Introduction
Trump’s win in the presidential election meant an immediate issuance of multiple executive orders soon after his inauguration in late January 2025. One of these orders is of particular importance, namely declaring the beginning of the United States withdrawal from the World Health Organization (WHO). However, it must be noted that this was not Trump’s first attempt to leave the Organization. During his first term as President, he had also declared that the US were to leave, however, this attempt was reversed when President Biden came into office.1 According to the executive order, the main reason for withdrawal is the WHO’s alleged mishandling of the COVID-19 pandemic and “other global health crises”. Additionally, the order claimed that the WHO needs urgent reforms due to ‘inappropriate political influence of other WHO member states’. Lastly, the Executive Order alleges that the US have been treated unfairly concerning payments to the organization, in comparison to other countries - specifically mentioning China.2
The WHO is a specialized agency of the United Nations, effectively focusing on all matters related to public health on an international scale. Presently, the WHO collaborates with 149 of its Member States to improve access to health care and promote well-being.3 The organization plays an essential role in global health governance due to its wide access to resources and its ability to establish and enforce international norms.4 Accordingly, the WHO Constitution divides the WHO’s core functions into three main categories; (1) normative functions; (2) directing and coordinating functions; and (3) research and technical cooperation functions.5 To specify, normative functions are mainly concerned with international agreements and non-binding standards, the directive functions primarily pertain to the variety of WHO health programmes and research functions are concerned with disease eradication and prevention.6
The aim of this article is to consider the consequences which may arise out of the United States’ withdrawal from the World Health Organization. One immediate concern regarding the U. withdrawal is the legal framework governing such an action. As a member of the WHO, the US is bound by the organization’s Constitution along with the joint resolution which outlines the procedure for withdrawal.7 The US has historically been one of the largest financial contributors to the WHO, thus a sudden halt in contributions may weaken the organization along with shifting the balance of power within it. The WHO plays a key role in coordinating international health surveillance and data-sharing agreements. A withdrawal could disrupt these partnerships, affecting the speed of outbreak detection, vaccine development, and global disease control efforts.
Legal Consequences of US Withdrawal
The United States first joined the WHO in 1948, through a joint Congress resolution, which formed the legal basis for becoming a membering state.8 Congress felt the need to include a withdrawal provision, as the WHO Constitution did not cover the matter of exiting the organization. The provision listed conditions which must first be met by the United States prior to officially being alleviated from all its ties to the WHO.9 The first condition requires a one-year notice ahead of withdrawal. Secondly, the US may only issue a notice provided they have paid their financial obligations in full for the current fiscal year.10 As of currently, the United States have still not met their financial obligations for 2025. Therefore, according to the terms of the resolution they cannot legally begin their withdrawal process. In further assessing the legality of the withdrawal, Trump’s unilateral decision to exit the Organization has also been deeply criticized. Some have claimed that this unilateral action violates US law due to the lack of express approval from Congress to leave.11 In this regard, the Youngstown Steel case is referenced as precedent to limit the president’s powers. The Supreme Court had decided that ‘when the President takes measures incompatible with the express or implied will of Congress, his power is at its lowest ebb’.12 As such, the US Congress, along with the courts have the power to block the one-sided exit from the WHO.13 On the other hand, it does remain an open question to what extent the President may unilaterally withdraw considering that it was not made clear within the resolution whether Congress approval was a necessary instrument for official withdrawal.14 However, the violations of international legal obligations are at risk, if it does turn out that Trump’s actions are not permitted.
Although the executive order will have a strong impact on the ties between the United States and the WHO, it will also be detrimental to global health governance. The order instructs the State Secretary to cease any involvement in the negotiations for the WHO Pandemic Agreement and changes to the International Health Regulations. These are both legal instruments which govern international cooperation for the prevention and control of diseases across borders and generally maintaining global health. Furthermore, the order stated that these agreements will no longer be binding to the US, which will likely have a strong weakening impact on the future responses to global health threats. Although there were many collaborative difficulties in managing the COVID-19 pandemic, coordinated efforts and multilateral agreements proved to have been one of the only working mechanisms for efficient global health governance. Furthermore, the US leave is also expected to create a leadership void in health governance, allowing states like China, which have made significant health investments, to come into power. This will likely cause countries to prioritize health systems and strategies without consulting the US, which increases the gaps in health coordination which may make the US more susceptible to pandemics and other future health emergencies.15
Conclusion
In summary, the US withdrawal from the WHO raises legal challenges, disrupts global health coordination, and weakens pandemic preparedness. Failing to meet financial obligations and lacking clear congressional approval may hinder the exit process, essentially not making it possible for the US to withdraw. The move also risks undermining international health agreements and shifting global health leadership to other nations, particularly China. By stepping away, the U.S. may diminish its influence in global health policy and increase its vulnerability to future health crises.
1 Berkeley Public Health, ‘U.S. withdrawal from WHO could bring tragedy at home and abroad’ (Berkeley Public Health, 24 January 2024) < https://publichealth.berkeley.edu/news-media/opinion/withdrawal-from-who could-bring-tragedy> accessed 17 February 2025.
2 White House, ‘Withdrawing The United States From The World Health Organization Executive Order’ (White House Gov, 20 January 2024) https://www.whitehouse.gov/presidential-actions/2025/01/withdrawing-the united-states-from-the-worldhealth-organization/> accessed 18 February 2025.
3 WHO, ‘About WHO’ (World Health Organization, Date Unknown) https://www.who.int/about> accessed 18 February 2025.
4Jennifer Prah Ruger and Derek Yach, ‘The Global Role of the World Health Organization’ [2014] 2(2) Global Health Gov https://pmc.ncbi.nlm.nih.gov/articles/PMC3981564/> accessed 19 February 2025.
5 Gain Luca Burci and Claude-Henri Vignes, World Health Organization (Kluwer International Law 2004)
6 Ruger and Yach (n 4).
7 Constitution of the World Health Organization (adopted 22 July 1946, entered into force 7 April 1948) 14 UNTS 185, article 7.
8 Lawrence O. Gostin, et al., ‘US withdrawal from WHO is unlawful and threatens global and US health and security’ [2020] 369(10247) The Lancet <https://www.thelancet.com/journals/lancet/article/PIIS0140- 6736(20)31527-0/fulltext> accessed 18 February 2025.
9Jean Galbraith, et al., ‘The Legal Problem with Trump’s WHO Order: The US Cannot Withdraw Until It Pays Its Dues’ (Just Security, 23 January 2024) <https://www.justsecurity.org/106748/trump-order-world-health organization/> accessed 18 February 2025.
10 U.S.C. Title 22, Chapter 7, Subchapter XX, Article 220c.
11 Gostin, et al. (n 8).
12Youngstown Sheet and Tube Company v. Sawyer, 343 U.S. 579 (1952).
13 Gostin, et al. (n 8).
14 Galbraith, (n 9).
15 Bailey Johnson, et al., ‘Unraveling Progress: The US Exit From The WHO And Its Global Consequences’ (Health Affairs, 3 February 2025) <https://www.healthaffairs.org/content/forefront/unraveling-progress-us-exit and-its-global-consequences> accessed 18 February 2025.
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