Nationalism in an age of pandemics

America wants to leave the WHO. This will make it, and rest of the world, less safe. All for a saving of $126m

Grok: US wrecking ball & WHO

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President Trump has announced America's withdrawal from the World Health Organization (WHO) a decision that has stirred debate about global health security and America's role in it. The article challenges criticisms of WHO's pandemic response, arguing that the core failures were China's delayed outbreak disclosure and slow governmental reactions worldwide during February. The piece warns that leaving WHO could harm America's interests along with global health security, and highlights that diminished U.S. influence in global health matters and increased Chinese sway within WHO may follow.

Nationalism in an age of pandemics

On his first day in office, President Trump said that America would withdraw from the World Health Organisation (WHO), a move he had tried during his first term but which was rescinded by President Biden when he entered office. The reason for this departure has been stated as dissatisfaction with WHO’s handling of the covid pandemic, an inability of the WHO to reform, and complaints about the cost of membership—which in the most recent year recorded was $126m. To put this in context it is about 0.0017% of the $7.3 trillion federal budget, or more relatably the cost for 126 people to join his Florida golf club Mar-a-Lago. For the WHO membership fee (which is annual), America gets many benefits (about which more later).

In the ensuing commentary, many people who seem misinformed about the work of the WHO piled in on social media and heaped blame on it for essentially being responsible for the covid pandemic (it wasn’t) and for being too politically close to China. It isn’t. It is in fact much more closely aligned with America.

Reading all the commentary, I can’t help but feel there seems to be a collective amnesia about what actually happened five years ago. The key point of failure was always that of the Chinese to recognise, and disclose, the novel outbreak accurately and promptly. The virus was spread through the air, is transmitted asymptomatically, and has all the characteristics of a virus that very likely could not have been stopped once it had been spreading for weeks (or more) inside China. The second key point of failure was the failure of governments around the world to act when the extent of the outbreak was clearly known in late January. These failure points are key to how the outbreak unfolded. (Some governments did chose to act early and swiftly (e.g. Denmark, Norway, Finland), and had different outcomes.)

So, yes, while WHO may have not been quick enough during January, having some extra time in January it is arguable that most countries would not have used that extra time at all, and would have merely extended the “wait and see” period that most followed. But let us look at the two main criticisms of WHO that are frequently referred to in when discussing the outbreak. One is that it was too late announcing a public health emergency—or PHEIC (pronounced “fake”), and too complimentary about China. The first criticism is accurate. The independent inquiry into WHO’s response agreed that it was too slow to announce the PHEIC. Some time in January was undoubtedly lost through trying to win the Chinese over to providing more data and to announcing a PHEIC.

However part of the reason for the delay was that WHO was also hampered by what was a binary PHEIC system—something that has subsequently been addressed. But consider the dilemma at the time, how do you call a public health emergency if a country is declining to give information about the extent and nature of an outbreak inside its borders? So the lateness of the PHEIC announcement really needs to be placed on the doorstep of the Chinese—who had far more data than they shared. Imagine what the outbreak might have been like if, at the end of December, China had said they had person-to-person transmission and released the viral sequence.

On the social media platform X, boss Elon Musk incorrectly tweeted that the move "restored American sovereignty over health". This is incorrect. The WHO can’t compel any country to give it health data. And that is why the Chinese continue to refuse to hand over more data about the origins of covid—as has been requested on many occasions.

The truth is more boring, the WHO can only get a country to yield more information, or deliver a better response, with diplomatic efforts and offers of resources. On the public cosiness of WHO towards China, not only was this a practical decision to try and win the Chinese over to revealing more information about the novel virus that was spreading within their borders, that strategy was in perfect alignment with the approach of the Trump administration at the time. Scott Gottlieb, a former FDA boss who worked with the first Trump administration, wrote in his memoir of this effort: “Mr Trump felt he got more with sugar than with salt when it came to Chinese leaders”.

That the efforts of Trump and Tedros failed to deliver more knowledge about the rapidly worsening situation in China does not negate the fact that it was a reasonable strategy at the time. (Mr Trump pivoted against China a little later.) Moreover, when Mr Trump withdrew from the WHO, this was initially an attempt to negotiate a deal with the organisation. It was rebuffed by the director general Dr Tedros. (What was on the table isn’t clear but I would guess it would have been to allow Taiwan as a WHO member at the health assembly, and some criticism of China.)

The lost month

By the end of January it was clear to anyone who was paying even the slightest attention that what was likely to be a pandemic was under way. The independent inquiry reported what I remember vividly at the time. That most countries chose to do little or nothing. They took a “wait and see” approach: “only a minority of countries took full advantage of the information available to respond” To put that in context, February 2020 was the month when we start to see a uptick in individuals buying face masks, hand sanitiser and freezers.

So here we are in 2025 and America says it will leave the WHO, and the UN says this will happen on January 22nd 2026. This move will make it, and the rest of the world, less safe. The irony of those applauding the move is that anyone who genuinely thinks that the WHO flubbed the prevention of a pandemic must now argue that taking scientific expertise and resources away from it will improve matters. Moreover, isn’t the $126m that will cause the deepest cut to the WHO but the loss of expertise from health and scientific agencies in America. Lawrence Gostin, a public health law professor at Georgetown University, called the withdrawal a "grievous wound to world health" and a "cataclysmic presidential decision".

To get a sense of how WHO acted recently to make the world safer, look at the Tanzanian health ministry’s response on January 13th to the WHO report that detailed an outbreak of what was the terrifying Marburg disease. ‘FAKE’ it tweeted on X. After a visit by the head of WHO, on January 20th the Tanzanian president announced the Marburg outbreak and the WHO released funding to handle the outbreak.

WHO cares?

Ongoing cooperation is actually crucial for America itself. For example there is a meeting in February where countries share information about circulating strains of influenza, and decide vaccine compositions for the upcoming flu season. As one of the largest consumers of annual flu vaccines and America relies on this programme to kickstart American domestic vaccine production ahead of winter outbreaks. The same group also provides early warnings about novel zoonotic viruses with pandemic potential.

One of the most concerning aspects of the withdrawal is its impact on the WHO's ability to respond to global health emergencies. The WHO acts as an agency of last resort during major disease outbreaks when governments and NGOs are overwhelmed—it sends its own staff in. During the terrible West Africa Ebola outbreak a number of years ago, it was WHO that went in when everyone else was running for the exits. It lost staff in the response. When the next deadly outbreak occurs and the NGOs and other governments are leaving, who are you going to call?

WHO also approves medicines and diagnostics for countries that have no ability to do this for themselves, enabling poorer countries to respond and contain outbreaks. To do this it relies on support from agencies such as the Food and Drug Administration in America (FDA), and staff in other agencies. Some organisation has to work in countries that do not have the capacity to contain infectious diseases.

The US has been a key player in the WHO since its founding in 1948, and has had an outsized influence on the organisation. By leaving the US will lose access to critical global health data and its influential voice in the World Health Assembly—something it regularly uses to annoy the Chinese by calling for WHO to recognise Taiwan as a full member. The departure of America could also allow China to expand its influence. China has typically done bilateral deals to influence nations (think vaccine diplomacy during covid), but a China with rising scientific expertise could seek to fill roles advising the WHO on scientific advice.

In conclusion, the US withdrawal from the WHO represents a significant shift in global health politics. The move has the potential to weaken international health security and diminish the US's role as a leader in global health. In an an increasingly connected world, co-operation is the best way to fight the growing threat of pandemics.

Update

On January 26th, in a passing comment at a rally, Trump floated the idea that America might at some point rejoin.

On January 27th, it was reported by the Associated Press that the U.S. Centers for Disease Control and Prevention (CDC) had been ordered to stop working with WHO immediately, upending expectations of an extended withdrawal.

In brief, the sudden directive, issued by CDC official John Nkengasong, requires all agency staff to stop working with WHO and await further guidance. The move comes as a surprise, potentially impacting global health efforts, including responses to outbreaks of Marburg virus and mpox in Africa. This is despite the fact that the formal withdrawal process requires congressional approval and a one-year notice. Health experts express concern about the immediate halt in CDC-WHO cooperation, emphasizing the mutual benefits of their collaboration in addressing global health challenges.

The administration has also frozen spending on PEPFAR, an anti-HIV program credited with saving millions of lives.

See also

The Economist. (2025, January 22). America's departure from the WHO would harm everyone.