a Win-Win for Global Health Security [Guest Essay]

Newsletter Edition #249 [The Files In-Depth]

Hi,

There is no saving from the weight of government policy. But that is what diplomacy is for: to make progress even when none is possible. It is too early in the year to give up on optimism!

Since President Trump announced the withdrawal of the U.S. from WHO, and the flurry of executive orders that followed, showing a determined retreat from global health and international development, questions have been asked to what extent is the U.S. really critical in the scheme of things. It turns out, more than the world would like.

It is not just the dollar numbers, and but the overall cumulative impact on global health and the unforeseen domino effect of such decisions. The weight of the American decision is already being acutely felt at WHO. (See our story from earlier this week: Countries Might Weigh Costs & Prioritize Items on WHO’s Agenda; Targets for Membership Fees at Risk Even as WHO Seeks 9% Hike for 2026-2027 Budget)

In today’s guest essay, leading global health legal scholar Lawrence O. Gostin of Georgetown University, lays out for our readers the pitfalls and the implications of President Trump’s decision to withdraw from WHO. He is also of the view that there is room for reforms, that could be the basis for a negotiated settlement between WHO and the U.S. government.

We are watching how stakeholders will shape the ongoing, somewhat forced transition at WHO.

Thank you for reading.

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Illustration Credit: Amy Clarke, Chembe Collaborative

I. GUEST ESSAY

A Negotiated Settlement with the Trump Administration & WHO, a Win-Win for Global Health Security

By Lawrence O. Gostin

Gostin is Distinguished University Professor, Georgetown University and Director, O’Neill Institute for National and Global Health Law, Washington, D.C., USA. He can be reached at gostin@georgetown.edu.

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In the aftermath of World War II, the United Nations created the World Health Organization (WHO) as its first specialized agency. In 1948, a congressional joint resolution allowed the U.S. to enter as a member of WHO. Congress also reserved the right of the U.S. to withdraw from WHO. This places the United States in a unique position as a WHO member because the WHO Constitution is silent on the matter of whether a member can withdraw.

In its joint resolution, Congress set two conditions for U.S. withdrawal: first, that the U.S. gives the United Nations one-year’s notice before a withdrawal takes effect, and two, that the U.S. has fully met its funding obligations to WHO for the current year.

In the opening months of the COVID-19 pandemic, Trump first threatened to withdraw from WHO. He asserted that WHO was failing in its response to COVID-19 and that China exerted excessive influence on the Organization. Then, on July 6, 2020, President Trump sent an official letter to the UN Secretary-General giving notice that the United States would withdraw from WHO, thus starting the one-year clock. The withdrawal, however, never took effect. On his first day in office, January 20, 2021, President Biden sent a letter to the UN Secretary-General rescinding Trump’s original letter.

What are the Terms of President Trump’s Executive Order?

On his first day in office on January 20, 2025, Trump issued an executive order asserting the United States’ intent to withdraw from WHO and directing his Secretary of State to provide formal notice to the United Nations and WHO. The order also stated that the president was revoking President Biden’s letter to the Secretary-General rescinding the first Trump administration’s notice to withdraw.

Along with stating the intent to withdraw from WHO, the order ends U.S. participation in negotiations on the pandemic agreement, and declares that neither the pandemic agreement nor the June 1, 2024, amendments to the International Health Regulations will be binding on the United States. The executive order immediately suspends transfer of any further funds or resources to WHO, recalls U.S. government employees or contractors who are working with WHO, and sets into motion several measures to protect U.S. public health in light of the withdrawal. Since the executive order, President Trump has ordered the U.S. Centers for Disease Control and Prevention (CDC) to cease funding, activities, and communications with WHO. For all intents and purposes, the U.S. has disengaged from the WHO.

The executive order points to WHO’s “mishandling of the COVID-19 pandemic” and other crises, its failure to reform, and undue political influence that China has had on the organization. Having worked with WHO for decades, the United States has exerted far more influence in the organization than China ever has. But ironically, if the U.S. withdraws, it could cede greater leadership to other member states, including China.

The Organization has undertaken a series of major reforms over the last several years. But there should be room for further reforms that could form the basis of a negotiated settlement with the Trump administration and the WHO, which would secure U.S. membership and funding. U.S. membership in WHO strengthens the Organization’s ability to improve health outcomes worldwide and also advances U.S. national security interests.

In President Trump’s executive order, he states that “WHO continues to demand unfairly onerous payments from the United States, far out of proportion with other countries’ assessed payments,” citing China’s contributions as being nearly nine times lower than those of the United States. This is highly misleading.

First, the level of the required membership dues (assessed contributions) is approved by WHO member states before every two-year budget cycle, including by the United States. Thus, these are levels to which the United States has agreed, not ones imposed by WHO. And second, the U.S. assessed contributions are only 31% more than China’s for the current (2024-25) biennium, with the United States providing 22% of total membership dues, or $260.6 million, and China providing 15.255%, or $171.2 million. The basis of the large gap cited in the executive order is voluntary contributions. In the last completed biennium (2022-23), the United States provided $1.066 billion (voluntary contributions plus funding to Emergency Contingency Fund), while China contributed only $42 million.

WHO’s overall level of funding is wholly incommensurate with its global mandate. It’s budget is roughly equivalent to a major U.S. hospital system. Consider that Emory Health Care Systems’s annual budget is $6.4 billion USD, while WHO's is $6.5 billion USD. This should mean that U.S. government funding should not be decreased, but that member states with large GDPs like the BRICS nations, and including China, should substantially rise.

Image Credit: Photo by Zetong Li, Pexels

Is the Executive Order Lawful?

Whether or not President Trump can withdraw from WHO through this executive order is legally questionable. The legality of the withdrawal hinges on three factors:

First, according to the joint resolution, the United States must give WHO one-year’s notice before a withdrawal takes effect. The executive order directs the Secretary of State to send notice, so in one year after Secretary Rubio sends the notice, this legal condition will be met. However, there is deliberate ambiguity in the Executive Order. Because President Trump rescinded President Biden’s executive order, Trump appears to suggest that the notice period is six months rather than a year.* If that is the intent, it would blatantly violate the terms of the 1948 Joint Congressional Resolution.

Second, the United States must fully meet its fiscal obligations to WHO for WHO’s “current fiscal year.” The United States has not yet paid the $260 million it owes to WHO for the 2024-25 biennium. Thus, this requirement has not yet been met, and by the terms of the executive order, pausing the transfer of funding to WHO, it cannot be met. And recall, President Trump immediately ceased all funding to WHO in his Executive Order. And he subsequently ordered the U.S. CDC to discontinue any communications, programs, or activities with WHO.

Moreover, as the Congressional Research Service has noted, the joint resolution is unclear as to whether the “current fiscal year” refers to the year of the notification, in this case, 2025, or the year that the withdrawal takes effect, or 2026. If the “current fiscal year” is the year that the withdrawal takes effect, the United States would need to pay its 2026 dues as well. That level will be established this May at the World Heath Assembly. It is not clear the extent to which the U.S. will participate at the WHA or the Executive Board meeting on 3-11 February 2025.

Note that in the very first article of the U.S. Constitution (Art I, S 8, Cl 1), it is the Congress, not the president, which holds the power of the purse: “The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States.” And as further detailed in the Impoundment Control Act of 1974, the president cannot unilaterally withhold money that Congress has appropriated for a particular purpose. Thus, if Congress appropriates further funding for WHO (whether for mandatory assessments or voluntary contributions), President Trump would be obliged to direct or permit his administration to transfer those funds to WHO. Yet, he has simply refused to transfer any funds to the WHO.

The third factor is whether Congress must also give its assent to WHO withdrawal, a contested matter. In the Joint Resolution, it states the United States can give notice of withdrawal, but it does not specify whether the president can act unilaterally as a proxy for the United States. The essential question is, in order to withdraw from an international agreement, whether the United States must use a comparable process as it undertook to join the agreement, which would be required if the “mirror principle” interpretation of the U.S. Constitution’s process for joining treaties is accepted. Under this theory, since joining WHO occurred through a joint resolution of Congress and action by President Truman, the withdrawal could only take effect with congressional approval. As the Congressional Research Service indicates, it is unclear whether or not Congress intended the president to be able to act alone or for another joint resolution to be necessary. Additionally, the U.S. has ratified the WHO Constitution, which is a treaty. Whether the president alone can rescind that ratification is legally uncertain.

Future Action

For the sake of both U.S. and global health, it is critical that the United States terminate its withdrawal process. If the United States proceeds with ending its relations with WHO, whether by withdrawing or, due to legal hurdles to withdrawing, simply disengaging entirely, everyone will suffer the consequences – Americans and people around the world, especially the most vulnerable. We will all be more at risk of disease outbreaks that engulf the world, and be less able to make progress against other health threats. And with the newest outbreaks of Ebola in Uganda and Marburg in Tanzania, risks on the African Continent could easily spillover to Europe and North America.

But the United States could instead step back from the brink and leverage WHO’s unique strengths to make us all safer and healthier. Bold reforms are possible, ways to create a more transparent, more accountable, more effective WHO – and even to find new approaches to funding where contribution from China and other countries with the economic wherewithal pay a higher share of WHO’s overall funding needs.

It’s time for mature leaders to engage in active diplomacy to create a win-win for global health. We need a stronger, nimbler and better financed WHO. And we need continued United States financing and leadership. That can still happen and it would advance U.S. national security interests.

Facing a fork in the road, the United States should choose the path of health for all.

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* President Trump’s Executive Order on Withdrawing the United States from the World Health Organization (WHO), dated January 20, 2025, directs the United States to withdraw from the WHO by “revoking” the Letter to the United Nations Secretary-General from President Biden dated January 20, 2021, which retracted the first notice of withdrawal issued by the prior Trump administration on July 6, 2020. Accordingly, we asked the Senate Committee on Foreign Affairs to ask this question of President Trump’s nominee for Secretary of Health and Human Services, Robert F. Kennedy, Jr: “When will the United States’ withdrawal from the WHO become final? On what date would the notice become effective?”.

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