President Donald Trump pulled the U.S. out of the World Health Organization via executive order Monday evening to the shock of some.

Trump cited the organization’s “mishandling” of the COVID-19 pandemic and the funds contributed by the U.S. in his executive order ending the country’s membership. The order came amid dozens of others during the first hours of Trump’s second term in the White House.

Here’s what we know about the decision:

Why did Trump remove the U.S. from the World Health Organization?

Trump signed an executive order hours after taking office Monday revoking the country’s membership in the WHO.

The executive order cites the organization’s “mishandling” of the COVID-19 pandemic, its “failure to adopt urgently needed reforms” and its “inability to demonstrate independence from the inappropriate political influence of WHO member states.”

The president also cited the “onerous payments” the U.S. gives as a member. The U.S. has paid WHO anywhere from $160 million to $815 million every year for the past decade, the Associated Press reports.

Trump ended the country’s WHO membership last time he was in office as well.

Trump severed ties with WHO and suspended funding to the organization during his first administration in July 2020 as COVID-19 cases surged globally and thousands of Americans died from the virus.

President Joe Biden reversed the order on his first day in office, making the U.S. a member of WHO again in January 2021.

What does this mean for the World Health Organization?

The U.S. was the organization’s largest donor in 2023, paying 18 percent of the organization’s total budget, WHO spokesperson Tarik Jasarevic said Tuesday.

“We hope the United States will reconsider and we look forward to engaging in constructive dialogue to maintain the partnership between the USA and WHO,” the organization said in a statement.

“For over seven decades, WHO and the USA have saved countless lives and protected Americans and all people from health threats,” the statement continued. “Together, we ended smallpox, and together we have brought polio to the brink of eradication.”

While Jasarevic declined to answer what Trump’s order would mean for the organization, the AP reports the loss of U.S. funding could hamper many of their global health initiatives including polio eradication efforts and research on new viral threats.

What does this mean for the U.S.?

U.S. agencies that work with WHO, such as the Centers for Disease Control and Prevention, will suffer from the president’s decision, the AP reports.

These agencies will no longer benefit from WHO-coordinated initiatives or have access to key research materials from the organization, such as their genetic databases, which are used to produce vaccines and medication, according to the AP.

Withdrawing from WHO and hampering its funding could also have a global impact.

“A U.S. withdrawal from WHO would make the world far less healthy and safe,” Lawrence Gostin, director of the WHO Collaborating Center on Global Health Law at Georgetown University, told the AP.

Gostin added that losing U.S. funding could devastate the organization’s epidemic response efforts.

The decision comes as the U.S. sees a spike in bird flu cases across the nation.

There are 67 confirmed cases of the bird flu as of Tuesday afternoon, according to the CDC, with at least one death from the virus confirmed. The death, reported in Louisiana, marks the first in the U.S. from the virus.

Before leaving office, the Biden administration allocated $300 million toward monitoring H5N1 bird flu and regional, state, and local preparedness programs, The Independent previously reported. A third of that is allocated for testing, outreach to high-risk populations, and increased surveillance of individuals who have been exposed to infected animals.

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