US President Donald Trump has signed an executive order to withdraw the US from the World Health Organization (WHO), alongside other orders on his first day in office.
This is not the first time Trump has pulled the US from the WHO; he first withdrew from the WHO in his first term, in addition to halting all funding. This decision was later reversed by former US President Joe Biden.
The US will most likely remain a WHO member state but impose conditions that the WHO must adhere to, including increased contributions from other member states, oversight of relations between mainland China and the WHO, and changes to policies like the WHO Pandemic Agreement, according to BMI, a unit of Fitch Solutions.
While BMI does not consider a formal exit as the most likely scenario, there “remains a significant possibility”. If this executive order is enacted, the US will leave the WHO in 12 months and cease all financial contributions to its work.
According to a White House press release, this decision to begin the withdrawal is based on concerns about the WHO's management of the Covid-19 pandemic and other global health issues, its failure to implement necessary reforms, its susceptibility to political influence from member states and the US's disproportionate financial contribution compared to other members.
Regardless of the US’s membership in the WHO, the Trump administration will cut funding and introduce restrictions for global health over the coming four years, as his administration prioritises tightening federal healthcare spending.
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The US has historically been by far WHO’s biggest financial contributor, leading both in voluntary and mandatory contributions to the organisation. Between 2022 and 2023, the US contributed over US$1.28 billion, or 19%, of the US$6.7 billion total WHO budget, followed by other key donors such as Germany and the Gates Foundation.
The White House cited a proportionally lower contribution per capita by mainland China compared with the US. Similar to Trump’s approach towards NATO member states, which involved increasing defence spending as a condition for the US to remain, BMI believes other WHO member states might consider increasing both their voluntary and mandatory contributions to the organisation to encourage the US to reconsider its WHO membership.
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But the US is also mindful of China’s rapidly growing role in global health financing and its position as the second-largest donor to WHO in mandatory funding.
Hence, the US might remain as a WHO member but pull out of key global health security and pandemic preparedness agreements and negotiations.
Per the executive order, the Secretary of State will halt negotiations on the WHO Pandemic Agreement and amendments to the International Health Regulations, rendering any actions taken to implement such agreements non-binding on the US.
“This would significantly undermine both funding and related policies on global efforts toward pandemic and epidemic preparedness, given the US’s significant policy and economic influence,” reads a Jan 22 note by BMI.
Formal withdrawal less likely
The next-most-likely scenario is that the US formally withdraws from the WHO, prioritising domestic health issues. The US will also have to recall or reassign all government personnel or contractors working with the WHO.
“This would significantly impact the organisation's funding, programmes and operations, as the US is its largest financial contributor globally,” says BMI, which was acquired in 2014 and integrated into Fitch Solutions in 2018.
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Losing its top financial contributor will affect WHO’s key programmes, including disease control, strengthening health systems, health security and emergencies, and population health initiatives.
The impact would be predominantly felt by low and middle-income countries, which often rely on WHO aid and technical assistance on infectious diseases such as malaria, tuberculosis, HIV/AIDS and neglected tropical diseases, says BMI.
“This poses downside risks to pharmaceutical and medical device companies, as reduced funding for WHO programmes could decrease demand for treatments and medical equipment in these regions, challenging market growth where WHO initiatives are crucial for healthcare delivery,” add analysts.
To continue its involvement in global health financing, the US would need to collaborate with international partners through either bilateral or multilateral agreements to take on essential activities previously managed by the WHO.
The Global Fund, GAVI Alliance and UNICEF — organisations heavily funded by the US — could potentially receive increased funding if the US terminates its support for the WHO, note BMI analysts.
Return to normal least likely
Finally, the least likely scenario is that Congress enacts legislation that mitigates the impact of the US withdrawal from the WHO, allowing US-WHO relations to return to normal under the Trump-Vance administration.
Although executive orders like a withdrawal from the WHO do not require Congressional approval and cannot be directly overturned by lawmakers, Congress could leverage its legislative powers to influence related policies, says BMI.
For instance, it could introduce funding provisions that support global health initiatives aligned with WHO objectives or establish partnerships with other international health organisations to maintain US involvement in global health governance.
“For instance, it could introduce funding provisions that support global health initiatives aligned with WHO objectives or establish partnerships with other international health organisations to maintain US involvement in global health governance,” says BMI.
In the past, Republicans have supported global health programmes, such as the President's Emergency Plan for AIDS Relief and the President's Malaria Initiative. “However, since Republicans will control both the House of Representatives and the Senate until the mid-term elections in 2026, it is unlikely that legislation to increase funding for global health initiatives will be passed, making this scenario less probable, at least in the short term,” says BMI.
