
Donald Trump’s disdain for global multilateral bodies, especially the United Nations and the World Health Organization (WHO), was apparent during his first term. It has now been acted upon at the very start of his second term. The US’s withdrawal from membership of the WHO was among the executive decisions announced on Day 1 of Trump 2.0.
Trump’s America First strategy states that the US must drive global policies best suited to its interests and not be influenced by consensus decisions that accommodate the priorities of other countries. Global solidarity is perceived as irrelevant in a transactional world driven by military and monetary power.
When Trump indicated intent to exit from WHO during his first term, 750 leaders from academia, science and law wrote to the US Congress on June 30, 2020, urging it to block that action. Writing in The Lancet in August 2020, several American public health leaders argued that approval of both houses of the Congress was essential for exiting WHO since the US had become a member of WHO in 1948 on the strength of a joint resolution by those two legislative bodies. President Harry Truman had cited that resolution as the legal basis for the US joining WHO. Unless an exit from WHO is the ‘’expressed will of the US Congress’’, the Supreme Court could hold the decision to be unconstitutional.
In 2020, Trump’s party controlled only one house of Congress. Since it now has a majority in both the Senate and the House of Representatives, the president’s decision would sail through. Criticism directed at WHO’s response to the pandemic would be used to undermine the credibility of that organisation. A charge that WHO had become highly influenced by China was repeated by Trump when he announced the decision. He also complained that the US was paying a disproportionately higher financial contribution.
WHO has appealed to the US to reconsider its decision. In the manner of a spouse seeking to avoid a painful divorce by invoking the memories of the good times the couple had shared, WHO said: “For over seven decades, WHO and the US saved countless lives and protected people from health threats. Together, we ended smallpox, and together we have brought polio to the brink of eradication. American institutions have contributed to and benefited from membership in WHO.”
This nostalgic sentiment is unlikely to result in Trump reversing his decision. So the world will have to brace for the turbulence that will hit global health as one of its powerful engines shuts down. The greatest impact would be felt in the global efforts for strengthening surveillance and control of infectious diseases. It is extremely harmful to global health security that this rupture should occur when the whole world is negotiating a pandemic treaty.
The Centers for Disease Control (CDC) and the National Institutes of Health (NIH) are the leading US health agencies. Many of their divisions are designated as WHO collaborating centres. They not only provide technical support to WHO, but also gain connectivity to global networks of similar centres. The CDC at Atlanta, for one, is a key global resource for pathogen surveillance.
While the CDC types influenza viruses, the WHO global Influenza tracking system aggregates data from around the world to study circulating viruses. Their collaboration is especially important when the US is presently reporting the largest number of H5N1 cases in the world. A breakdown of collaboration among global scientific and public health agencies can set the stage for another pandemic.
The US government has also signalled a disengagement with global health by ordering scientists at NIH and CDC to stop international travel and desist from organising or participating in global meetings. They have even been ordered not to engage in scientific correspondence till further orders. Collaborative projects of NIH are stalled and technical support from CDC has ceased for now.
Previously, the US exhibited leadership in global health through initiatives like the President’s Emergency Plan For AIDS Relief. This programme, launched by George W Bush, had been helping many African nations to obtain life-saving drugs for AIDS and stopping mother-to-child transmission of the virus. The suspension of aid to global health programmes has interrupted drug supplies. Other global programmes for control of infectious diseases, especially tuberculosis, will also be adversely affected. India, coupling self-reliance with strategic bilateral and multilateral partnerships, is less vulnerable.
By disengaging with WHO, the US will lose access to global health data that WHO gathers from different sources. By not having a seat at the table in the technical expert committees and the general assembly of WHO, the US will lose the ability to influence many global health regulations, technical guidelines, international agreements and treaties that may affect US ‘national interests’—especially those linked to American transnational pharmaceutical, medical equipment and food industries. While WHO can still engage technical experts from US universities as consultants, American presence will no longer be a feature of WHO’s decision-making bodies in many vital areas of global health.
During international health negotiations, the US would draw on the support of other Anglo-Saxon countries and the European Union (EU). Given the recent attacks by Trump and Elon Musk on the leadership of the UK, Canada and EU, it is unlikely that they will act as surrogates of the US to protect or promote American interests at WHO. The US may need to operate through private foundations that fund WHO. But will they oblige?
Other countries will fill the vacuum. China is well-positioned to do so, with its strong economy poised to advance its geopolitical interests in Asia and Africa. Other BRICS countries, including India, may increase their contributions. The EU, too, may wish to become a lead supporter. Meanwhile, WHO itself must introspect on how best to reform its financing and governance mechanisms.
(Views are personal)
K Srinath Reddy | Author of Pulse to Planet; Distinguished Professor of public health, PHFI