A child receives a shot during the launch of the extension of the world’s first malaria vaccine pilot program.

The World Health Organization (WHO) could see lean years ahead if the US withdraws membership under the new Trump administration. Such a withdrawal, promised on the first day of Donald Trump’s new administration, would in effect cut the multilateral agency’s funding by one-fifth.

The severe cut would be uncharted territory for the WHO, potentially curtailing public health works globally, pressuring the organization to attract private funding, and providing an opening for other countries to influence the organization. Other countries are not expected to make up the funding loss.

The WHO works to improve the health of millions of people globally – from working to eradicate polio and tuberculosis to coordinating US HIV and Aids prevention work in Africa.

“There are many influential people around him that say he’ll announce the withdrawal on day one in office,” Lawrence Gostin, a global health law expert at Georgetown University who opposes US withdrawal from the WHO, said. “The threat is real, it’s palpable and it’s likely.”

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The WHO has declined to comment on any potential preparations for such a move.

In a press conference on Thursday, a WHO spokesperson, Dr Margaret Harris, told reporters: “This is a government in transition, and as a government in transition they need the time and space to make their own decisions, to make that transition. And we are not going to make any comment further.”

The same day, the WHO made an “emergency appeal” for funds, citing the threats of climate breakdown and conflict to world health. In addition, the WHO held its first ever “investment round” in May 2024, promising to use member states’ financial commitment to save 40 million lives through 2028.

A US funding withdrawal would also put pressure on the WHO Foundation to make up the shortfall. The independent Swiss entity was established during the pandemic to raise funds from “non-state actors”, including wealthy individuals and corporations. The foundation was announced in May 2020, the same month that President-elect last threatened to withdraw US funding from the WHO.

“The WHO plays a critical role in global health security, disease outbreaks and eradication, international emergencies, and mobilization of global cooperation,” Anil Soni, CEO of the WHO Foundation, said in a statement.

“The Organization is critical in protecting US business interests worldwide. Its programs in disease surveillance, outbreak response, and pandemic preparedness help prevent disruptions to supply chains, international markets, and trade. No other organization has the capacity and bandwidth to coordinate international rapid response efforts, to share medical research and innovation, and to disseminate critical intelligence worldwide.”

Past WHO Foundation donors include the global food giant Nestlé, the makeup company Maybelline and Meta, the parent company of Facebook and Instagram. The foundation has granted anonymity to some donors, a practice which academics criticize as making it difficult to spot conflicts of interest.

An arm of the United Nations, the US helped found WHO in 1948 through a joint resolution of Congress. The US remains its largest funder, providing about 22% of all member states’ assessed contributions. The US is the only member state that can withdraw from the agency.

The US provided $1.2bn to WHO in 2023 – a fraction of the federal government’s $6.1tn budget and about what Joe Biden spent in one round of student loan debt relief in 2024.

Although the US is legally required to provide written notice of intent to withdraw one year before taking any action, legal experts worry WHO funding could, in practical terms, disappear virtually overnight.

Trump’s renewed efforts to withdraw funding and support from the WHO were first reported in December – one of many potential day-one actions. Like much of Trump’s health policy agenda, the pandemic haunts the promise. Trump argued WHO was overly deferential to the Chinese government during the pandemic, and announced he would withdraw the US in May 2020.

“The world is now suffering as a result of the malfeasance of the Chinese government,” Trump said in a Rose Garden speech in May 2020 announcing his plan to withdraw. “Countless lives have been taken, and profound economic hardship has been inflicted all around the globe.”

Trump’s decision was rendered moot when Biden won the election in 2020, and promptly reversed course. Gostin sees no such reprieve in the upcoming administration.

“This time he has four years to accomplish this goal,” said Gostin.

Resentment against the WHO has simmered in Republican circles since the pandemic. Some conservatives accuse the agency of threatening US sovereignty in a new pandemic treaty, which seeks to distribute vaccines equitably around the world. The first Covid-19 vaccine was released in the US in December 2020. Much of the global south lacked vaccines for years afterward, even as wealthy countries stockpiled doses.

Ironically, legal experts worry that withdrawing the US from the WHO would provide an open door for Chinese government influence, a country Trump views as one of the US’s chief global rivals.

Experts say withdrawing from the WHO could also harm US national security interests by cutting off access to programs such as pandemic preparedness and seasonal influenza strain sequencing (used to develop annual flu shots).

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