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Petrie Dish: Should the US leave the WHO? 'Your Local Epidemiologist' weighs in

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The White House website is being displayed on a mobile phone, with World Health Organization seen in the background, seen in this photo illustration. Taken in Brussels, Belgium, On 21 January 2025. (Jonathan Raa Sipa USA)
Jonathan Raa/Jonathan Raa/Sipa USA via Reuter
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The White House website is being displayed on a mobile phone, with World Health Organization seen in the background, seen in this photo illustration. Taken in Brussels, Belgium, On 21 January 2025. (Jonathan Raa Sipa USA)

When Donald Trump was inaugurated for his second term in office on January 20th, 2025, he began signing executive orders. He signed dozens of them that first week, impacting everything from immigration, climate change and oil exploration, eliminating federal diversity programs, directives defining gender and much, much more.

Many of them made clear that this wouldn’t be an administration that stood on multilateralism. "America First" wouldn’t be just a campaign slogan. It would be the zeitgeist of the second Trump Administration. That idea was explicit in an executive order announcing Trump’s intention to withdraw the United States from the World Health Organization.

This move was not a surprise. He’d first announced this intention during his first term, but this time he had plenty of runway to follow through. Trump’s complaints remained the same as during his first term, though. He accused the international health agency of mishandling the COVID-19 pandemic. He also said it cost too much, and that it unfairly charged the United States much more than it charged China. And speaking of China, the executive order continued, the WHO deferred too much to that country.

Is there any merit to Trump’s claims? Katelyn Jetelina is an epidemiologist and data scientist who gained a loyal following during the early months of the COVID pandemic, appearing on social media and later on her Substack as Your Local Epidemiologist. At the time, she was a professor in Dallas, and she started posting to share information about the novel coronavirus and the pandemic for her students and colleagues to make sense of the constantly evolving public health landscape. She quickly acquired a much larger audience, that has only grown in the five years since.

Jetelina once worked at the World Health Organization, and she thinks Trump may be on to something, even if she doesn’t agree that withdrawing from the WHO is the answer. So let’s take a look at Trump’s critiques.

Mishandling of the Pandemic

Jetelina says there is some weight to that claim.

“They were too slow to declare a public health emergency,” Jetelina said, “and it impacted all of us.”

Was the UN agency also too deferential to China? “Yes, especially in those early days of the pandemic,” she said.

Jetelina pointed out that navigating a pandemic isn’t easy, particularly for an international health agency that is charged with coordinating the health response, worldwide.

“There are systemic issues at play here. WHO just doesn't have the power to force countries to share data or comply with recommendations,” Jetelina said, “it can only work with the information it's given, and early in the pandemic, that information was limited.”

Cost

When Trump signed his executive order withdrawing from WHO he claimed that China was paying $39 million for membership while the U.S. was paying $500 million, despite China having a much larger population. That’s big, if true, and while the U.S. is paying more than China for membership, the figures are a bit more complicated than that.

“The U.S. is the single biggest donor to WHO,” Jetelina said. “Germany is the next in line, but by hundreds of millions of dollars. We are, by far, the biggest donor.”

Jetelina points out, however, that these figures aren’t calculated based on a nation’s population. “Some of the who's formula is based on economy,” Jetelina said. “So there's a reason why the U.S. pays much more than China at this moment.”

Here's the formula. The WHO draws money from two buckets. One is assessed contributions. It’s a kind of membership due, and the agency calculates the amount of each country's dues based on its economic wealth, not its population. The U.S. has the wealthiest economy on the planet, so it pays the highest dues.

But the numbers aren't as far apart as Trump seems to think. For the 2024/2025 biennial, the U.S. is expected to contribute $264 million to China's $181 million.

However, assessed contributions only make up 20% of the WHO’s budget. The remaining 80% comes from voluntary contributions. This is where the gap between the U.S. and China widens significantly.

For the most recent budget, the U.S. voluntarily contributed $442 million. China volunteered $2.5 million.

That's a huge gap, yes. But it's also a voluntary gap.

World Health Organization worked in protective gear preparing to visit a home where a woman died of Marburg disease.
Thomson Reuters
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Reuters
World Health Organization worked in protective gear preparing to visit a home where a woman died of Marburg disease.

What’s Next

Less than a week after Trump signed his executive order, he hinted at a rally that he might be willing to negotiate.

“Maybe we would consider doing it again,” he said. “I don't know. Maybe. We would have to clean it up a little bit.”

So what might that look like? Jetelina points to three things that WHO could use to make the case that Trump should bring the United States back into the fold.

The first? Self-interest. Jetelina said protecting the health of populations in poor and vulnerable countries is also protects Americans. “Infectious diseases don't respect borders,” Jetelina said, “COVID, flu, Ebola, you name it. Without WHO? There's really no centralized system to respond to global health threats, and when one country suffers, the world is at risk.”

This might be particularly resonant as the WHO has uncovered and is helping manage an outbreak of Marburg in Tanzania, and as the threat from H5N1 bird flu and tuberculosis increases in the United States.

Second, Jetelina said there are geopolitical interests at play. “There's soft power here,” she said. “I think it's really important the U.S. maintains its influence in global health by leading with principles of transparency and accountability.”

China is eager to step into the leadership void that would be created by the exit of the United States from the World Health Organization. An editorial published in The Atlantic the first time Trump announced his intention to withdraw from the WHO suggested that China had outsmarted the Trump Administration and has been rewriting the rules of the global order to be more in line with those of autocracies than democracies. This has far-reaching implications, not the least of which is that the U.S. would have limited influence over how things like pandemics are handled in the future.

Jetelina’s third point would be that we should be a good neighbor. We should help poor and vulnerable countries meet their public health needs because it's the right thing to do.

“Public health is a team sport, whether you are local, national, or looking through an international lens,” Jetelina said. “We need to play our part.”

So, where do we go from here? Jetelina said that's the billion-dollar question. "The WHO is not perfect. It definitely needs reform," she said. "Abandoning is not the answer."

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