The United States said Thursday that it had officially completed its withdrawal from the World Health Organization (WHO). 

But WHO member states are not obliged to accept the US departure as legally binding until it pays up on some $260.6 million in dues owed for 2024- and 2025, WHO’s Director General contends in a report to WHO member states, published this week. 

The report, to be discussed at an upcoming meeting of WHO’s Executive Board governing body 2-7 February, cites a little-known provision of the original Congressional Act ratifying US membership in WHO in 1948, which states:

“The United States reserves its right to withdraw from the organization on a one-year notice, provided, however, that the financial obligations of the United States to the organization shall be met in full for the organization’s current fiscal year.”

Meanwhile, an angry joint statement by US Health and Human Services Secretary Robert F. Kennedy Jr and US Secretary of State Marco Rubio accused WHO of holding hostage the US flag that has now been removed from its pole outside of WHO’s Geneva headquarters until the dues are delivered.

“Even on our way out of the organization, the WHO tarnished and trashed everything that America has done for it.  The WHO refuses to hand over the American flag that hung in front of it, arguing it has not approved our withdrawal and, in fact, claims that we owe it compensation. From our days as its primary founder, primary financial backer, and primary champion until now, our final day, the insults to America continue.”

Thursday’s US announcement – and ensuing brouhaha over the legalities around withdrawal – comes exactly one year after President Donald Trump signed an executive order to leave the agency, within hours of being inaugurated as President in January 2020.  

Blames WHO for delayed action on global emergency and transmission modes of virus 

A separate statement by the Department of Health and Human Services (HHS), announcing the completion of the year-long withdrawal period on Thursday, focused on WHO’s behaviour during the COVID pandemic, charging that late response to the fast-moving virus in the early days of the pandemic had exacerbated the damage done. 

“The WHO delayed declaring a global public health emergency and a pandemic during the early stages of COVID-19, costing the world critical weeks as the virus spread,” charged HHS in its statement. 

“During that period, WHO leadership echoed and praised China’s response despite evidence of early under-reporting, suppression of information and delays in confirming human-to-human transmission. The organization also downplayed asymptomatic transmission risks and failed to promptly acknowledge airborne spread,” said the HHS statement.

“After the pandemic, the WHO did not adopt meaningful reforms to address political influence, governance weaknesses or poor coordination, reinforcing concerns that politics took priority over rapid, independent public health action and eroding global trust. 

“Its report evaluating the possible origins of COVID-19 rejected the possibility that scientists created the virus, even though China refused to provide genetic sequences from individuals infected early in the pandemic and information on the Wuhan laboratories’ activities and biosafety conditions.”

Spat over US payment of back WHO dues and WHO’s return of US flag 

Along with the flag spat, the joint press release by Kennedy Jr and Rubio, took a deeply bitter tone saying:  

“The WHO tarnished and trashed everything that America has done for it…..Although the United States was a founding member and the WHO’s largest financial contributor, the organization pursued a politicized, bureaucratic agenda driven by nations hostile to American interests.” 

Their statement also stressed that “all U.S. funding for, and staffing of, WHO initiatives has ceased.” However, behind the scenes, some White House sources as well as global health experts questioned if this is entirely the case. For instance, US Centers for Disease Control scientists participated in last year’s WHO consultation to determine the composition of the seasonal flu vaccine; a senior HHS official told reporters in Washington that such limited engagement might still continue in this year’s session, planned for February.

In terms of funding, new US global health policy will focus on “direct, bilateral, and results-driven partnerships.” Since withdrawing from WHO and abruptly closing down USAID, Washington has signed some 15 such bilateral deals mostly with African countries, amounting to an estimated $16 billion. See related story.

One Year Later: The Effect of US ‘Chainsaw’ on Global Health

WHO – legally, US needs to pay dues to withdraw  

The unpaid dues at the center of debate include assessed contributions of $130.3 million for 2024, which the previous US Administration of former President Joe Biden failed to pay before Trump took over the White House in January 2025. Added to that is another $130.3 million in unpaid dues  for 2025, before withdrawal took effect this January. 

In a report to the upcoming EB meeting, WHO Director General Dr Tedros Adhanom Ghebreysus, notes that in fact, there is no legal means for a country to withdraw from the Organization – short of a change in WHO’s 1948 Constitution that another member state might find “unacceptable”. Since WHO has never changed its Constitution that remains purely theoretical. 

“[t]he draftsmen of the Constitution of WHO, by reason of the world-wide character of  the struggles against disease, placed great emphasis on the need for the organization to be completely universal, and, as in the case of the Charter [of the United Nations], deliberately omitted any withdrawal clause,” states the WHO report. 

Uniquely, however, among all 194 WHO member states, the US Congress retained the legal right to withdraw when it ratified the US decision to join WHO on 14 June 1948 – a condition accepted by WHO.   

The Congressional act, however, also committed the US to pay up on outstanding dues before it leaves: 

“In adopting this joint resolution the Congress does so with the understanding that, in the absence of any provision in the World Health Organization Constitution for withdrawal from the organization, the United States reserves its right to withdraw from the organization on a one-year notice, provided, however, that the financial obligations of the United States to the organization shall be met in full for the organization’s current fiscal year.”   See related story:

Member States to Discuss US Withdrawal from WHO as Failure to Pay 2024-25 Fees Violates Legal Obligations

Argentina’s withdrawal not legally valid 

The lack of any real legal offramp for other nations to leave WHO also means that Argentina’s February 2025 declaration that it was withdrawing is legally invalid, and need not be accepted by WHO member states, according to the Director General’s EB report: 

“Unless the Health Assembly were to decide to adopt a different approach to this issue than it has taken on previous occasions, the conclusion may be drawn that the purported notification of withdrawal by Argentina should not be accepted as effective.”

The notices of withdrawal by Argentina and the United States are not the first by disgruntled member states.  

In 1949-50, at the height of the cold war, the Soviet Union and six Soviet puppet governments in Ukraine, Belorussia, Bulgaria, Romania, Albania and Czechoslovakia – all notified WHO that they were withdrawing. By 1956, the member states had all rejoined, with WHO’s agreement to accept a symbolic fee for the time that their membership was suspended.   

In response to a query by Health Policy Watch, a WHO spokesperson said that the legal issues around the US and Argentinian moves would be further discussed by WHO member states at the upcoming WHO Executive Board Meeting, February 2-7 – with the final decision of how to respond left up to them. 

‘Lose-lose’ proposition

Over the course of the past year, Director General Tedros has launched various appeals both public and behind the scenes to the US to reconsider its action – saying that the withdrawal is a lose-lose proposition. 

Loss of support from the US, historically WHO’s largest donor, has meanwhile triggered a budget crisis, leading to the planned reduction of about 25% of the regular workforce by June 2026 – and turmoil amongst staff. 

Even with the drastic cutbacks, the agency still has to fill an outstanding $1 billion budget deficit for the current 2026-2027 biennium of planned spending.  See related story here:

EXCLUSIVE: WHO Cutting Up to 25% of Staff by June 2026 – But ‘Shadow Workforce of Consultants’ Is Unreported  

How to woo back the US?

Critics of Washington’s moves both in the US and internationally have called upon the Trump administration to reconsider – saying that withdrawal will only exacerbate the very problems that it has claimed the Organization is fostering.   

Former CDC director Tom Frieden, described the move as a “grave error”: “Walking away from WHO doesn’t create accountability or reform. It gives the U.S. less say and less warning. History shows what cooperation can achieve. Through WHO, the world eradicated smallpox and reduced millions of preventable deaths. Those successes protected Americans too,” Frieden said.

“Because these emergencies can start anywhere, a multilateral approach involving all countries is needed. Global health security is squarely in the U.S. national interest,” said the Canadian physician General Peter Singer, a former senior advisor to Tedros, in Think Global Health, published by the Council on Foreign Relations. 

But Singer also called on WHO and its member states to advance a deeper reform agenda – shaped around the three pillars of “accountability”, “innovation” and “trust” – noting that the looming 2027 election of a new WHO Director General offers a pivotal opportunity for deeper institutional change.  

“WHO’s decisions on the origins of the pandemic, mode of transmission, and its recommendations on public health measures and quarantine—even when defensible on scientific grounds—contributed to controversy and appear to have affected trust among governments and public alike,” argued Singer. 

“In public health crises, institutions should actively seek to challenge their own internal decision-making,” he added, calling for more proactive debate considering adversarial points of view (red-teaming) during internal decision-making as well as better monitoring of public attitudes.  

“The election of a new director general in May 2027 offers an opportunity to revisit these issues,” Singer added, saying, “The ideal candidate would be one who underscores country ownership, revitalizes the WHO’s results agenda, promotes the organization as the world’s leading scaler of health innovations, makes the WHO the most neutral organization in the UN system, and establishes mechanisms to protect trust in pandemics.” 

Image Credits: Felix Sassmannshausen/HPW, Twitter: @WHO, Anonymous/HPW, Health Policy Watch , HHS.