Donald Trump is set to pull the United States out of the World Health Organization (WHO) on the first day of his presidency. Experts warn the move would be mutually harmful for both parties.
Trump, who will be inaugurated for a second and final term as US president on January 20, also tried to withdraw from the WHO in July 2020, at the end of his first administration.
But fully cutting ties with the WHO couldn't happen overnight due to a long-standing congressional resolution requiring the president to give a year's notice and pay back any outstanding obligations.
Because of that timeline, Joe Biden's election to the presidency in 2020 just months after Trump's decree, enabled the Democrat to reverse the decision.
Trump's likely move will face no such barriers this time around. On his first day in office, he could give notice of a US withdrawal from the WHO, which would then take effect in January 2026.
The US is the biggest source of WHO funding
If the US did withdraw from the WHO, it would be a major blow to the organization's budget and its ability to coordinate international health programs and policy.
The WHO is a United Nations agency comprised of 196 member countries, which pay into the organization via "assessed contributions" — effectively a membership fee — based on GDP and population figures on a two-year funding cycle.
The US accounts for nearly a quarter of these funds, ahead of China, Japan and Germany.
Donor-directed or "specified" contributions — where the giver dictates how and where the money is used — account for more than 70% of the total budget.
That presents a deep structural problem for the operation of the WHO, according to Gian Luca Burci, a former WHO lawyer now working as a global health law specialist at the Geneva Graduate Institute.
"Donors attach a lot of strings, so the WHO becomes very donor-driven," Burci told DW. "The US gets quite a bit in terms of return for relatively little money."
"There are many issues that the US attaches a lot of importance to, regardless of who sits in the White House," Burci added, "in particular on health emergencies, on pandemics, on disease outbreaks, but also on getting data of what happens inside countries."
The loss of its top financial contributor would leave the WHO with few options to make up the shortfall. Either other member states would need to increase their funding, or its operations budget would need to be stripped back.
Leaving the WHO would also hurt the US
The relationship between the WHO and Donald Trump began to deteriorate in 2020, when he accused the WHO of being a "puppet of China” during its response to COVID-19.
"He continues to rail against China and says that WHO is in the pocket of China, that China influences it," said Lawrence Gostin, a professor of global health law and director of the WHO Collaborating Center on Public Health Law and Human Rights at Georgetown University, US.
Gostin said exiting the WHO would be an "own goal" for the US and would come at the cost of the "enormous influence" the country has in global health.
"I think it would be deeply adverse to US national security interests. It would open the door to the Russian Federation, China and others. That might also be true with the BRICS: South Africa, India, Mexico," Gostin told DW.
Leaving the WHO would increase health risks of disease outbreaks
Withdrawal would also make the world a less healthy and safe place. Isolating itself from the global health community would put the US at a protective disadvantage during disease outbreaks.
"There are many things the United States can do alone, but preventing novel pathogens from crossing our borders simply is not one of them," Gostin said.
He points to the current concerns around H5N1 avian influenza in the US: "We're not going to have access to the scientific information that we need to be able to fight this because avian influenza is a globally circulating pathogen."
"WHO has an influenza hub where it monitors all the strains around the world. [The US Centers for Disease Control and Prevention] is a very close partner and we use those data to develop vaccines and therapeutics. We'd be flying blind," Gostin said.
Threat could force more change, and US win
Trump's withdrawing the US from the WHO would certainly transform the US-WHO relationship, but it wouldn't necessarily end it.
Burci is open-minded about what that future relationship could look like.He suggests the US could act like non-governmental organizations and charities by making voluntary contributions to programs it ideologically supports.
"[They] may continue to fund some projects [and] activities so it's possible that the WHO would not lose the entirety of the US contribution," Burci said.
Trump also casts himself as a dealmaker president, so he could use the withdrawal as a stick to force US-endorsed reforms in Geneva.
The WHO's performance in a modern world has long been criticized, and not just by the US. However Gostin notes some reforms have begun in the wake of its handling of COVID-19.
While WHO's "transformation agenda" has also been in place for nearly eight years, Trump may be able to further strong-arm change.
Gostin would rather see Trump engage his dealmaker than isolationist persona in his WHO dealings.
"He could send a letter withdrawing, or, he could do a deal with WHO to make it a better, more resilient, more accountable and transparent organization, which would be a win-win for the United States, for WHO and the world," Gostin said.
