If US Pulls Out of WHO, Will Other Member States Step Up? World Health Organization 14/01/2025 • Kerry Cullinan Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to print (Opens in new window) A motley alliance of organisations converged on Geneva in June 2024 to protest against the WHO and its pandemic agreement, urging their governments to pull out of the global health body. Now the US president-elect is poised to do just that. If the United States withdraws from the World Health Organization (WHO) when Donald Trump assumes the presidency next week (20 January), will other member states – particularly China – step up to safeguard global health? “The signs coming out of Trump’s transition team paint a bleak picture for the WHO. Trump tried to pull out of WHO during his first term, and his surrogates have strongly suggested that he will complete a US withdrawal during his second term. That could come as early as Day One,” says Professor Lawrence Gostin, O’Neill Chair in Global Health Law at Georgetown University. According to US law, the president has to give a year’s written notice of the withdrawal in a letter to the United Nations (UN) Secretary-General. “But instead of sending a letter, I hope he will do a deal. That deal might mean continued US membership and funding in exchange for significant reforms of WHO such as increased transparency and accountability,” Gostin told Health Policy Watch. However, he concedes that “most indications are that he will withdraw”, describing this as “catastrophic for the WHO, as well as US security”. “The world would be far less safe without WHO. And a US withdrawal would make Americans far more vulnerable to pandemic threats. I cannot imagine a world in which we do not have an empowered WHO.” US is by far largest donor The WHO’s budget for the two-year 2024-2025 period is $6.83 billion, made up of assessed and voluntary contributions. Assessed contributions are the mandatory membership fees calculated by the UN, based largely on countries’ gross domestic product (GDP). Of the 194 WHO member states, the US is by far the largest funder. It is due to pay over $261 million in “assessed contributions” during 2024/5. US contribution to WHO in the 2024-25 biennium China, the second-largest contributor in terms of assessed contributions, is due to pay $181 million for the period. As China is still classified as a “developing country”, it benefits from lower rates. But assessed contributions only cover around 20% of the budget, with the bulk coming from voluntary contributions, most of which are earmarked for specific programmes. Here the US runs rings around China. In 2023, the US made voluntary contributions to WHO amounting to over $367 million. In comparison, China’s paltry offering was slightly less than $4 million. China’s contribution to WHO in the 2024-2025 biennium Not even during the COVID-19 pandemic, widely regarded to have started in China, did that country make any significant contribution to WHO. When assessed and voluntary contributions are combined, the European Commission, Germany and the United Kingdom all contribute more to the WHO than China. Ironically, when Trump tried to pull out of the WHO in 2020, he claimed it was because China had “total control” over the global body. Yet from its low financial investment and the demure conduct of its WHO representatives, China does not seem that interested in the global body. WHO’s top 25 donors for 2024/25 China favours bilateralism Chinese President Xi Jinping boasted this week that his country has $1 trillion trade surplus, so China is better positioned than most other member states to step up to fill the gaping hole the US withdrawal will leave. But China has shown little interest in supporting global health multilateralism. Its interactions at the WHO are muted and lack initiative. In negotiations for a pandemic agreement, for example, the Chinese representatives have situated themselves with the group of countries advocating for equitable access to pandemic-related products, but its representatives seldom make significant proposals. Instead, China prefers bilateral agreements which enable it to wield direct influence over the countries it assists, “[China] is active in bilateral collaboration, South-South collaboration and the Belt Road Initiative, and has dispatched medical teams, built infrastructure and provided assistance with health technology overseas,” according to academics from China and Thailand in Journal of Global Health article. “Despite its bilateral health initiatives, China has invested little in established multilateralism mechanisms. Although several university global health institutes have been established, China’s participation on the global health stage, such as at the World Health Assembly, has been limited.” While the US also uses bilateralism as a political tool to ensure support and loyalty, it has simultaneously asserted its dominance on the global stage through multilateral bodies of the UN. Europe is preoccupied by Ukraine; turns to the right Europe is also unlikely to come to the aid of the WHO. The region is preoccupied with, and financially stretched by, Russia’s war in Ukraine. “Since the start of the war, the EU and our member states have made available over $140 billion in financial, military, humanitarian, and refugee assistance,” according to the EU. With Trump’s threat to end US military assistance to Ukraine, the EU may feel compelled to increase its financial support to Ukraine. In addition, key European nations that have supported multilateralism in the past now have right-wing parties within government intent on slashing foreign aid. Croatia, the Czech Republic, Finland, Italy, the Netherlands and Slovakia join Hungary as right-wing ruled countries. In virtually all other European countries, support for right-wing parties has grown considerably – most notably in Germany, Austria, France and Portugal. The EU has thus neither the means nor the will to cough up more for global health. ICRC members unload supplies in Ukraine. ‘Anti-globalist’ Trump to chop UN fees Trump has claimed that the WHO’s pandemic agreement currently being negotiated is “a pretext to advance a global government”. An avowed “anti-globalist”, he has little interest in multilateral institutions unless they directly benefit the US. In addition, he wants more money for the US domestic budget, partly because he will be short of cash if he fulfils election promises to cut taxes. Cutting membership fees to global bodies is an easy way to get this, and the WHO is not the only body in Trump’s sights. During his last presidency, Trump cut US funding to the UN Population Fund (UNFPA), effectively shrinking the budget of the global sexual and reproductive health agency by around 7%. Once again he raised the China bogeyman, erroneously accusing the agency of supporting population control programs in China that include coercive abortion. During his first term in office, Trump stopped implementing all aspects of the Paris Agreement – the global commitment to confine global warming to 1.5°C – with immediate effect in June 2017. He claimed that it undermined the US economy, hamstrung its ability to open new oil and coal fields, and put the US “at a permanent disadvantage to the other countries of the world”. During last year’s election campaign, Trump officials told Politico that he intends to do this in his second presidency, and may also withdraw the US from the UN Framework Convention on Climate Change. Leadership vacuum But if Trump sees through his isolationist threats and withdraws the US from global forums, this will leave a leadership vacuum that may empower rivals China and Russia. The expanding BRICS Group, set up to counter Western domination in multilateral forums, may well be interested in assuming greater global prominence. Initially comprising of Brazil, Russia, India, and China at its inception in 2009, its membership has swelled to include South Africa, Iran, Egypt, Ethiopia, the United Arab Emirates and Indonesia – covering 45% of the world’s population. The US may also weaken its own health if its steps outside the WHO. It is less likely to get timely information about pathogens with pandemic potential, for example, if it is outside the fold. However, Trump claimed in a speech a few months back that he is going to “form a new coalition of nations strongly committed to protecting health while also upholding sovereignty and freedom”. Perhaps he intends the anti-abortion Geneva Consensus Declaration, signed by some of the most right-wing countries on the planet, to form the springboard for this lofty ambition. “Under my leadership, the United States will also rejoin the Geneva Consensus Declaration, created by my administration and signed by 36 nations, to reject the globalist claim of an international right to abortion.” pic.twitter.com/1r4R4l23Pg — Team Trump (Text TRUMP to 88022) (@TeamTrump) September 20, 2023 Trump’s supporters have been pushing hard for more countries to support this Declaration in the past four years. But this will also cost the US dearly if it is its convenor and it has to start a new global body from scratch. So perhaps Trump’s desire to pull out of the WHO is less about the cost of membership fees and more about ideology and ensuring US dominance in whatever global forums it is part of. Image Credits: https://open.who.int/2024-25/contributors/top25, ICRC. 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