Not only is the United States a critical player in global health, but the WHO is deeply integrated into U.S. public health efforts at home. Under U.S. law, the president cannot immediately and unilaterally withdraw from the organization. The U.S. Congress, courts, and public can all work to prevent this damaging move. But even if they do, the president’s actions will have immediate effects. Trump is moving rapidly to freeze relations, disrupting ongoing operations of U.S. health agencies. Further extracting the United States over the next year would be difficult and harmful. U.S. experts work daily with WHO, sharing information and expertise to protect Americans’ health and save lives around the world. Those who suggest that the United States can go it alone, substitute another institution, or work with WHO in a transactional manner on certain issues misunderstand global public health and international relations. Simply put, the United States needs the WHO, even with its imperfections.
WHO plays an indispensable role on disease outbreaks. The U.S. Centers for Disease Control and Prevention (CDC) has invested heavily in innovative global disease surveillance to identify foreign outbreaks—crawling the Internet and social media, for example, for key words that might indicate an epidemic. But more detailed, actionable data—and cooperation from other governments—is necessary to p lan effective responses. And COVID-19 has shown how political sharing public health information can be; many governments are reluctant to share information, particularly if they don’t see eye-to-eye with the United States. Thus, the CDC depends on the WHO to broker global information sharing—from the epidemiological data needed to prepare health systems to the viral genomic sequences needed to create tests. It was only as part of a WHO mission that U.S. scientists even got access to the epidemic in Wuhan, China, to begin with. Working only from what U.S. public health officials can gather themselves would hobble U.S. efforts to combat disease. Meanwhile, helping to stop disease outbreaks before they spread is a key U.S. global health security strategy and the WHO is an essential partner. In the Democratic Republic of the Congo, for example, health workers could halt an Ebola outbreak in the middle of active war in part because WHO staff and its Global Outbreak Alert and Response Network members were deployed to areas deemed too dangerous for U.S. personnel.
Disease response is one of many areas where the WHO and U.S. public health are intertwined. The United States is home to 83 different WHO collaborating centers—research institutes, universities, and U.S. government agencies that work at the intersection of U.S. and global public health. Of these, more than 20 are at CDC and the National Institutes of Health, where they focus on areas Congress has identified as priorities, ranging from biosecurity to travelers’ health, cancer, and smallpox. This collaborative work will presumably cease immediately under the president’s moves unless Congress acts.
Such centers also participate in the process of developing an influenza vaccine, a process the U.S. government could be cut out of for the first time. That could interrupt efforts to prevent a dangerous flu epidemic this winter, a double emergency for U.S. hospitals dealing with COVID-19. The WHO’s Global Influenza Surveillance and Response System aggregates information from 112 countries around the world to track and study flu. Twice a year, the organization convenes its collaborating centers, including at the CDC, to share data and virus samples and design that year’s vaccine—critical since new flu strains are usually first spotted in Asia, not in the United States. Severing ties with the WHO would end CDC’s status as a collaborating center and hub for this work.
The flu vaccine is not the only one the U.S. should be worried about. The WHO is coordinating access to a COVID-19 vaccine to safely reopen societies and economies. If the most effective vaccine is developed outside the United States, and the United States is not part of the frameworks negotiated through the WHO, the U.S. public could be at the back of the line.
Withdrawing from the WHO also threatens enduring bipartisan U.S. global health priorities. The Global Polio Eradication Initiative, which is housed at the WHO, is the center of a global effort tantalizingly close to ending polio, which remains endemic only in Nigeria, Afghanistan, and Pakistan. CDC experts are inextricably embedded in the initiative, to which the United States has been the second-biggest donor. Were the country to withdraw from the effort, a historic opportunity to eradicate a terrible disease and save millions of children from paralysis could be lost. The WHO also provides pivotal support to the U.S. President’s Emergency Plan for AIDS Relief, helping countries to adopt new testing, treatment, and prevention technologies to end the AIDS crisis. At a time when the COVID-19 pandemic threatens to double the death toll from HIV and AIDS, tuberculosis, and malaria, any disruption would be devastating.
The WHO’s processes are deeply imperfect, and reform is warranted. In part, the WHO has limited power to compel countries to take action or share information. But substituting U.S. bilateral efforts is unlikely to succeed. Some U.S. allies would work closely with it on health efforts, but many other governments around the world would be reluctant. Governments cooperate and share information through the WHO because it is an international organization where they have power in decision-making, building trust, and predictability. And in a multipolar world, powerful countries will not cooperate without gaining influence at WHO—that is the trade-off among sovereign nations.
It will be necessary to improve the WHO’s powers and agreements between countries. Revision of the International Health Regulations (IHR), a legally binding treaty adopted at the World Health Assembly, is the venue to accomplish the Trump administration’s stated goal to speed information sharing and pressure recalcitrant governments. Giving the WHO greater powers to gather and share outbreak information without the permission of member states, creating new capacity for external review of “official” data, improving WHO’s ability to work with non-state actors, agreeing to consequences for states who do not rapidly share information, and other ideas will be on the table. The United States will have little influence in revising the IHR if it vacates its seat at table within the WHO.
The WHO is woven deep into the fabric of U.S. public health. Extracting it will be difficult, disruptive, and damaging. It is naive to think that the essential functions of the WHO could be recreated through bilateral accords—indeed, the long history of failure in state relations on health is proof positive. Trying to do so, and failing, is the last thing the world needs in the middle of a global pandemic.
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