Opinion piece on the US' withdrawal from the World Health Organisation

The United States’ withdrawal from the World Health Organization: lessons and implications for global health governance

Co-authors:

Julius Mugwagwa^*1, Margaret Siyawamwaya¹, Pritika Garodia¹, Stephanie Young¹, Kay Wenger¹, and Remy Twiringiyimana¹

¹University College London, Department of Science, Technology, Engineering and Public Policy (UCL – STEaPP)

*Corresponding author: Julius Mugwagwa (j.mugwagwa@ucl.ac.uk)

Summary

The United States' decisions to withdraw from the World Health Organization (WHO) in 2020 and 2025 mark significant inflection points in global health governance. These actions, driven by critiques of inefficiency, bias, and national political considerations, disrupt multilateral efforts to address global health issues and highlight tensions between national interests and collective action. In this opinion piece, we examine the motivations and implications of these withdrawals, drawing on global health governance frameworks and diplomacy theories in our analysis. We explore the immediate and long-term impacts on international health systems, consider potential opportunities arising from the withdrawal, and reflect on historical precedents to offer lessons for the future.

Introduction

The World Health Organization (WHO) has played a pivotal role in global health governance since its establishment in 1948, fostering international collaboration to combat pandemics, strengthen health systems, and promote equitable healthcare access (World Health Organization, 2025[1]). Despite its critical contributions, the organization has faced persistent challenges, including accusations of inefficiency, politicization, and financial dependency on a few key donors[2].

In 2020[3], the United States announced its withdrawal from the WHO during the COVID-19 pandemic, citing dissatisfaction with the organization’s response to the crisis and its perceived bias toward certain member states. The decision sparked widespread concern about the stability of global health governance and the implications of diminished U.S. leadership in international health. Subsequently, the Presidential Letter to the Secretary-General of the United Nations signed on January 20, 2021, retracted and revoked the United States’ July 6, 2020 notification of withdrawal. Five years later, on January 20, 2025, the U.S. has again withdrawn from the WHO (Whitehouse.gov, 2025[4]), further exacerbating tensions and raising questions about the future of multilateral health initiatives.

This brief opinion piece explores the reasons behind these withdrawals and their broader implications for global health governance. We utilize theoretical constructs from global health diplomacy and governance to analyse the disruptions caused by the U.S. disengagement and consider the potential for positive change in response to these challenges. Additionally, we reflect on historical precedents, such as the U.S. withdrawals from UNESCO, to extract lessons that may guide future interactions between nation-states and multilateral organizations.

Reasons behind the withdrawals

1. Perceived inefficiencies in WHO: The U.S. government has on both occasions cited concerns over the WHO's alleged inefficiencies and bureaucratic challenges. They argue that the organization has been slow to respond to health crises and lacks transparency in its dealings with member states.
2. Accusations of bias towards certain Member States: In both instances, the U.S. administration has expressed concerns about perceived favouritism within the WHO. In 2020, accusations were directed at the organization’s handling of China during the COVID-19 pandemic. In 2025, similar concerns have been raised about its engagement with other emerging powers, raising questions about the WHO’s impartiality[5].
3. Financial contributions and accountability: The United States, as the largest financial contributor to the WHO, has argued that its funding does not translate into commensurate influence or accountability. This argument has been amplified during the 2025 withdrawal, with claims that reforms promised after the 2020 crisis have not been adequately implemented[6].
4. Domestic political considerations: Both withdrawals were influenced by domestic political dynamics. The 2025 decision reflects ongoing debates within the U.S. about the value of multilateralism and concerns over the perceived erosion of national sovereignty in international organisations.

Global Health Governance frameworks and Diplomacy theories

1. Global health governance frameworks: Global health governance (GHG) frameworks emphasize the importance of cooperative international mechanisms to address cross-border health challenges. These frameworks highlight key principles such as equity, accountability, and collective action. The U.S. withdrawals disrupt the balance within these frameworks, creating a vacuum in leadership and resources. The WHO’s reliance on multilateral engagement is a cornerstone of GHG, and the absence of its largest contributor amplifies systemic vulnerabilities (Rowson et al, 2012[7]).
2. Theories of international health diplomacy: Health diplomacy theories, such as "soft power" and "smart power" approaches, provide a lens to analyse the U.S. actions. Soft power, emphasizing influence through cooperation and cultural exchange, is potentially undermined by the U.S. disengagement. Similarly, the potential for smart power, which combines military, economic, and diplomatic tools to achieve policy goals, is diluted by the withdrawal, as the U.S. Withdrawal will forfeit its ability to shape global health policies effectively (Nye, 2004[8]).
3. Institutionalism and power dynamics: Institutionalist theories stress the role of international organizations in fostering cooperation among states. The U.S. withdrawals reveal tensions in institutional structures, including perceived inequities in decision-making power and financial obligations. Realist perspectives on power dynamics further contextualize the withdrawals as strategic moves reflecting national interests over global commitments (Keohane and Martin, 1995[9]).

Implications of the withdrawals

1. Impact on global health governance: The withdrawals will potentially undermine the WHO’s financial stability and operational capacity. The organization faces compounded challenges directly due to reduced funding and in tandem due to potential trust deficits following these repeated U.S. disengagement[10] (Whitehouse.gov, 2025).
2. Erosion of multilateralism: The repeated withdrawals might signal a broader trend of retreat from multilateralism by major powers. This erosion raises concerns about the ability of international institutions to address global challenges without cohesive support from key stakeholders.
3. Effects on developing countries: The loss of U.S. funding and technical expertise will disproportionately affect low- and middle-income countries, which rely heavily on WHO programmes for disease control, immunisation, and health system strengthening. These impacts could be even more severe in 2025 due to the ongoing global health crises. The sudden withdrawal of support without allowing the WHO and member states to gradually implement other measures, will affect on-going global health prevention and control programmes for diseases such as HIV/AIDS, malaria and tuberculosis. These infectious diseases, which may be endemic to one part of the world, currently kill 2.5 million people every year[11] but still know no boundaries.
4. Isolation of developments in the US from the rest of the world and vice versa: The absence of communication channels and data-sharing mechanisms may lead to the isolation of scientific and technological advancements between the U.S and other countries. As a result, innovations developed in the U.S may remain confined within the national boundaries due to the lack mechanisms for accountability and dissemination. This fragmentation has the potential to exacerbate disparities in disease response and management on a global scale.
5. Lessons from similar precedents: Historical precedents, such as the U.S. withdrawal from UNESCO in 1984 and 2017[12], offer valuable lessons. These withdrawals demonstrated the risks of politicising international institutions and underscored the importance of balancing national interests with global commitments. The U.S. rejoined UNESCO in 2023[13], highlighting the cyclical nature of disengagement and re-engagement (Farnham, N, 1986[14]).

Possible positive implications of the withdrawal

1. Catalyst for institutional reforms: The withdrawal could serve as a wake-up call for the WHO to address criticisms related to inefficiency, transparency, and accountability. Pressure to reform may result in a stronger, more agile organisation better equipped to handle future global health crises.
2. Encouragement of regional initiatives: The absence of U.S. leadership might encourage other countries and regional blocs to step up their contributions to global health initiatives. This could lead to a more decentralised and diversified approach to health governance, potentially reducing over-reliance on a single donor nation[15].
3. Opportunities for innovation: The reduced funding from the U.S. may force the WHO and its partners to deepen their exploration of innovative financing mechanisms and partnerships with the private sector, potentially unlocking new resources for global health. Developing countries could draw insights from this experience to prioritise investment in self-reliance, particularly by fostering homegrown health innovations and indigenous knowledge systems.
4. Increased domestic investment in health: For the U.S., redirecting funds previously allocated to the WHO could bolster domestic health programs, addressing pressing healthcare challenges within its borders. Such investments could also contribute to a stronger public health system capable of supporting global health indirectly through research and innovation[16].

Lessons and recommendations

1. Strengthening multilateral reforms: The repeated withdrawals underscore the need for substantive reforms within multilateral organizations to address inefficiencies, enhance transparency, and ensure equitable representation of member states (World Health Organization, 2023[17]).
2. Balancing national and global interests: Countries must balance domestic priorities with the need for global cooperation. The U.S. experience highlights the consequences of prioritizing short-term national interests over long-term global health goals (Rowson et al, 2012).
3. Building resilient global institutions: The international community should focus on building resilient institutions that can withstand political and financial shocks, ensuring continuity in addressing global health challenges.

Conclusion

The United States' withdrawals from the WHO in 2020 and 2025 epitomise the enduring challenges of aligning national priorities with global health needs. While these actions are disruptive for multilateral health governance, they also expose the vulnerabilities of existing systems and create opportunities for reform and innovation. A strengthened, more inclusive WHO may emerge in response, spurred by the need to address criticisms and adapt to a decentralised global health landscape. Moving forward, fostering resilience, equity, and international collaboration will be essential in strengthening responses to future crises. Fundamentally, it remains imperative for individual nations, including the U.S, to reconcile domestic priorities with the shared responsibility of global health.