US to withdraw from the WHO. Here's what the Trump Administration should do instead.

Leverage is a good thing. Let's use it.

WHO Director-General, Dr. Tedros Ghebreyesus. Getty Images / Fabrice Coffrini.

On the first day of his presidency, Donald Trump signed an executive order to withdraw the United States from the World Health Organization.

This was not a surprise. In 2020, Trump sent the WHO a list of demands (some of which had apparently already been met) and quickly announced the decision to withdraw our support back then. It was only President Biden’s election that prevented that decision from coming to fruition.

I was asked about on CNN today. Here’s the clip from my appearance, followed by a summary of my talking points, and some I didn’t have time for on the air.

What should we do instead of leaving the WHO?

Rather than leaving the WHO, we should leverage the fact that we are the organization’s largest donor (~$1.3 billion in a recent year) to negotiate reforms within the organization. As Dr. Ashish Jha wrote in STAT, we'd benefit from changes in the WHO’s approach to vaccine endorsement, and we’d like to see its posture become a little more US-friendly. As Dr. Jha correctly pointed out, the WHO is quick to criticize nations when it’s politically expedient to do so (rather than strictly when warranted), while letting others off the hook.

As I said in the CNN segment, I’ve never been shy about criticizing particular decisions made by the WHO, and I’ve specifically called them out on TV in the past. But I’ve also found their leadership to be receptive to feedback, practical, and well-intentioned.

So, I think President Trump’s decision to leave the WHO is more emotional than technical. The WHO is an easy scapegoat for our own failures around Covid-19. Look, I get that it’s easy to just blame someone else sometimes. It can feel empowering. In actuality, it’s an illusion (or worse, a delusion) that accomplishes nothing.

On the technical side, there are advisors and experts in the federal government (both Trump appointees and career officials) who have the required technical expertise and wisdom to sit down and assess the costs and benefits of this move.

The costs of staying in the WHO are minimal. Our financial contribution is a rounding error in our budget. Another notion that has been advanced is that being a member of the WHO is somehow a threat to our sovereignty. That honestly reflects a pretty low opinion of our own power and agency. Personally, I think we’re alright. And that’s before any reforms that we might be able to negotiate by staying.

Meanwhile, the benefits of remaining in the WHO are substantial…

What are some good things the WHO does?

In my discussions with my colleagues in the last day, I was reminded of many positive things the WHO does to benefit Americans and people everywhere. Examples include data collection so we know where outbreaks are, how many people are affected, and where to send limited resources. Remember, the WHO declared a “public health emergency of international concern” about the novel coronavirus-19 disease on January 30, 2020. (Note: I said February 12th on CNN, because I had just reviewed a revised press release with that date.) This was an important warning to the world to prepare for what was to become the Covid-19 pandemic. That determination may seem obvious in retrospect, but it’s not easy. Experts have to understand the scope and severity of any number of threats on a rolling basis. Only a small number of outbreaks lead to such declarations, which guards against alarm fatigue. This expertise costs time and money and does not come out of thin air.

Emergencies: My friend Dr. Tsion Firew pointed out, for example, that while WHO contributions helped control a scary recent outbreak of the Marburg virus in Rwanda, that particular nation has good surveillance and other public health strengths in place. Still, the WHO’s external declaration of the end of the outbreak was, to me, extremely useful. (A nation dealing with an outbreak can’t always be relied upon to provide a dispassionate assessment, so the WHO’s conclusions were extremely valuable in that instance.) But in a place with less transparency and resources, the WHO’s contributions would be essential. What other international body has the expertise and the immediate trust and clout to enter a nation and provide on-the-ground assistance? Nobody. So, if there’s another Ebola or Marburg outbreak (like the current one in Tanzania that the WHO shined a light on well before Tanzania itself admitted the issue), the best chance for controlling a problem before a single case arrives on US soil is for international assistance to be welcomed. There exists no other organization capable of responding to a wide variety of health threats like the WHO.

And it’s not like the US is going to go it alone. If the plan were for the money we give the WHO to go towards our own replacement, I might question whether we could really do any better—but at least it would be a sign that we “get it.” Diseases do not respect borders.

Day-to-day. My colleague Dr. Atul Gawande reminded me that data, leadership, and coordination from the WHO helps us get the best-possible annual influenza vaccine synthesized each year, including for North America. Without the funding that supports this program, the effort would be hindered, leading to a future with worse flu seasons, marked by more hospitalizations and deaths.

International respect. Being a member of the WHO (and supporting it) gives the US clout and respect around the world. It shows that we are not arrogant and that we wish to use our incredible wealth and strength as a nation to help humanity. Pulling out risks making us look like self-absorbed jerks. It reads as pouty, not powerful.

What next? Let’s negotiate!

The last round of funding that the US provided to the WHO will eventually run out. Our membership expires next year. If and when that happens, the WHO will either be severely wounded or other nations or bodies will have to step up to fill the financial hole.

Meanwhile, whether we are WHO members or not, we will still benefit from the work it does. I suppose that the WHO might survive without our help (though I am not an economist, nor am I familiar with the financial outlook). But rather than being its primary benefactor, we’ll be reduced to being a recipient of its charity.

It’s not too late to reverse course. The Trump administration could go to the WHO and make some demands that might improve the organization. If that happens, I’ll applaud it. (It won’t, in my view, validate the brash approach of this executive order; I believe the global headlines are not a net positive for us.)

This last part is important: Part of making sure the next four years are not an abject disaster is to acknowledge when things actually go well, just as we call out problems. Otherwise, the incentive to do the right thing may not always be politically apparent to this particular administration that seems to have a lot axes to grind. At the end of the day, the goal is to help our fellow Americans and humans around the world. Resolvable grievances should not stand in the way.