The withdrawal of the United States of America from the World Health Organization is set to have far-reaching impacts on global health. Reimagining the existing WHO is vital for the global health agenda. Discuss. (2025, 15 Marks)
Since 1948 the World Health Organization has been the “directing and co-ordinating authority on international health work”: it certified smallpox eradicated in 1980 and sets global health norms. The US withdrawal, announced on 20 January 2025 and treated by Washington as effective from 22 January 2026, removes its largest funder and tests whether a regime can outlive the exit of its hegemon.
Why Washington Left, and Whether It Has
- The executive order charged WHO with mishandling COVID-19, deference to China and an unfair financial burden on the US.
- The exit is legally contested. The 1948 US reservation allowed withdrawal only once current dues were paid; about US$280 million for 2024–25 remains unpaid, so the 79th World Health Assembly (May 2026) agreed to suspend US voting rights from May 2027 if the arrears persist.
The Far-Reaching Impacts
- Financial: the US supplied close to a fifth of WHO income; the 2025 Assembly cut the 2026–27 base budget to US$4.2 billion, 21% below the original proposal.
- Technical: US agencies anchored surveillance, laboratory networks and data-sharing, which no cheque replaces.
- Contagion of exit: Argentina followed, and the 2026 Assembly declined to recognise its notice, leaving its status unresolved because the Constitution has no withdrawal clause.
- Geopolitical: China pledged US$500 million over five years, yet never gave WHO’s origins inquiry the early-outbreak data it sought. Amitav Acharya‘s “multiplex world” (The End of American World Order, 2014) fits: leadership is dispersing, not transferring to one successor.
- Normative: the US stands outside the Pandemic Agreement (WHA78.1, May 2025) and the 2024 amendments to the International Health Regulations.
Why Reimagining, Not Replacing, Is Vital
Robert O. Keohane‘s After Hegemony (1984) argued that regimes can outlive the power that built them because they cut transaction costs and supply information; John J. Mearsheimer replies that institutions merely reflect power. WHO’s survival supports Keohane, but only if it is rebuilt:
- Funding: reach 50% assessed contributions by 2030–31 and end donor-driven earmarking.
- Authority: independent verification and access powers and a graduated alert scale.
- Equity: finish the PABS annex on pathogen access and benefit-sharing. The 2026 Assembly extended talks by a year, to May 2027 or a special session; developing countries insist on binding benefit-sharing contracts with manufacturers, the EU on research incentives.
- Agenda: integrate climate and health, antimicrobial resistance and traditional medicine, which India champions through the WHO Global Centre at Jamnagar.
- Coherence: align Gavi, the Global Fund and other vertical funds behind country plans (the 2023 Lusaka Agenda).
India’s stake is direct: as the largest vaccine producer and co-author of the India–South Africa TRIPS waiver proposal, it gives the equity argument leverage as well as moral force.
Conclusion
The US exit wounds WHO but exposes older defects: dependence on a few donors and authority that stops at the border. A reimagined WHO, with predictable funding, verification powers and a fair benefit-sharing bargain, serves global health better than fragmentation, while leaving the door open for Washington’s return.