US Withdrawal From WHO Leaves Real Problems Unaddressed

On day one of his new administration, United States President Donald Trump signed an executive order notifying an intent to withdraw from the World Health Organisation (WHO). This has drawn celebration from some, dismay from others, and probably disinterest from the vast majority of the population more concerned with feeding families and paying off debt. The executive order also leaves much unaddressed, namely the substantive issues that have changed WHO and international public health over the past decade.

Change is certainly needed, and it is good that the WHO’s largest direct funder is expressing real concern. The reactions to the notice of withdrawal also demonstrate the vast gulf between reality and the positions of those on both sides of the WHO debate. The new administration is raising an opportunity for rational debate. If this can be grasped, there is still a chance that the WHO, or an organisation more fit for purpose, could provide broad benefit to the world’s peoples. But the problems underlying the international public health agenda must first be acknowledged for this to become possible.

What actually is the WHO and what did it do?

Despite being the health arm of the United Nations (UN), the WHO is a self-governing body under the 194 countries of the World Health Assembly (WHA). Its 34-member executive board is elected from the WHA. The WHA also elects the Director General (DG), based on ‘one country, one vote’. Its 1946 constitution restricts its governance to states (rather than private individuals and corporations) so in this way it is unique among the major international health agencies. While private individuals and corporations can buy influence, they can be completely excluded should the WHA so wish.

With 8,000 staff, the WHO is split into six regions and a head office in Geneva, Switzerland. The regional office of the Americas, also called the Pan-American Health Organisation (PAHO), is based in Washington DC and preceded the WHO, having been established in 1902 as the International Sanitary Bureau. Like other regional offices, PAHO has its own regional assembly, obviously dominated by the US, and is largely self-governing under the wider WHO and UN system.

The WHO is funded by countries and non-state entities. While countries are required to provide ‘assessed’ or core funding, most of the budget is derived from voluntary funding provided by countries and private or corporate donors. Nearly all voluntary funding is ‘specified’, comprising 75% of the total budget. Under specified funding, WHO must do the funders’ bidding. Most of WHO’s activities are therefore specified by its funders, not WHO itself, with a quarter of this being private people and corporations with strong Pharma interests.

Therefore WHO, while governed by countries, has effectively become a tool of others – both state and non-state interests. The US is the largest direct funder (around 15%), but the Bill and Melinda Gates Foundation (BMGF) is a close second (14%), and the partly Gates-funded Gavi public-private partnership (PPP) is third. Thus, Mr Gates arguably has the largest influence in terms of specifying the WHO’s actual activities. The European Union and World Bank are also major funders, as is Germany and the United Kingdom (i.e., the remaining large Western Pharma countries).

In response to its funders, the WHO has shifted focus to areas where large Pharma profits can be accrued. Pharma must insist on this as it has a fiduciary responsibility to maximise return on investment for its shareholders by using its WHO connections to sell more product. The obvious way to make lots of money in Pharma is by spreading fear of vaccine-preventable diseases, and then making vaccines and selling them free from liability to as large a market as possible. This was highly effective during the COVID-19 response, and the WHO is now sponsored by these interests to implement the surveil-lockdown-mass vaccinate paradigm behind the recent amendments to the International Health Regulations and the draft pandemic agreement.

While a shamefully willing tool, the WHO is not driving this. The US started the IHR amendment process and heavily backed it until the recent change of administration. The new administration, while signalling an intent to withdraw from WHO, has not signalled a withdrawal from the pandemic industrial complex the US helped develop.

Critical to understanding the US withdrawal is the fact that the COVID-19 outbreak and response would have looked almost identical if WHO did not exist. WHO was not involved in the gain-of-function research, in vaccine development or in vaccine mandates. It abrogated its own ethical principles and prior recommendations in pushing lockdowns and mass vaccination, and did huge harm in the process. However, it was countries that funded and conducted the virus modification that likely spawned COVID-19. It was countries, in concert with Pharma, that mandated lockdowns on their people and pushed vaccination most heavily (the WHO never recommended the COVID-19 vaccines for children).

This is not a defence of WHO – the organisation was incompetent, dishonest and negligent during COVID-19. It was a public health disgrace. It has continued to deliberately mislead countries regarding future pandemic risk and inflated return-on-investment claims in order to sell the policies that benefit its sponsors. But remove the WHO, the World Bank (the main funder of the pandemic agenda), the PPPs looking to sell pandemic vaccines (Gavi and CEPI), the Gates Foundation, Germany, the UK, the EU and the US health ‘swamp’ itself, and Pharma with its compliant media will still exist. Pharmaceutical companies have other options to bring a veneer of legitimacy to their pillaging through public health.

The US notice of withdrawal

As President Trump’s 20th January order of withdrawal notes, it repeats an executive order from mid-2020 that was subsequently revoked by President Biden. In theory it takes at least 12 months for a withdrawal to take effect, based on the Joint Resolution of Congress in 1948 through which the US joined, subsequently agreed by the WHA. However, as the new executive order is intended to revoke the Biden revocation, the remaining time to run is unclear. The waiting period could also be shortened by a further Act of Congress.

The 2025 notice of withdrawal is interesting, as the reasons given for withdrawal are relatively benign. There are four:

1. Mishandling of the COVID-19 outbreak and other (unspecified) global health crises. The “mishandling” is undefined, but may include WHO support for China in obscuring COVID-19 origins as highlighted in the recent COVID-19 House of Representatives sub-committee report. There are few obvious candidates for other truly global health crises that WHO mishandled, except perhaps the 2009 Swine Flu outbreak and monkeypox, unless the executive order refers to any international (global) public health issue (in which case there are many).
2. Failure to adopt urgently needed reforms.  These are undefined. Of concern, the only reforms the US has been pushing on the WHO in the past few years (pre-Trump administration) were intended to increase the authority of the WHO over sovereign states and the authority of its work. The recent Republican-dominated House sub-committee report recommended the same.
3. Inability to demonstrate independence from the inappropriate political influence of WHO member states. This is presumably aimed at China, but is also concerning, as WHO is subject to its member states through the WHA. It would be strange if the US was hoping to free WHO from such constraints. There is no mention of private sector involvement, now about 25% of WHO funding, that many would claim is the core reason for the corruption and deterioration of the WHO’s work.
4. Unfairly onerous payments by the US. The US provides 22% of WHO’s assessed (core funding) but this is only a fraction of US payments. The vast majority of US payments have been entirely voluntary, and the US could presumably choose to stop these at any time, removing most of its funding but not its voting rights. With China listed by WHO as paying less than Somalia and Nigeria in the current 2024-25 biennium (per mid-January 2025), the US has a reasonable gripe here, but a simple one to fix.

Missing from the executive order is any reference to the other promoters of the pandemic or emergency agenda. The World Bank’s Pandemic Fund is untouched by this executive order, as are the PPPs. CEPI (vaccines for pandemics) and Gavi (vaccines in general) provide private industry and investors such as the Bill and Melinda Gates Foundation with direct decision-making roles they cannot ensure through WHO.

The executive order requires the Director of the White House Office of Pandemic Preparedness and Response Policy to “review, rescind and replace the 2024 US Global Health Security Strategy”. It is hoped that this signals a recognition of the lack of an evidence base and financial rigour around the current policy. Indeed, the policy promoted by the US, WHO, the World Bank and PPPs is irrelevant, by design, to a laboratory-released pathogen such as that which probably caused COVID-19. The actual mortality from natural outbreaks that it is designed for has been declining for over a century.

Implications of withdrawal

A full withdrawal of the US from WHO will presumably reduce US influence within the organisation, enhancing that of the EU, China and the private sector. As it ignores the World Bank and the PPPs, it will not greatly affect the pandemic agenda’s momentum. COVID-19 would still have happened had the US been out of the WHO before 2020, mRNA mass vaccination would still have been driven by countries and Pharma with the help of a compliant media. The WHO acted as a propagandist and helped waste billions, but never advocated vaccine mandates or mass vaccination of children. Though the WHO was appalling, the driving forces behind the wealth concentration and human rights abuses of the COVID-19 era clearly originated elsewhere

If the US withdraws its 15% of the WHO budget – about $600 million per year – others (e.g. EU, Gavi, Gates Foundation) could fill the gap. The executive order mentions withdrawing US contractors, but these are few. Nearly all WHO staff are directly employed, not seconded from governments. The main effect will be to reduce coordination with agencies such as the US Centres for Disease Control and Prevention (CDC). The US will have a continuing need to use WHO services, such as for prequalification (regulation) of hundreds of millions of dollars of commodities bought and distributed by USAID and related programmes but not regulated through the FDA. This is not a problem – the WHO lists are public – but the US would simply continue to use WHO services without paying for or influencing them.

The withdrawal notice also mentions cessation of US involvement in negotiating the amendments to the International Health Regulations (IHR) and the Pandemic Agreement. The IHR negotiations concluded eight months ago, and the US has until July 19th (10 months after receipt of the WHO’s notification letter of September 2024) to signal rejection. The IHR are separate from WHO membership. The Pandemic Agreement is subject to wide disagreement between countries, and it is unclear whether it will go forward. However, provisions in the FY23 US National Defence Authorisation Act (page 950 to 961) are already stronger than the US would be signing up to with these WHO agreements.

The history of US withdrawals from UN institutions is also one of subsequent re-entry after a change in administration. Leaving the WHO without US influence will presumably make it even less like what the Trump administration would like, should history should repeat itself and the next administration re-join.

The hope is that the US withdrawal will force major reform within the WHO – one of the key reasons provided in the withdrawal notice. However, there is no hint in the executive order of the desired direction of change, or whether the US will adopt a more rational pandemic policy. If such an intent were made clear, other countries would follow and the WHO itself may actually reboot. However, withdrawing without addressing these fallacies underlying the pandemic agenda entrenches the vested interests who profited through COVID-19 and clearly aim to continue doing so.

Being real about reality

The enthusiasm for the WHO withdrawal seems widely to have forgotten two things:

1. The pandemic agenda and the COVID-19 response that exemplified it are not primarily WHO programmes. (The WHO said do essentially the opposite in 2019.)
2. The actual pandemic industrial complex of surveil-lockdown-mass vaccinate is already essentially in place and does not need the WHO for it to continue.

The WHO Bio-Hub in Germany is largely a German Government and Pharma agency with a WHO stamp; the World Bank pandemic fund is the main current funding source for pandemic surveillance; the 100 day vaccine programme (CEPI) is directly funded by hapless taxpayers; and the Medical Countermeasures Platform is a partnership between countries, Pharma, the G20 and others. These would probably continue irrespective of WHO’s existence. The pandemic industrial complex made hundreds of billions of dollars through COVID-19 and has capacity and incentive to continue.

The complexity of all this is being addressed on social media by statements such as “The WHO is rotten to the core”, “The WHO is unreformable”, or even “Pure evil” – all unhelpful labels for a complex organisation of 8,000 staff, six fairly independent regional offices and dozens of country offices. The WHO’s work on reducing the distribution of counterfeit drugs saves perhaps hundreds of thousands of people each year, and these people matter. Its standards for tuberculosis and malaria management are followed globally, including by the US. In several countries its technical expertise saves many lives.

The organisation desperately needs reform, as President Trump notes. Its current leadership, having spent the last few years blatantly misleading and lying to countries about COVID-19 and pandemic risk, seem unlikely candidates to help. They have played the tune of private interests over the needs of the world’s people. But the WHO’s structure makes it the only major international health institution that countries alone can actually force to reform. It simply needs sufficient member states of the WHA to force exclusion of private interests and to force WHO back to diseases and programmes that actually have a significant bearing on human wellbeing.

Should such reform prove impossible, then the coalition of countries built around the reform agenda can replace it with a new organisation. The massive bureaucracy that global health has become needs to be seen through the same lens as that in the US. The fantasy built around pandemic risk is not substantively different from many similar fantasies on the domestic agenda that the Trump administration is now targeting. It is similarly erosive of human rights, freedom and human flourishing. Addressing this is an opportunity we would be foolish to miss.

Dr David Bell is a clinical and public health physician with a PhD in population health and background in internal medicine, modelling and epidemiology of infectious disease. Previously, he was Programme Head for Malaria and Acute Febrile Disease at FIND in Geneva and coordinating malaria diagnostics strategy with the World Health Organisation. He is a Senior Scholar at the Brownstone Institute.