The United States Officially Withdraws from the WHO: A Turning Point in Global Health Governance and the Geopolitical Vacuum
23/01/2026
On January 22, 2026, Washington officially notified the World Health Organization that the United States' 78-year membership had come to an end. This was not a clean break—over 130 million dollars in unpaid dues, disrupted data-sharing channels, and unresolved legal disputes cast a complex shadow over this separation. Lawrence Gostin, a public health law expert at Georgetown University, offered a blunt assessment: In my view, this is the most destructive presidential decision of my lifetime.
The impact of this decision extends far beyond the budget sheets at the WHO headquarters in Geneva. It is reshaping the landscape of global health governance, redefining the roles of major powers in transnational health crises, and may alter the way humanity responds to the next pandemic for years to come.
A Long-Brewing Separation: The Multiple Motives Behind the U.S. Withdrawal
The Trump administration, in explaining its decision to withdraw, presented a seemingly coherent logical chain: the WHO's mishandling of the COVID-19 pandemic, failure to advance necessary reforms, and inability to demonstrate independence from inappropriate political influence. However, analysis reveals that behind these surface-level reasons lie deeper political considerations and strategic shifts.
Gaming with China Becomes a Key Driving Force. In his statement, Trump explicitly accused China of exerting excessive influence over the World Health Organization while contributing too little. He noted that China's population is nearly three times that of the United States, yet its assessed contributions to the WHO are only one-tenth of those from the U.S. This comparison is highly provocative but overlooks a crucial fact: over 80% of U.S. financial support to the WHO comes from voluntary contributions rather than mandatory dues. These voluntary contributions are often earmarked for specific purposes and inherently carry clear political intentions.
Gosting's analysis reveals the contradiction: Trump's claim that China has excessive influence over the WHO is inaccurate. In reality, the United States has consistently been the most influential member of the organization. The decision to withdraw does not diminish China's influence; instead, it may create more space for it. This strategic miscalculation reflects the extension of America's unilateralist diplomatic thinking into the realm of public health.
Institutional Discontent Overlaid with America First. Another factor, less discussed but equally significant, is the Trump administration's longstanding discontent with the lack of American leadership within the WHO. Since its establishment in 1948, none of the WHO's nine Directors-General have been from the United States. Given that the U.S. contributes the most funding and experts, this lack of representation is viewed by Washington as an unfair reflection.
The COVID-19 pandemic became the final straw that broke the camel's back. The WHO did make mistakes in the early stages of the pandemic—once advising the public that masks were unnecessary and incorrectly asserting that the coronavirus was not airborne (a position that was not officially corrected until 2024). These missteps were politicized by the United States as evidence of the organization's incompetence and the need for reform. However, using the operational errors of a multilateral institution as grounds for withdrawal, rather than as leverage to drive internal reform, is itself a debatable logic.
Double Impact: The Global Cost of Funding Cuts and Brain Drain
The most immediate impact of the U.S. withdrawal is financial. Out of the WHO's annual budget exceeding 3 billion euros, the U.S. contributes approximately one-fifth, or nearly 700 million dollars per year. This includes around 111 million dollars in mandatory assessed contributions and 570 million dollars in voluntary donations. These funds support dozens of critical programs, ranging from polio eradication initiatives to AIDS prevention, from maternal health to emerging virus surveillance.
The funding gap will directly translate into a cost in lives. Dr. Judd Walson, an infectious disease expert at Johns Hopkins University, estimates that funding cuts alone could lead to over 750,000 excess deaths in 2026, most of them children. Behind these numbers lies the contraction of specific programs: tuberculosis control plans may be scaled back, malaria prevention networks may develop gaps, and vaccine distribution systems in impoverished countries could grind to a halt.
WHO has already begun addressing this financial crisis. According to Stat News, the agency has frozen hiring, restricted travel, shifted all meetings online, and suspended IT equipment upgrades and office renovations. More critically, there have been staff reductions—by mid-2026, WHO's workforce is projected to shrink by 22%, with approximately 400 positions already eliminated. Director-General Tedros Adhanom Ghebreyesus noted in a recent press conference that the U.S. withdrawal is a lose-lose situation for both the United States and the world.
Brain Drain is Equally Fatal. The United States provides the WHO not only with funding but also with hundreds of employees possessing professional public health knowledge, along with extensive technical support from the U.S. CDC. These experts participate in formulating global health standards, assessing influenza strains, updating vaccine formulations, and coordinating multinational research. Their withdrawal means the WHO's capacity in technical decision-making and scientific guidance will significantly decline.
American scientists will also lose critical platforms. They will no longer formally participate in WHO committees, governing bodies, governance structures, and technical working groups. This includes the key panel that assesses the prevalence of influenza strains and decides on updates to flu vaccines. Dr. Ronald Nahas, President of the Infectious Diseases Society of America, called this move short-sighted, misleading, and scientifically reckless, emphasizing: Global cooperation is not a luxury, but a biological necessity.
Data Disconnection: The Self-Weakening of U.S. Public Health Defense
The Trump administration claimed that the United States could replace the intermediary role of the World Health Organization by establishing direct bilateral data-sharing agreements with various countries. However, public health experts widely believe that such an idea is nearly naive.
The data-sharing mechanism of WHO is the product of decades of trust-building. As a neutral platform, the organization aggregates disease surveillance information from 194 member states, including those with strained relations with the United States. Through this system, the United States gains early warnings, positioning itself at the forefront when new outbreaks emerge, enabling rapid development of vaccines and drugs. Losing this channel would mean the United States would have to rely on fragmented, unreliable bilateral arrangements.
Gostin sharply pointed out the dilemma: many emerging viruses are first discovered in China, but will China sign data-sharing agreements with the United States? Will African countries do so? Will countries subjected to high tariffs by Trump send us their data? This argument is almost laughable. He believes that the United States can, at most, reach such agreements with dozens of countries, far from being a substitute for a global network.
The public health system within the United States will also bear direct consequences. A ready example is measles. In 2016, the WHO declared measles eradicated in the Americas. However, since early 2025, the U.S. has recorded approximately 2,500 infections and 3 deaths. Health Secretary Robert Kennedy initially recommended vitamin A and cod liver oil as treatments, only acknowledging vaccination as the most effective measure after the outbreak worsened. Experts anticipate that the WHO will soon declare the U.S. is no longer a measles-free country.
The longer-term impact lies in the United States' ability to respond to the next pandemic. Without global data flows, the U.S. early warning system will develop blind spots. Vaccine development will be delayed due to a lack of critical strain information. Tom Boliki, Director of Global Health at the Council on Foreign Relations, warns: The United States cannot isolate itself from transnational health threats. This not only makes Americans less safe but also endangers citizens of other countries.
Power Restructuring: Who Will Fill the Vacuum Left by the United States?
The withdrawal of the United States has created a significant power vacuum, leading to a restructuring of the global health governance landscape. Analysis indicates that three major forces may attempt to fill this gap: China, the European Union, and private foundations.
China Faces Opportunities and Challenges. From a geopolitical perspective, the withdrawal of the United States naturally provides space for China to expand its influence within the World Health Organization. A spokesperson from China's Ministry of Foreign Affairs previously stated that China will continue to support the WHO in fulfilling its duties, deepening international cooperation, and strengthening global health governance. However, observers like Gostin point out that there is a gap between China's actual actions and its rhetoric.
China has long portrayed itself as a responsible participant within the WHO, but its actions do not align with this image. Gostin points out that China has received substantial funding from the Global Fund, yet it has given little in return. Most of China's health development assistance is not channeled through the WHO; instead, it is carried out through bilateral arrangements under the Belt and Road Initiative. While this model may expand China's political influence, it could potentially undermine the overall effectiveness of the multilateral system.
If China wishes to become a reliable global health leader, substantive changes are necessary. Gostin believes that the first step might be to allow an independent investigation into the origins of the COVID-19 virus. If China permits an independent panel of scientists commissioned by the WHO to visit Wuhan, the origin of the virus could potentially be determined. However, this has not yet occurred, and I do not believe it will happen in the future. This lack of transparency will limit China's ability to gain trust from other countries.
The Rising Role of Europe and Germany. With the withdrawal of the United States, Germany, together with the Bill & Melinda Gates Foundation, has become one of the largest funders of the WHO. In recent years, Germany has been providing over 100 million euros annually to the WHO and committed additional funding in 2025 to support reforms and compensate for the losses resulting from the U.S. withdrawal.
German Federal Health Minister Nina Walcken, during her meeting with Tedros Adhanom Ghebreyesus in Davos, emphasized the crucial role of the World Health Organization in fostering international understanding beyond bilateral and unilateral actions. For Germany, the withdrawal of the United States presents both a challenge and an opportunity—the challenge lies in taking on greater financial responsibilities, while the opportunity lies in potentially assuming a leadership role in global health governance.
The Expanding Influence of Private Capital. The share of private funders such as the Bill & Melinda Gates Foundation in the WHO budget may further increase. These funds are often earmarked for specific purposes, which could fragment the WHO's agenda more, making priorities more driven by donor preferences rather than global needs.
An Uncertain Future: The Retreat of Multilateralism and the Fragmentation of Global Health
The United States' withdrawal from the WHO marks the continuation of a broader trend: global multilateralism is under pressure, with major powers increasingly inclined to adopt unilateral or small-group approaches to address transnational challenges. This shift poses a profound threat to global health security.
Global Health Governance May Become Fragmented. Without the participation of the United States, the authority and enforcement capacity of the WHO will be called into question. Other countries may follow the example of the United States, selectively participating in multilateral health initiatives or establishing competitive mechanisms. This fragmentation will weaken the ability to coordinate responses to global pandemics, leading to uneven resource allocation and inconsistent response measures.
Legal Precedents and Procedural Disputes Remain Unresolved. Gostin and others have questioned the legality of Trump's withdrawal decision, arguing that since the United States joined the WHO through an act of Congress, it should also withdraw through an act of Congress. This procedural dispute could potentially lead to legal challenges in the future, especially if a future administration attempts to rejoin.
Unpaid membership dues become a legacy issue. The WHO states that the United States owes over 133 million dollars in membership fees for 2024-2025, while a U.S. State Department spokesperson has clearly indicated that no payments will be made to the WHO before its planned withdrawal on January 22, 2026. This financial dispute could damage the United States' credibility within international organizations and affect future cooperation.
Global health experts generally agree that in an interconnected world, pathogens do not respect national borders. The spread of HIV, Ebola, and COVID-19 has demonstrated that the health security of any country depends on global cooperation. The United States' decision to withdraw from the World Health Organization is essentially an attempt to reassert absolute sovereignty in an interdependent world—an effort that is both unlikely to succeed and potentially counterproductive.
Tedros's hope perhaps represents the universal aspiration of the international community: I hope they will reconsider. However, in the current political climate, such reconsideration may take years. During this period, the world must adapt to a WHO without formal U.S. participation, while addressing increasingly complex global health challenges. The cost of this experiment will be measured in human lives and health.
Reference materials
https://www.tagesschau.de/ausland/asien/who-austritt-usa-china-100.html
https://www.cbsnews.com/news/us-withdraws-world-health-organization/
https://www.statnews.com/2026/01/22/health-news-unproven-potentially-dangerous-autism-treatments/
https://www.ctvnews.ca/world/article/us-completes-withdrawal-from-world-health-organization/
https://www.wcvb.com/article/us-finalizes-withdrawal-world-health-organization/70098544
https://abcnews.go.com/Health/wireStory/us-completes-withdrawal-world-health-organization-129472310
https://www.chicagotribune.com/2026/01/22/us-world-health-organization-withdrawal/