“The United States intends to withdraw from the WHO,” Donald Trump wrote in one of his many executive orders issued on Jan. 20. Public health officials – locally, nationally and globally – are alarmed by the potential impact. The World Health Organization, which is credited with eradicating smallpox and significantly reducing the burden of polio, began in 1948 as a branch of the United Nations focused on global health.
“If the U.S. withdraws from the WHO, there is more of a chance of outbreaks of diseases like polio and measles,” said Dr. Vidhya Prakash, associate dean of clinical affairs and population health and chief medical officer at SIU Medicine in Springfield. “Further, the U.S. is shut out of data on what strains should be included in the seasonal influenza vaccine and even access to samples of these strains to produce enough vaccine in time for each year’s influenza season,” she said.
Bird flu is an example of a potential public health threat where the U.S. needs access to the latest data, Prakash said.
The WHO currently consists of 194 member countries. The U.S. was a founding member, joining in 1948 by an act of Congress, and has been a leader in WHO’s work ever since. Crucial roles of WHO include detecting, monitoring and responding to emerging health threats, gathering and evaluating data from around the world and developing guidelines on how to best handle health threats and crises. By withdrawing from WHO, the U.S. will not have access to key data, and U.S. scientists will not have a voice to contribute their expertise, said Prakash. Subsequent to his executive order, Trump also directed staff at the Centers for Disease Control and Prevention to cut off all communication with the WHO.
The WHO also provides vaccines and drugs for various diseases. Withdrawing from the WHO will not only affect humanitarian efforts around the globe, but is anticipated to adversely impact the supply chain and thus people in the U.S. as well. Halting distribution of HIV drugs jeopardizes the health of people living with HIV, which drives resistance and the chance of death due to inadequate treatment. The WHO has been instrumental in guiding the global response to monkeypox, bird flu, Marburg virus and mitigating likelihood of outbreaks of measles and malaria.
Trump wrote in his executive order: “The WHO continues to demand unfairly onerous payments from the United States, far out of proportion with other countries’ assessed payments.” Funding from the WHO comes from assessed contributions from member countries and voluntary contributions.
Assessed contributions are based on a country’s gross domestic product, and the percentage is agreed upon by the United Nations’ General Assembly. Assessed contributions cover less than 20% of the total budget, according to the WHO. The remainder comes from voluntary contributions from member states and other United Nations organizations, intergovernmental organizations, philanthropic foundations, the private sector and others, such as the Bill and Melinda Gates Foundation.Â
The U.S. has contributed more in voluntary contributions than its required assessed contribution, in recognition of its role in humanitarian aid as well as the crucial need for detection, monitoring and data collection to guard against emerging health threats. Investment in prevention and monitoring are widely considered cost-effective, given the enormous economic impact of responding to health crises.
The WHO website documents how member countries and other contributors are involved, crediting the U.S. for its leadership: “The United States is a strong advocate for global health security. An example is the fight against polio, where the country is a key partner in the WHO-led eradication efforts, which protect Americans and communities worldwide from the resurgence of this preventable disease.”
The U.S. is also acknowledged for “delivering life-saving humanitarian assistance to communities devastated by conflict, natural disasters and disease outbreaks” and for being “a strong proponent of WHO’s reform and transformation, promoting efficiency to ensure that WHO is better equipped to address global health challenges.”
Prakash said the WHO has been monumentally important to world health. There are always opportunities for improvement, as in any organization, but Prakash said any perceived inefficiencies are not a reason to withdraw, which would have a much bigger cost.
As with many of Trump’s executive orders, there is confusion about timing, funding and the role of Congress. Withdrawal happens immediately, but the financial obligations remain for one year. Dr. Tedros Adhanom Ghebreyesus, director general of the WHO, announced a hiring freeze and limited renegotiation of contracts due to the financial implications of U.S. withdrawal.
Dr. Sameer Vohra, director of the Illinois Department of Public Health, issued a statement expressing concerns about the potential impact of U.S. withdrawal from the WHO. He is a pediatrician and founding chair of the SIU School of Medicine’s Department of Population Science and Policy. Vohra wrote: “The U.S. may lose internal access to WHO’s global surveillance system, which provides the United States, including Illinois, with early warnings of outbreaks by monitoring disease activity in more than 150 countries. Without access to this network, Illinois could lose critical time detecting threats like new COVID-19 variants, Ebola, avian influenza and more.”
Vohra noted that Illinois may become less able to monitor new or emerging diseases entering the state. He said this is particularly important because Chicago is home to O’Hare International Airport, the second-busiest airport in the U.S. and a primary point of entry for international travelers.
“Illinois will now need to explore alternate tools and resources to understand and address global crises, obtain data and quickly identify emerging threats in the absence of any confidential information provided by the WHO,” Vohra said.
In spite of these challenges, Vohra said IDPH is dedicated to protecting public health throughout Illinois. He announced that IDPH is convening a coalition of global health experts in Illinois to determine how to better coordinate Illinois’ global response and maximize resources to protect the public health of Illinois residents.
Rotary International is the world’s first and largest humanitarian service organization with a global network of 1.2 million members in more than 170 countries. It has been working to eradicate polio worldwide for more than 35 years and is a founding partner of the Global Polio Eradication Initiative. The WHO coordinates the major strategic planning, management and administration processes of the Global Polio Eradication Initiative. The Bill and Melinda Gates Foundation is also a partner with Rotary and the Global Polio Eradication Initiative. The Gates Foundation issued a statement that read in part: “…instead of retreating, leaders in the United States should prioritize strengthening WHO’s capacity to address global health challenges.”
The American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, American College of Physicians, American Osteopathic Association and American Psychiatric Association issued a joint statement calling on Congress to reject the administration’s proposal:
“For more than 70 years, the WHO has played a leading a role in protecting, supporting and promoting public health in the United States and around the world. Withdrawing from the WHO will hamper our country’s ability to predict and respond to major public health emergencies and limit access, communication and information sharing to a global network of health professionals. We urge Congress to reject the administration’s proposal to withdraw from the WHO and ensure the United States can continue to have a seat at the table where critical public health decisions are being made.”
This article appears in Combating human trafficking.
