One of the first actions of the new Trump administration was to withdraw from the World Health Organization. Many public health advocates quickly raised alarm bells, citing longstanding arguments about the importance of the agency and what the U.S. stood to lose by withdrawing its membership and money.
It is unlikely that these advocates paused to consider that leaving the WHO is exactly the disruption needed after years of reform efforts that were long on talk but short on results. One of us knows this firsthand, having worked inside the WHO at the highest levels; the other has seen this as a private-sector innovator seeking to navigate its bureaucratic maze.
The WHO was created in 1948 with the objectives of the “attainment by all peoples of the highest possible level of health” and to address the spread of infectious disease outbreaks across countries. U.S. leadership at the time and through the decades since has been critical to both the science of WHO and its finances.
The U.S. currently contributes just over $1 billion and is by far the largest national donor to the WHO budget. But the issue is not money, a mere .06 percent of the U.S. government budget. The issue is the organization.
The WHO at one point in its history was the world’s true north star for infectious diseases and the promotion of health. Sadly, the organization has deteriorated, in both management effectiveness and scientific expertise, making it less efficient and more chaotic.
During COVID, when the world needed it most, the WHO failed at many levels. Delays in declaring COVID to be an airborne virus remain an astounding uncorrected error. Meanwhile, the central bureaucratic processes of WHO and COVAX (the Geneva-based coalition launched by the WHO to “coordinate” the COVID response across agencies) often impeded rather than supported an effective response at regional and country levels.
Even those who acknowledge its limits often state that the WHO needs U.S. support because it performs key functions in medicines and vaccines that advance American private-sector interests in health. Or they say that, absent U.S. funding, the WHO will be dominated by America’s enemies, with any chance for reform doomed as long as the U.S. remains on the outside looking in.
In fact, the reality is quite the opposite. None of WHO’s functions determine the success or failure of the American private sector. Slow processes and heavy bureaucracy in working with the private sector through WHO’s Framework for Engagement with Non-State Actors means that the agency is often a roadblock to advancing lifesaving American health products. And when it comes to America’s putative enemies, concerns about China and other adversaries have been present during years of U.S. full funding.
WHO reform has been a theme for the last two decades for the U.S. Yet, despite recent assertions last month by WHO leadership that the organization has “reformed totally,” it continues to have serious human resources issues, and even its own reform efforts (from strengthening country offices to addressing harassment after the U.N.s largest sexual abuse scandal) remain continuing problems.
The U.S. government does get value out of its relationship with WHO. Nonetheless, it is at far too great a price and for far too little return, at far too slow a pace. Yes, having a void in global health over time will hurt American interests, but continuing business as usual will hurt America and the world far more in the years ahead.
For those committed to serving the mission of global health, engagement rather than hand-wringing is the best strategy. What does this look like?
First, ensure that the withdrawal announcement from WHO results in changes. The disengagement should not be binary — either fully engaged or nothing. Making this announcement matter means launching negotiations for a retooling of the global health architecture.
Important funding meetings are happening this year, not just for the WHO but for all major “global health initiatives,” including the Global Fund, which provides funding and leadership in the fight against HIV, tuberculosis and malaria and was created largely with American leadership. Leveraging the withdrawal notice period — however long it eventually is — to negotiate targeted roles for other institutions in the wake of pulling back from WHO is smart for America.
Second, look for immediate and better solutions to prepare the U.S. for the next pandemic. Past experience with COVID-19, Ebola and mPox have taught us that relying on public organizations with time-limited funding is always going to be a losing battle. Investments and lessons learned from Operation Warp Speed have laid the foundation for smarter approaches to pandemic response, whereby private organizations can step up to sustainably serve both non-emergency global health needs and outbreak roles, with customers as the primary funding mechanism.
Finally, work with other countries to remake a global health organization that is fit for purpose. The argument has always been that if you tore WHO down and started over, it would end up looking like it does today. This is not true. An organization that has strong regional offices, with an efficient, small central leadership and a focused mandate, would address both budget and mismanagement issues and set the organization up for succeeding at a narrower set of achievable, measurable, targeted goals.
Clearly, the abrupt halt to U.S. involvement in WHO has caused considerable immediate uncertainty for both global health programs and the many millions of patients around the world who benefit from U.S. financial, medicinal and scientific support. But it can also signal a new opportunity to fix at last what is broken and failing in global health.
Edward Kelley is the former director of service delivery and safety at the World Health Organization and head of Global Heath for Apiject Systems, an injection technology company. Jay Walker is chairman of Apiject and founder of over 60 companies, including priceline.com, and the tenth most patented living inventor.
