What a potential US exit from the WHO means for the world

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What a potential US exit from the WHO means for the world

Global health in flux: What a potential US exit from the WHO means for the world

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The United States (US), under President-elect Donald Trump, is expected to formally withdraw from the World Health Organisation (WHO) upon reoccupying the White House, paving the way for extraordinary consequences for global health. While it comes as no surprise that the US role in global health leadership comes under the scanner once again, the global health community must take notice of what this signifies, take cognisance of what global health needs, and develop steps to address the altered landscape.

Not-so-hidden biases

In 2020, Trump initiated steps to withdraw from WHO, citing the organisation’s biases towards China by not placing accountability over the country’s handling of COVID-19. The international community criticised WHO for failing to timely declare COVID-19 as a Public Health Emergency of International Concern (PHEIC). This arose when WHO was already under scrutiny for its inaction during the 2013 MERS-CoV outbreak and its delayed declaration during the 2014 Ebola outbreak. During COVID-19, China’s influence over WHO was brought to light when the country was reluctant to share data with the agency and failed to expeditiously declare the human-to-human transmission of the virus. In December last year, the WHO spokesperson, Maria van Kerkhove urged China to provide it with samples from the pandemic emphasising a ‘moral and scientific imperative’ but China remains insistent that it has provided the agency with all of its samples.

The international community criticised WHO for failing to timely declare COVID-19 as a Public Health Emergency of International Concern (PHEIC).

The US’ likely withdrawal from WHO comes at a juncture when the origins of COVID-19 continue to be politicised. The Republican-led Select Subcommittee on the Coronavirus Pandemic concluded that ‘COVID-19 most likely emerged from a laboratory in Wuhan, China, ’ citing that gain-of-function research in a laboratory with inadequate biosafety levels was the primary cause of the lab leak. It attributed the pandemic to failures in overseeing ‘potentially dangerous research’ by the US National Institutes of Health (NIH) and WHO in succumbing to political pressure from the Chinese Community Party (CCP) to cover the lab leak that allegedly occurred at the Wuhan Institute of Virology (WIV).

Unanswered origins

While the House Democrats refuted the Select Subcommittee’s report, citing it as having ‘fuelled extreme narratives’ over the pandemic, the true origin of COVID-19 may never be revealed. Reports advocating a naturally occurring viral spillover event are inconclusive; they have failed to demonstrate that animals in the Wuhan Wet Market were infected with SARS-CoV2 and were the source of animal-human transmission. Interestingly, the US Department of Energy ruled, with ‘low confidence,’ that a lab leak was the likely origin, moving away from their previously held neutral stance. While the National Intelligence Council is firm on a viral spillover event as the cause of the outbreak, the Federal Bureau of Investigation (FBI) maintains that a laboratory incident may be the cause. The continued politicisation of the origins of COVID-19 and the lack of concrete scientific evidence pointing to either a zoonotic outbreak or a laboratory incident dispel any notion that the true origin will ever be revealed.

Global health and national interests at loggerheads

It comes as no surprise that the Trump administration would question the role of the US in global health efforts. The US has dominated global health leadership by diverting enormous funds to countering infectious diseases, notably linking the security and economic development of the developed world with that of the Global South. However, COVID-19 demonstrated that despite these efforts, the US was ill-prepared. In essence, a US foreign policy that incorporated global health failed to protect its national interests from COVID-19. The US faced the biggest economic contraction since the Great Depression and there were 1.2 million deaths in the US attributed to COVID-19.

The US has dominated global health leadership by diverting enormous funds to countering infectious diseases, notably linking the security and economic development of the developed world with that of the Global South.

The Biden administration attempted to restore the US leadership in global health by reversing Trump’s 2020 withdrawal from WHO. However, polarised domestic politics and geopolitics aroused questions over what US engagement with global health meant. For instance, Biden continued Operation Warpspeed (OWS)—a legacy of Trump 1.0—where COVID-19 vaccines were manufactured in record time. Vaccine nationalism and inequities stemming from COVAX (COVID-19 Vaccines Global Access), however, stymied these efforts, while vaccine diplomacy efforts by Russia and China further altered the health landscape. Thus, global health failed to demonstrate its value in American foreign policy.

Brace for impact  

As the world braces for the unpredictability of the new Trump presidency, it is necessary to examine the implications of a US withdrawal from WHO. Such a decision will send shockwaves as the US is one of WHO’s largest contributors, funding nearly US$1.28 billion in 2022-2023. This withdrawal will impact international surveillance and responsiveness to health threats, disrupt the collaboration efforts between various US organisations and WHO for research and development and reduce experienced technical and administrative manpower. Funds to the US Agency for International Development (USAID), the National Institutes of Health’s Fogarty International Center and programmes devoted to HIV/AIDS, malaria, and tuberculosis will likely be slashed. Contributions to the United Nations Population Fund (UNFPA) and the President’s Emergency Plan for AIDS Relief (PEPFAR), which focus on reproductive health and HIV prevention, respectively, are likely to be affected. A ‘global gag rule,’ or a funding blockade to foreign organisations that aid in providing access to abortions may be reimposed, while the recently revived initiative on cancer therapies—Cancer Moonshot—is likely to be terminated.

Funds to the US Agency for International Development (USAID), the National Institutes of Health’s Fogarty International Center and programmes devoted to HIV/AIDS, malaria, and tuberculosis will likely be slashed.

Trump sceptics brace for an administration that is apathetic to health but nuances indicate that we may be witnessing a recast of how the US incorporates health into its foreign policy. Notably, OWS demonstrated that American biotechnology and pharmaceutical industries were capable of swiftly producing innovative countermeasures to address a novel threat, cementing these industries as core vital interests. Innovations for pandemics and climate change-related health issues will be driven through incentives such as intellectual property (IP) rights and geopolitical competition. The agenda also includes steps to address domestic drug prices, promote harmonisation of the regulatory aspects of the US Food and Drug Administration (FDA) with global counterparts, and subject vaccines to increased scrutiny over safety. Biden’s biosecurity and biosafety agenda may be echoed; increased oversight of biosecurity practices is reported to occur through structural reforms of the NIH, whose collaboration with the EcoHealth Alliance and WIV, came under the scanner for its alleged role in the pandemic.

Sitting ducks? 

The US is clear in its need to realign the role of global health in its foreign policy, and the Global South needs to formulate steps to address this altered landscape. From a security perspective, no country can afford to look away from health. Thus, there exists the possibility that the US may not leave WHO and instead may slash its contributions. A US funding vacuum will likely be filled by China, which has already begun altering the healthcare landscape through its Health Silk Road. Europe is another contender, but with the United Kingdom (UK) lowering its overseas development assistance (ODA) to health from 16.7 percent in 2020 to 7.6 percent in 2023, activities will rely on the European Union (EU). A considerable amount of resources was diverted away from global health to the ongoing conflicts in Russia-Ukraine and West Asia indicating that the lacuna will be filled by philanthropies like BMGF, but it remains to be seen to what extent these gaps can be filled.

A US funding vacuum will likely be filled by China, which has already begun altering the healthcare landscape through its Health Silk Road.

This power shift, where global health objectives are significantly less steered by ‘traditional strongholds in the Global North’ can be construed as an opportunity for the Global South to address its critical health needs. The current discourse is an impetus for the Global South to persuade WHO for urgently needed reforms including increased transparency and accountability, and address several contentious issues that negotiations over the Pandemic Treaty have brought about. The pathogen access benefit sharing (PABS) mechanism—a system to ensure the sharing of genetic resources—is unlikely to bring about the equity and fairness it claims, indicating that alternatives to this mechanism are needed. Further, BRICS can address health through a bottom-up approach and through localisation, where foreign aid is channelled through local organisations. Finally, taking into consideration the adverse outcomes that resulted from the politicisation and securitisation of COVID-19 and the rampant disinformation and misinformation campaigns that ensued, the Global South can endeavour to ensure that science is communicated responsibly and countries like India take concrete steps in incorporating biosecurity into national security frameworks to be on par with global counterparts.

The US is determined to alter the standing global health has on its foreign policy. COVID-19, polarised domestic politics, and geopolitical tensions have overshadowed any apparent benefit the US would gain from increased engagement on global health. While it is not prudent for the US to completely step away from global health efforts, this serves as an impetus for India and the rest of the Global South to rethink the global health landscape, which undoubtedly needs reform and address its needs.


Lakshmy Ramakrishnan is an Associate Fellow with the Health Initiative at the Observer Research Foundation

The views expressed above belong to the author(s). ORF research and analyses now available on Telegram! Click here to access our curated content — blogs, longforms and interviews.

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