On January 20, President Donald Trump signed an executive order to withdraw the United States from the World Health Organization. This decision, echoing his earlier attempt in 2020, represents a significant pivot in US global health policy.

While the stated rationale for withdrawal includes criticisms of the WHO’s handling of the Covid-19 pandemic, alleged political biases and the financial burden on the US, this move risks undermining global health security, weakening America’s influence on international health, and exposing the nation to greater health vulnerabilities.

In his executive order, Trump cited the WHO’s “mishandling of the COVID-19 pandemic”, particularly in relation to its response to the outbreak in Wuhan, China. He accused the organisation of failing to hold China accountable for its initial lack of transparency, which many argue allowed the virus to spread unchecked. This criticism, while not unfounded, overlooks the complexities of managing a global health crisis and the WHO’s role as a mediator rather than an enforcer of international policies.

Another cornerstone of Trump’s decision was the perceived financial imbalance in American contributions to the WHO. Over the past decade, the US has been the largest donor, contributing between $100 million and $122 million annually in assessed dues and nearly $1.3 billion in voluntary funding for 2022-2023 alone. By contrast, China, with a population over four times that of the US, contributes significantly less, approximately $58 million.

Trump’s argument that this financial disparity is “unfairly onerous” reflects his broader approach to recalibrating international financial commitments. However, this focus on dollars ignores the broader benefits that WHO membership brings to the US, including access to critical health data, scientific collaboration, and global coordination during pandemics.

Trump also highlighted the WHO’s need for reform, citing inefficiencies and susceptibility to political influence from member states. These criticisms have some merit – the WHO has faced long-standing challenges in agility and governance – but many public health experts argue that reforms are best achieved through active engagement rather than withdrawal.

The decision could also have significant repercussions for the United States. Most immediately, it threatens to isolate the US from the global health community, limiting access to critical health intelligence and surveillance systems. For example, the WHO’s influenza surveillance program plays a crucial role in identifying emerging flu strains and developing vaccines. Without this collaboration, the US risks falling behind in its preparedness for seasonal flu and other pandemics.

It can disrupt ongoing collaborations between US agencies like the Centers for Disease Control and Prevention and the WHO. Dozens of Centers for Disease Control staff currently work with the WHO on issues ranging from disease outbreaks to vaccine development. Losing these partnerships would weaken the US’s ability to respond to global health threats, which, in an interconnected world, inevitably affects American lives.

The withdrawal also jeopardises the US’s ability to shape global health policy. As the largest donor, the US has historically wielded significant influence within the WHO, steering initiatives on maternal health, disease eradication, and pandemic preparedness. By stepping back, the US cedes this leadership role to other nations, notably China, which has shown a willingness to fill the vacuum. This shift could have far-reaching geopolitical consequences, as global health becomes another arena for strategic competition.

America’s departure from the WHO would leave a gaping hole in the organisation’s budget and operational capacity. The WHO relies heavily on US funding to support programs addressing infectious diseases, maternal and child health, and health emergencies. Without this support, many of these initiatives could falter, endangering millions of lives, particularly in low- and middle-income countries.

Furthermore, the US’s withdrawal could erode trust in multilateral institutions at a time when global cooperation is more critical than ever. Health threats like antimicrobial resistance, climate-related health crises, and future pandemics require coordinated international action. The absence of US leadership weakens the global response to these challenges and diminishes the effectiveness of collective efforts.

Public health experts and policymakers across the political spectrum have voiced strong opposition to Trump’s decision. Dr Ashish Jha, former White House Covid-19 Response Coordinator, called the withdrawal a “strategic error” that “makes Americans and the world less safe”. Similarly, Dr Tom Frieden, former director of the Centers for Disease Control, warned that disengaging from the WHO undermines global health security and leaves the US vulnerable to emerging health threats.

Trump’s decision disregards the lessons of the Covid-19 pandemic, which underscored the interconnectedness of global health. Diseases do not respect borders, and a weakened WHO increases the likelihood of localised outbreaks spiraling into global crises. Moreover, withdrawing from the WHO at a time when the world is grappling with health challenges like the resurgence of polio and the spread of avian influenza sends a troubling message about America’s commitment to global health.

The US withdrawal came while, under the leadership of Director-General Dr Tedros Adhanom Ghebreyesus, the WHO has demonstrated resilience and adaptability in navigating unprecedented global health challenges. Ghebreyesus has spearheaded critical reforms to enhance transparency and accountability within the organisation, while maintaining a steadfast commitment to equitable healthcare access. His ability to rally nations in the face of crises like Covid-19 and Ebola has underscored the importance of a unified global health response.

The WHO is not without flaws but the solution lies in reform, not abandonment. The US should leverage its leadership position to advocate for greater transparency, efficiency, and accountability within the organisation and support the Director general’s initiatives. This could include pushing for reforms to funding structures, improving response mechanisms for health emergencies, and strengthening oversight of member states.

Re-engagement with the WHO would also signal America’s commitment to multilateralism and its recognition of global health as a shared responsibility. With collaboration, the US can help build a stronger, more resilient WHO that is better equipped to address future health challenges. The criticisms of the WHO are valid but disengagement is a costly and counterproductive response.

In an era where health crises are increasingly transnational, America’s leadership in global health is not just a moral imperative but a strategic necessity. Withdrawing from the WHO risks isolating the US at a time when global cooperation is more essential than ever. As history has shown, the health of one nation is inextricably linked to the health of all.

Ashok Swain is a professor of peace and conflict research at Uppsala University, Sweden.