For decades, the United States has held considerable power in determining the direction of global health policies and programs. President Donald Trump issued three executive orders on his first day in office that may signal the end of that era, health policy experts said.<\/p>\n
Trump\u2019s order to withdraw<\/a> from the World Health Organization means the U.S. will probably not be at the table in February when the WHO executive board next convenes. The WHO is shaped by its members: 194 countries that set health priorities and make agreements about how to share critical data, treatments, and vaccines during international emergencies. With the U.S. missing, it would cede power to others.<\/p>\n \u201cIt\u2019s just stupid,\u201d said Kenneth Bernard, a visiting fellow at the Hoover Institution at Stanford University who served as a top biodefense official during the George W. Bush administration. \u201cWithdrawing from the WHO leaves a gap in global health leadership that will be filled by China,\u201d he said, \u201cwhich is clearly not in America\u2019s best interests.\u201d<\/p>\n Executive orders to withdraw from the WHO and to reassess America\u2019s approach to international assistance<\/a> cite the WHO\u2019s \u201cmishandling of the COVID-19 pandemic\u201d and say that U.S. aid serves \u201cto destabilize world peace.\u201d In action, they echo priorities established in Project 2025<\/a>\u2019s \u201cMandate for Leadership,\u201d a conservative policy blueprint from the Heritage Foundation.<\/p>\n The 922-page report says the U.S. \u201cmust be prepared\u201d to withdraw from the WHO, citing its \u201cmanifest failure,\u201d and advises an overhaul to international aid at the State Department. \u201cThe Biden Administration has deformed the agency by treating it as a global platform to pursue overseas a divisive political and cultural agenda that promotes abortion, climate extremism, gender radicalism, and interventions against perceived systemic racism,\u201d it says.<\/p>\n As one of the world\u2019s largest funders of global health \u2014 through both international and national agencies, such as the WHO and the U.S. Agency for International Development \u2014 America\u2019s step back may curtail efforts to provide lifesaving health care and combat deadly outbreaks, especially in lower-income countries without the means to do so alone.<\/p>\n \u201cThis not only makes Americans less safe, it makes the citizens of other nations less safe,\u201d said Tom Bollyky, director of global health at the Council on Foreign Relations.<\/p>\n \u201cThe U.S. cannot wall itself off from transnational health threats,\u201d he added, referring to policies that block travelers from countries with disease outbreaks. \u201cMost of the evidence around travel bans<\/a> indicates that they provide a false sense of security and distract nations from taking the actions they need to take domestically to ensure their safety.\u201d<\/p>\n Less Than 1%<\/strong><\/p>\n Technically, countries cannot withdraw from the WHO until a year after official notice. But Trump\u2019s executive order cites his termination notice from 2020. If Congress or the public pushes back<\/a>, the administration can argue that more than a year has elapsed.<\/p>\n Trump suspended funds to the WHO in 2020, a measure that doesn\u2019t require congressional approval. U.S. contributions to the agency hit a low of $163 million<\/a> during that first year of covid, falling behind Germany and the Gates Foundation. Former President Joe Biden restored U.S. membership and payments. In 2023, the country gave the WHO $481 million<\/a>.<\/p>\n As for 2024, Suerie Moon, a co-director of the global health center at the Geneva Graduate Institute, said the Biden administration paid biennium dues<\/a> for 2024-25 early, which will cover some of this year\u2019s payments.<\/p>\n \u201cUnfairly onerous payments\u201d are cited in the executive order as a reason for WHO withdrawal. Countries\u2019 dues are a percentage of their gross domestic product, meaning that as the world\u2019s richest nation, the United States has generally paid more than other countries.<\/p>\n Funds for the WHO represent about 4% of America\u2019s budget for global health<\/a>, which in turn is less than 0.1% of U.S. federal expenditures each year. At about $3.4 billion, the WHO\u2019s entire budget is roughly a third of the budget for the Centers for Disease Control and Prevention, which got $9.3 billion in core funding in 2023.<\/p>\n The WHO\u2019s funds support programs to prevent and treat polio, tuberculosis, HIV, malaria, measles, and other diseases, especially in countries that struggle to provide health care domestically. The organization also responds to health emergencies in conflict zones, including places where the U.S. government doesn\u2019t operate \u2014 in parts of Gaza, Sudan, and the Democratic Republic of the Congo, among others.<\/p>\n In January 2020, the WHO alerted the world to the danger of the covid outbreak by sounding its highest alarm: a public health emergency of international concern. Over the next two years, it vetted diagnostic tests and potential drugs for covid, regularly updated the public, and advised countries on steps to keep citizens safe.<\/p>\n Experts have cited missteps at the agency, but numerous analyses show<\/a> that internal problems account for the United States\u2019 having one of the world\u2019s highest rates of death due to covid. \u201cAll nations received the WHO\u2019s alert of a public health emergency of international concern on Jan. 30,\u201d Bollyky said. \u201cSouth Korea, Taiwan, and others responded aggressively to that \u2014 the U.S. did not.\u201d<\/p>\n \u2018It\u2019s a Red Herring\u2019<\/strong><\/p>\n Nonetheless, Trump\u2019s executive order accuses the WHO of \u201cmishandling\u201d the pandemic and failing \u201cto adopt urgently needed reforms.\u201d In fact, the WHO has made some changes through bureaucratic processes that involve input from the countries belonging to it. Last year, for example, the organization passed several amendments<\/a> to its regulations on health emergencies. These include provisions on transparent reporting and coordinated financing.<\/p>\n \u201cIf the Trump administration tried to push for particular reforms for a year and then they were frustrated, I might find the reform line credible,\u201d Moon said. \u201cBut to me, it\u2019s a red herring.\u201d<\/p>\n \u201cI don\u2019t buy the explanations,\u201d Bernard said. \u201cThis is not an issue of money,\u201d he added. \u201cThere is no rationale to withdraw from the WHO that makes sense, including our problems with China.\u201d<\/p>\n Trump has accused the WHO of being complicit in China\u2019s failure to openly investigate covid\u2019s origin, which he alludes to in the executive order as \u201cinappropriate political influence.\u201d<\/p>\n \u201cThe World Health Organization disgracefully covered the tracks of the Chinese Communist Party every single step of the way,\u201d Trump said in a video<\/a> posted to social media in 2023.<\/p>\n On multiple occasions, the WHO has called for transparency<\/a> from China. The agency doesn\u2019t have the legal authority to force China, or any other country, to do what it says. This fact also repudiates Trump\u2019s warnings that a pandemic treaty under negotiation at the WHO impinges on American sovereignty. Rather, the accord aims to lay out how countries can better cooperate in the next pandemic.<\/p>\n Trump\u2019s executive order calls for the U.S. to \u201ccease negotiations\u201d on the pandemic agreement. This means the pharmaceutical industry may lose one of its staunchest defenders as discussions move forward.<\/p>\n In the negotiations so far, the U.S. and the European Union have sided with lobbying from the pharmaceutical industry<\/a> to uphold strict patent rights on drugs and vaccines. They have opposed efforts<\/a> from middle-income countries in Asia, Africa, and Latin America to include licensing agreements that would allow more companies to produce drugs and vaccines when supplies are short in a crisis. A study published in Nature Medicine<\/a> estimated that more than a million lives would have been saved had covid vaccines been available around the world in 2021.<\/p>\n \u201cOnce the U.S. is absent \u2014 for better and for worse \u2014 there will be less pressure on certain positions,\u201d Moon said. \u201cIn the pandemic agreement negotiations, we may see weakening opposition towards more public-health-oriented approaches to intellectual property.\u201d<\/p>\n \u201cThis is a moment of geopolitical shift because the U.S. is making itself less relevant,\u201d said Ayoade Alakija, chair of the Africa Union\u2019s Vaccine Delivery Alliance. Alakija said countries in Asia and Africa with emerging economies might now put more money into the WHO, change policies, and set agendas that were previously opposed by the U.S. and European countries that are grappling with the war in Ukraine. \u201cPower is shifting hands,\u201d Alakija said. \u201cMaybe that will give us a more equitable and fairer world in the long term.\u201d<\/p>\n Echoes of Project 2025<\/strong><\/p>\n In the near term, however, the WHO is unlikely to recoup its losses entirely, Moon said. Funds from the U.S. typically account for about 15% of its budget. Together with Trump\u2019s executive order<\/a> that pauses international aid for 90 days, a lack of money may keep many people from getting lifesaving treatments for HIV, malaria, and other diseases.<\/p>\n Another loss is the scientific collaboration that occurs via the WHO and at about 70 centers it hosts at U.S. institutions such as Columbia University and Johns Hopkins University. Through these networks, scientists share findings despite political feuds between countries.<\/p>\n A third executive order<\/a> commands the secretary of state to ensure the department\u2019s programs are \u201cin line with an America First foreign policy.\u201d It follows on the order to pause international aid while reviewing it for \u201cconsistency with United States foreign policy.\u201d That order says that U.S. aid has served \u201cto destabilize world peace by promoting ideas in foreign countries that are directly inverse to harmonious and stable relations.\u201d<\/p>\n These and executive orders on climate policies track with policy agendas expressed by Project 2025. Although Trump and his new administration have distanced themselves from the Heritage Foundation playbook, CBS News reviewed<\/a> the work histories of the 38 named primary authors of\u00a0Project 2025\u00a0and found that at least 28 of them worked in Trump\u2019s first administration.\u00a0One of Project 2025\u2019s chief architects was Russell Vought, who served as director of the Office of Management and Budget during Trump\u2019s first term and has been nominated for it again. Multiple contributors to Project 2025 are from the America First Legal Foundation, a group headed by Trump adviser Stephen Miller that\u2019s filed complaints against \u201cwoke corporations.\u201d<\/p>\n Project 2025 recommends cutting international aid for programs and organizations focused on climate change and reproductive health care, and steering resources toward \u201cstrengthening the fundamentals of free markets,\u201d lowering taxes, and deregulating businesses as a path to economic stability.<\/p>\n Several experts said the executive orders appear to be about ideological rather than strategic positioning.<\/p>\n The White House did not respond to questions about its executive orders on global health. Regarding the executive order saying U.S. aid serves \u201cto destabilize world peace,\u201d a spokesperson at USAID wrote in an email: \u201cWe refer you to the White House.\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n