Trump’s withdrawal from the WHO could millions of people in poorer countries

Donald Trump’s decision to withdraw from the World Health Organization (WHO) puts the lives of millions of people in poorer countries at risk, according to analysts, who say other nations must step up and invest in health to plug the gap.

The new US president pulled the country out of the WHO—as well as from the 2016 Paris Agreement to limit global warming—in a flurry of executive orders signed on the first day in the Oval office on Monday (20 February), citing among other things the UN health agency’s handling of the COVID-19 pandemic and other global health crises.

The move was met with widespread condemnation from the global health community.

Pete Baker, policy fellow and deputy director of global health policy at the Center for Global Development, a think tank, said it would have far-reaching impacts.

It undermines global health security and risks progress on critical issues like pandemic preparedness and antimicrobial resistance.”

Pete Baker, policy fellow and deputy director of global health policy at the Center for Global Development

Rebecca Grais, executive director of the Pasteur Network, an international group of health research organisations, acknowledges there are flaws in the multilateral system. But she says leaving the WHO entirely is not the best way to address them.

“The WHO provides critical guidance and support, particularly for populations with the least resources and the least access to healthcare,“ Grais told SciDev.Net.

“These communities will bear the brunt of the consequences,” she added.

Trump cast doubt on the WHO’s independence, claiming it was compromised by “inappropriate political influence” from member states, as well as complaining that the US bore the biggest financial burden of all members.

The US is the WHO’s largest donor,  contributing US$1.28 billion to the WHO’s 2022-23 budget in assessed and voluntary contributions, according to the WHO’s latest data. Taking into account a US$2 billion shortfall in WHO funds overall, this accounts for around 15 per cent of the total budget, according to analysts.

However, the US was “highly restrictive on how WHO can use its money”, according to Baker.

He hopes that if other member states or philanthropists can step up and provide more flexible funding—even if less than the previous US contribution—this could help WHO be more agile and focused in delivering its mandate.

Pandemic preparedness

For Baker, the accompanying withdrawal of US support from the Pandemic Agreement negotiations is the bigger threat.

“The political support of the US for the global health security architecture is irreplaceable,” he explained.

“If [the withdrawal] continues, it will seriously hamper the world’s efforts to ensure preparedness for future health threats.”

Grais also said the decision puts global health initiatives at risk, including the ongoing pandemic treaty negotiations, whose future is in doubt without the participation of the world’s largest economy.

She said the move will potentially delay access to medicines in low- and middle-income countries even further as patent waivers require significant global consensus.

“Without US involvement, achieving that consensus could become more challenging, as the US is a major player in global pharmaceutical research and development and policymaking,” she added.

US-based pharmaceutical companies, which are among the largest patent holders, may feel less pressure to participate in global initiatives for voluntary licensing or patent waivers if US policy diverges from WHO recommendations, Grais said.

‘Changemakers’ needed

“At a time when collaboration is essential, this move undermines the shared responsibility needed to tackle health crises,” she added.

“As always, it’s the most vulnerable populations that stand to lose the most.”

Peggy Oti-Boateng, executive director the African Academy of Sciences, said it was unfortunate that the US has pulled out of WHO, leaving a void for other world economic powers to occupy.

“It is time now for African countries to prioritise to invest more in science research and innovation including health, food security, energy and climate change,” Oti-Boateng told SciDev.Net.

“Africa cannot continue to rely on other superpowers when we have all the resources, human capital, and natural resources, if strategically managed, to see a great transformation of the continent.

“We need to have African leaders who are committed and ready to be changemakers.”

WHO reforms

The WHO said it regretted the announcement that the US intends to withdraw from the organisation.

“WHO plays a crucial role in protecting the health and security of the world’s people, including Americans, by addressing the root causes of disease, building stronger health systems, and detecting, preventing and responding to health emergencies, including disease outbreaks, often in dangerous places where others cannot go,” it said in a statement.

According to WHO, the participation of the US and other member states over the past seven years has allowed it to implement the largest set of reforms in its history, to transform its accountability and cost-effectiveness.

“We hope the United States will reconsider and we look forward to engaging in constructive dialogue to maintain the partnership between the USA and WHO, for the benefit of the health and well-being of millions of people around the globe,” it said.