What the US withdrawal from WHO means for global health security?

The United States' recent announcement to withdraw from the World Health Organization (WHO) has raised concerns across the global health community, particularly regarding the potential disruption of global health governance, pandemic preparedness, and healthcare access.

On January 20, 2025, President Donald Trump announced the United States' withdrawal from the WHO and the cessation of its funding.

As per data from WHO for the biennium 2020–2021, Germany leads with a contribution of $1,011 million, accounting for 14.4% of total funding, followed by the United States with $681 million (9.7%). The Bill & Melinda Gates Foundation contributed $592 million, or 8.4%, while the United Kingdom and the GAVI Alliance contributed $531 million (7.6%) and $371 million (5.3%) respectively.

These contributions, comprising both assessed and voluntary donations, are vital in supporting WHO’s global health initiatives, including pandemic preparedness, vaccine distribution, and broader health programmes across various regions. For the 2024-2025 biennium, the United States was expected to contribute around $958 million, making up nearly 15% of the WHO’s total budget of $6.5 billion.

 What it means 

The WHO expressed its regret, seeing the announcement as a significant shift in global health dynamics. It said the decision could impact collaborative efforts in addressing public health emergencies and advancing healthcare systems worldwide.

Dr Rashmi Chaturvedi Upadhyay, Senior Pharma Consultant at Dialectica, an information services firm, warned that this move could disrupt vaccine access, potentially widening health disparities between nations, including in India. "The short-term effects are already visible — India is facing export shocks," Dr Upadhyay explained, pointing out that reduced funding from the U.S. could make it harder for India to continue its large-scale vaccine production and distribution. This issue extends beyond India; countries in Africa, where polio eradication efforts have been underway for years, could face challenges. Southeast Asia, which depends on essential HIV antiretrovirals, may experience shortages, and conflict zones could see an increase in preventable diseases like measles as healthcare systems become more strained.

While the immediate effects of the withdrawal are concerning, Dr Upadhyay also highlighted the potential long-term consequences. The U.S. has been a key source of scientific expertise and financial support for WHO’s work, particularly in pandemic preparedness. The absence of U.S. funding and leadership could weaken systems like the Global Influenza Surveillance and Response System (GISRS), which relies on U.S. laboratories for a substantial portion of virus-sharing. Dr Upadhyay warned that without the U.S., GISRS could face delays, slowing vaccine development and potentially leading to economic losses worldwide in the event of the next pandemic. This, she believes, could undermine global health efforts.

Founded in 1948, the WHO has played a crucial role in safeguarding the health and security of people globally, including Americans. By addressing the root causes of disease, enhancing health systems, and responding to disease outbreaks, the WHO has led global health initiatives. It has often operated in regions where others are unable to, addressing pressing health crises.

US role in WHO 

The United States, a founding member of the WHO, has been integral in shaping the organisation’s work. Over the past seven decades, the collaboration between WHO and the U.S. has saved many lives and protected Americans and the global population from various health threats. Joint efforts led to the eradication of smallpox and the near eradication of polio, highlighting the importance of this long-standing partnership.

Dr Naveen Thacker, President of the International Paediatrics Association, also weighed in on the potential implications of the U.S. withdrawal. He highlighted the important role that WHO plays in emergency responses, including stockpiling vaccines and providing drugs in humanitarian and conflict settings. "A reduction in U.S. funding could undermine these efforts, leaving many vulnerable populations at risk," Dr Thacker said. India, which has long benefited from U.S.-supported programmes like USAID, is particularly vulnerable to these changes, as the country’s pharmaceutical industry plays a central role in the global health supply chain. The launch, rollout, and distribution of new vaccines may be delayed, which could have consequences for the Indian pharmaceutical sector, which is heavily reliant on international funding and partnerships, he said.

As the global health community grapples with the effects of the U.S. withdrawal from WHO, Dr Upadhyay stressed that the need for collaboration has never been more critical. "The consequences of the U.S.-WHO split are significant," she said. "Without collaboration between the U.S. and WHO, the world risks entering a situation where access to healthcare is influenced more by geopolitics than need." Nevertheless, she believes that by reimagining global health governance, with India’s manufacturing capacity and decentralised innovation, the global community can work together to address the equity gap and ensure that healthcare remains a universal right.

"The WHO is a global mechanism that brings together member states, supported by a network of laboratories and collaborative centres," Dr Thacker said. "The capacity to prepare for future pandemics will be weakened due to the United States’ position as a major funder. Collaborative research and innovation will also be limited. A weaker WHO is detrimental to global health, but there is still room for improvement within the organisation. Countries that rely on WHO for technical guidance will see restricted access," he said.

Need for dialogue

As a technical agency, WHO deals with a wide range of healthcare challenges. A reduction in U.S. funding, Thacker said, could negatively affect global health initiatives, including those related to HIV, cholera, and other diseases.

"The interconnected nature of global health means that no country, including India, will remain unaffected by these changes," Dr Thacker warned. "WHO’s support for developing and underdeveloped nations will be impacted. WHO works closely with GAVI, being part of the GAVI Alliance, and the reduction in external funding will have significant business and health implications. India, which benefits from programmes such as USAID, will see a direct impact. The launch, rollout, and distribution of new vaccines will also be affected, which will have broader consequences for the Indian pharmaceutical industry."

The WHO hopes that the United States will reconsider its decision, emphasising the importance of constructive dialogue to uphold this vital partnership. Despite several challenges, Dr Upadhyay is optimistic about the potential for global health recalibration. She pointed out that India’s push for self-reliance in the production of Active Pharmaceutical Ingredients (APIs) could reduce the country’s dependence on external sources, particularly those from the U.S. India’s goal to achieve 90% domestic production of Active Pharmaceutical Ingredient (APIs) by 2030 could help stabilise the country’s supply chains and position India as a stronger player in the global health market. India’s involvement in regional partnerships, such as the Quad Vaccine Partnership, could help mitigate some of the fallout from the U.S. withdrawal and strengthen global health systems moving forward.

Dr Upadhyay also called for a shift from sovereignty to solidarity in global health governance. She suggested that the G20 should direct more resources into strengthening the WHO’s contingency fund, as was done during the COVID-19 pandemic when countries like Germany and Japan pledged emergency funding. This, she believes, could help cushion the impact of U.S. withdrawal and support WHO’s ongoing work to address health emergencies worldwide. Additionally, India’s ability to leverage its pharmaceutical expertise to foster South-South partnerships, like its “Vaccine Maitri” initiative, could be crucial in ensuring that vaccines and other essential medicines reach countries that need them.

Dr. G.V.J.A. Harshavardhan, Director General, Indian Vaccine Manufacturers Association (IVMA), believes that the withdrawal of the U.S from the WHO, has financial implications, as the US was a major contributor. "With the U.S. no longer supporting the WHO, other countries will need to increase their contributions. It is crucial that the WHO continues its work especially in the Global South and equip itself to deal with the anticipated pandemics and harmonization of regulations for the manufacture of biological products," he says. "The IVMA supports the role of India to lead the world in the number of vaccine doses produced and also be equipped to develop and manufacture pandemic vaccines as per proven technologies. Following the withdrawal of the US, the other WHO members, all of which are UN members, will need to collaborate and ensure the continued functioning of the WHO to stabilise global health," he adds.