SINGAPORE: Assuming President Donald Trump’s executive order is not revoked, the US will officially leave the World Health Organization (WHO) on Jan 22, 2026. In the interim, the Centers for Disease Control and Prevention (CDC) has been instructed to cease further activities and communications with the WHO.

Even a temporary withdrawal will be highly disruptive. And there could be disastrous consequences should a new pandemic arise.

Already, there are concerns that bird flu outbreaks in the US could potentially turn into the next human pandemic. The H5N1 avian influenza virus has mainly infected livestock, though several human cases including one death has been reported in the US.

The US’ withdrawal creates a huge gap in funding and technical expertise not just when it comes to health emergencies, but also long-running programmes like polio eradication. 

On the financial front, the US has been the largest funder of the WHO historically: It provided US$1.28 billion in the 2022-2023 biennial budgetary cycle, accounting for 16.3 per cent of all contributions. Germany was a distant second at 10.9 per cent.

Beyond financial support, US government officials have also provided technical expertise and leadership, through advisory panels and secondments. The US has also partnered the WHO in investigating and responding to outbreaks around the world as part of international teams.

NO COUNTRY CAN GO IT ALONE ON GLOBAL HEALTH

In the long run, it is unlikely to be in the US’ best interest to “go it alone” or rely solely on other forms of bi- or multilateral agreements in global health. The COVID-19 pandemic has hammered home a fundamental: Disease knows no borders.

Few experts believe that this withdrawal will be permanent or even prolonged beyond the current US administration, given the great interdependence of global health and the unique role the WHO plays as a neutral forum and global actor. Mr Trump had initiated withdrawal from the WHO in 2020, but this was reversed by successor Joe Biden on his first day of office in 2021.

During a global emergency, the WHO plays a crucial role in coordinating responses. The International Health Regulations require countries to report outbreaks that could be of international concern and members share information, samples and technical guidance through the WHO.

While various multilateral institutions (such as UNICEF), public-private partnerships (such as Gavi, the Vaccine Alliance), private foundations (such as the Gates Foundation) and international non-governmental organisations (such as Doctors Without Borders) contribute to health globally, none match the scope and reach of the WHO.

The WHO alone possesses the unique convening power to forge policy consensus among governments and establish international health norms. The eradication of smallpox in 1980 was one such landmark achievement, with both the US and Soviet Union cooperating through the WHO despite the Cold War.

Nonetheless, US efforts to increase its parallel multilateral partnerships for global health or biosecurity via its National Security Council apparatus could, at the very least, weaken the WHO’s authority and power in the short term.

Mr Trump’s executive order also puts a stop to US negotiations on the WHO Pandemic Agreement that was intended to address weaknesses in global pandemic prevention, preparedness and response. This effort was already faltering when member states failed to negotiate a consensus last year, and with this latest blow, the prospect of a substantive agreement by the time of the World Health Assembly in May is bleak.

WORLD HEALTH ORGANIZATION IN NEED OF REFORM

It is unlikely that the US withdrawal will encourage other countries to leave the WHO. But what is clear is that Mr Trump is not alone in his criticism of the organisation - and it is in need of reform in multiple areas ranging from sustainable financing to its governance and decision-making processes.

That said, the WHO has undertaken reforms in recent years, including - fortuitously - historic changes to its funding model in order to make its work more sustainable and flexible. In May last year, member states agreed to gradually increase their assessed contributions or “membership dues” so that they will cover 50 per cent of its core budget by the 2030-2031 biennium.

For the past decade, assessed contributions - which the WHO can allocate freely - have accounted for less than 20 per cent of the core budget. The majority of funding has come from voluntary contributions that are generally earmarked for specific programmes and projects. This had raised concerns that the WHO’s strategic priorities are being shaped by donor priorities rather than global health needs, with undue influence concentrated in the hands of a few major donors.

This gradual increment will start in the 2024-2025 biennium, offsetting to a small extent the loss from US contributions. It is plausible that other countries and organisations may increase their contributions if and once the US withdrawal takes effect.

In the face of the imminent financial shortfall, WHO staffer Tania Cernuschi started an innovative “One Dollar, One World” campaign to crowdsource US$1 billion with 1 billion people giving just a dollar. WHO Director-General Tedros Adhanom Ghebreyesus has also announced cost-cutting measures, including freezing hiring and re-evaluating which of its many health programmes to prioritise or scale back.

WHICH COUNTRIES WILL STEP UP?

Could China step into the vacuum left by the US? China did rapidly pledge an additional US$30 million in April 2020, once US announced a temporary halt in funding to the WHO over concerns about COVID-19 pandemic management. 

However, China’s contributions have remained under 3 per cent of the core budget in the past. Given its preference for bilateral aid - especially via its Health Silk Road initiative - it is unlikely that China will increase its contributions to the WHO multifold in a short period of time.

In such times of uncertainty, small but strategic nations like Singapore can yet play an important role in stabilising global health governance, an effort that can only be to their benefit.

Beyond increasing Singapore’s WHO contributions proportionately, we also leverage our expertise in public health, governance and biomedical research to support the WHO and the region. This includes diplomatic engagement and contributing to ongoing reforms targeted at improving the WHO’s efficiency and streamlining its bureaucracy.

By stepping up alongside other nations, Singapore can help bridge the temporary gap in technical expertise while also working and advocating for stronger regional collaboration via bilateral partnerships and multilateral structures. The Association of Southeast Asian Nations (ASEAN) cooperates through the ASEAN Health Sector and the upcoming ASEAN Centre for Public Health Emergencies and Emerging Diseases.

The pending US withdrawal from the WHO will be a major disruption for global health and its governance, but it also presents an opportunity for reform. Despite its challenges and past mixed record, the WHO remains the most important and effective platform for global cooperation and leadership in health. It is too crucial an entity to let fail through the next few challenging years.

Prof Hsu Li Yang is Director, Asia Centre for Health Security and Vice Dean for Global Health at the Saw Swee Hock School of Public Health, National University of Singapore.