What would the return of Trump mean for the World Health Organisation?

Few will need reminding that in April 2020 then US President Trump announced he would be suspending payments to the World Health Organisation (WHO). A few weeks later, he threatened to withdraw funding completely and – on May 29th – confirmed that the US would be completely withdrawing its membership of the Organisation. Formal notification was given to the UNSG in July – giving WHO 12 months notice of the US’s termination of membership. Trump lost to Biden later that year and one of Biden’s first decisions was to reverse Trump’s decision. But with Trump currently leading Biden across the swing states, it’s looking increasingly likely that he is going to win the November US Presidential election. If that happens, what would Trump’s return to office mean for WHO?

Trump is a law unto himself and bears a grudge. Whatever decisions that he made but which were reversed by Biden, I would expect him to reinstate – like a vengeful child. He is immune to rational argument and appears not to value international cooperation. The mis/disinformation swirling around the Pandemic Accord negotiations about it ceding power to WHO and threatening the sovereignty of WHO’s member states is a gift to the Republican Party generally, and to Trump in particular.

Recall the letter to Biden from Republican senators calling for him to withdraw US support for both the IHR amendments and the pandemic treaty negotiations. There is no love lost here: “The WHO’s failure during the Covid-19 pandemic was as total and predictable and did lasting harm to our country”. The senators call for Biden to withdraw from both the International Health Regulation revisions and the Pandemic Treaty negotiations, and instead “shift… focus to comprehensive WHO reforms that address its persistent failures without expanding its authority”.

On the plus side, while these Republican senators are hostile towards the WHO, they are not calling for Biden to withdraw completely US support for the Organisation. So, at least there’s that. Unfortunately, there are plenty of Republicans who do want Trump to withdraw completely from WHO; they even have legislation ready and waiting. Both ‘The No Taxpayer Dollars for the World Health Organization Act‘ and ‘The WHO Withdrawal Act” were introduced to Congress in 2023, for example, and have a total of 163 co-sponsors – all Republican – between them. It’s unlikely, therefore, that if Trump were to announce for a second time his intention to leave WHO, that he would be met with much opposition from within his Party.

Back in 2020, various commentators provided a list of objections to Trump’s decision. Here are a few of them:

• Legality. As long as the US gives WHO a year’s notice and pays up what it owes for the current fiscal year, then there is a legal provision to exit. But, even with that provision, the legal case is not clear cut.
• Health. It’s in the health interests of the US population to remain a member of WHO. These arguments – summarised here, and here didn’t dissuade Trump then, and won’t in the future.
• WHO and GPG: Withdrawal would seriously impact funding to WHO, threatening its functionality and thus ability to provide a global public good. This argument was made by various commentators, including myself, but will again fall on Trump’s deaf ears.

Nobody knows what Trump would actually do, of course; it’s merely speculation at this point. But, if he does win against Biden in November, and then goes on to announce termination, financially-speaking where would that leave WHO? In terms of Assessed Contributions (ACs), the US – like most Member States – has paid upfront what it is obliged to pay: $261m. So that’s in the bag for WHO’s 2024-25 budget. It’s also committed $343m in specified Voluntary Contributions (VCs) (you can get data up to April from the Budget Portal). So, unlike 2020, no funds have been withheld in 2024. If Trump decided to withdraw immediately after he was elected, the fiscal year rule would – I think – be satisfied. It would still be a disaster for WHO, though. If you compare the 2022-23 and 2024-25 bienniums, you can see how much of a shortfall in funding WHO would have to accommodate. The US contributed $739m VCs in 2022 and $368m in 2023 – total for 2022-23 = $1107m. As noted, so far the US has contributed $343m in VCs for the 2024-25 biennium. That means the US still has to pay an additional $764m to match the previous biennia’s VCs. Trump could simply refuse to do that.

The other thing to consider is the timing of WHO’s first investment round. I wrote about the IR in January, and we don’t know much more now than we did then, so I won’t repeat myself here. You can also read Priti Patnaik‘s summary (subscribers only). More details will follow as the WHA proceeds, but it looks like the first ‘summit’ will be in November – around about the same time as the US elections. The success of the IR won’t be judged solely on how much money is pledged for WHO’s GPW14, and the ‘baseline’ is quite easy to achieve. But if Trump beats Biden, you could expect there to be zero interest in the IR from Trump. Or, he could use it as an opportunity to publicly hold WHO over a barrel. If WHO wants our money, then it will have to do x, y and z (in other words, exactly the line followed by the Republican senators that we started this post with). Politically, the US under Trump would be in a position to scupper the IR on its maiden voyage.

As should be apparent, this is all ifs and buts. I don’t have a crystal ball and I’m not making any predictions. Trump seems like a vengeful psychopath to me. And with a second term, that psychopath could wreak havoc on the international order – flawed as it is; imperfect as it; inequitable as it is. If the first casualty of a second Trump presidency is the WHO, then that would be calamitous – maybe not immediately, but eventually. If I were the WHO Secretariat, I would be working on a Plan B.

Andrew