Trump's Snub to Global Health Leaves The Field Wide Open

Newsletter Edition #247 [The Files In-Depth]

Hi,

Global health is not a zero-sum game, but political expediency demands simplistic narratives, whether it is contributions to global health financing or how outbreaks emerge.

In today’s edition, we examine the various implications of the U.S. withdrawal from World Health Organization. While it will take weeks and months to fully understand the impact of such a decision, the consequences will be enormous. (While there is plenty of theorizing around the implications, the very real impact on sexual minorities, women and children, among other issues, is not an abstraction.)

We spoke to a range of experts, policymakers, diplomats for this story.

Thank you for reading.

Global health is being remade again. And we are closely tracking these transitions. Support us through this tumultuous phase in global health policy-making.

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Best,

Priti

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Illustration Credit: Amy Clarke, Chembe Collaborative

I. ANALYSIS

Trump’s Snub to Global Health Leaves The Field Wide Open

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The decision of President Donald Trump ordering the U.S. exit out of World Health Organization, has not just made financing pressures more acute for the UN’s only technical agency, it has also upended American, and as a consequence, global health policy-making. This will potentially unleash vast, and possibly irreversible changes in the overall governance of the field.

It is a legitimate question to ask if so much depends on just one WHO member state. The answer to this is both yes and no.

The U.S. and its government agencies, are the biggest contributors to WHO.

According to WHO, the share of US funding of about US$706 million in the WHO financing, represents 10% of the approved budget for 2024-2025 of US$ 6.8 billion and 18% of the total revenue at the end of December 2024 (US$ 3.9 billion).

The U.S. is the biggest donor to the institution taking into account both voluntary contributions and membership fees. (The financial period for WHO’s programme budget is two consecutive calendar years)

So, when the U.S., pulls the plug on financing as ordered by President Donald Trump, hours after he assumed office earlier this week on January 20, 2025, the consequences for WHO are near immediate. However, this is not entirely clear given current contractual arrangements, and potential legal challenges to such a decision. (We discuss this more in detail below)

Apart from the financing issues, the overall direction of the Trump presidency will have lasting and deep impacts on global health, whether it is addressing health emergencies, or sexual and reproductive health, or even on matters of race – the bedrock of inequities in many countries including the U.S. While there are financial implications for these disciplines within global health, the ripple effect of such policies on these issues could spread and far, and win willing allies across the Atlantic, and in many other parts of the world.

It will be no exaggeration to say that this has a seismic effect on the field. (This has not been out of the blue. There were indications that President Trump would take such a measure given his previous decision in 2020.)

Scholars have questioned and contested, the outsized influence of American policy on global health. But given the deep influence and investments by the U.S. over decades, the field has been decisively forged, governed and shaped by American interests. Senior diplomats from developing countries have often described this as “insidious”.

All of that could potentially change, if other countries (193 member states of WHO, apart from the U.S.) decide to step up, not only in terms of plugging the hole in financing for an organization that is already struggling, but if they articulate clear visions and interest on how they want WHO and global health to be shaped. That looks like a distant possibility though. Inward looking politics, a retreat from internationalism, tariffs wars and cosy bilateralism, will dominate political calculations, that could leave multilateralism floundering.

Given that Europe is grappling with myriad geopolitical challenges and domestic pressures, the field is wide open for other players, including non-state actors to step in. If COVID-19 was any marker, changes in global health governance will move swiftly.

Experts say there appears to be no appetite, or leadership among member states, to rescue WHO, because of political and financial frailties. A leadership vacuum, therefore provides carte blanche for interested parties. After all, multistakerholderism is a reality for much of the United Nations, and for countries.

(Also, see one of the actions in Trump’s order: “identify credible and transparent United States and international partners to assume necessary activities previously undertaken by the WHO.”)

Apart from implications for the U.S., this could really be an irreversible moment for WHO and for global health. This is the most likely scenario, experts say: exit American government, and enter American philanthropists. If this crisis is perceived as posing near-existential risks for WHO, all gates will be opened to accept funding from private sources. And we well know, that once such a transition occurs, it will become a part of the firmament in global health.

In this comprehensive story, we examine the U.S. Presidential orders that affect global health, and how experts see these issues evolving. We look at the impact on WHO financing; on recent and on-going negotiations for Prevention, Preparedness And Response during health emergencies; and the wider impact on global health.

Image credit: Photo by Mahdi Bafande, Pexels