In recent years, the U.S. and the World Health Organization (WHO) have had a relationship that makes Hollywood breakups look tame. In 2020, President Donald Trump walked out, slamming the door on what he called a dysfunctional, China-biased bureaucracy. A year later, Biden rushed to patch things up, eager to restore American influence in global health. Now, in 2025, Washington is heading for the exit again, this time under a second Trump administration.
The decision, while dramatic, is not shocking. The U.S. and the WHO have long had a strained relationship, marked by accusations of inefficiency and financial dependence. What is truly surprising is that America’s exit, though challenging, creates a crucial opportunity for the WHO to restructure, diversify funding, and strengthen its independence from Western political influence.
In 2020, Trump first announced the U.S.’s withdrawal from the WHO, citing his frustration with its handling of the COVID-19 pandemic. His administration accused the organization of failing to hold China accountable for its lack of transparency during the early spread of the virus. The move was widely criticized domestically and internationally, due to concerns that it would weaken global pandemic response efforts.
Biden reversed the decision in 2021, restoring U.S. membership and funding to the international organization. However, the underlying criticisms Trump brought to light—inefficiency, bureaucratic delays, and vulnerability to political influence by other foreign superpowers—never disappeared. Indeed, many of these concerns lingered even after the U.S. resumed its role as the WHO’s largest single contributor.
The second withdrawal indicates a deeper retreat by the U.S. from multilateral health organizations, aligning with broader adjustments in America’s foreign policy efforts. The Trump administration has made their preference for domestic policy efforts over global governance evident: already, Trump has removed the U.S. from the United Nations Human Rights Council, rejected pleas to resume funding for the United Nations Relief and Works Agency for Palestine Refugees, withdrawn most US Agency for International Development staff from their global assignments, and repeatedly threatened to exit the World Trade Organization. The President’s nationalistic approach to historically multilateral endeavors signals an American disengagement from global health leadership, forcing the international community to question whether or not this withdrawal will benefit or harm world health initiatives.
The U.S. contributes approximately 15% of the WHO’s total budget, over $1.2 billion biennially. Its departure will leave a significant funding gap, potentially disrupting vaccine distribution efforts, disease prevention and treatment, and global health security initiatives, particularly in low-income nations. Thus, the WHO must now scramble to secure alternative funding sources or risk cutting critical health programs globally. This raises a crucial question: who steps in to fill the void in leadership?
China could attempt to increase its influence, given its rising role in global health diplomacy, a result of its expansion of the Belt and Road Initiative. Other global superpowers like the European Union and Japan may take a more active role, aiming to keep the WHO aligned with Western health priorities. However, the option that may offer the most upside for the WHO is a complete restructuring of funding and leadership.
The WHO has long been caught in U.S.-China tensions. Accusations of bias from both sides—of favoring China during COVID-19 or favoring Western interests in vaccine distribution—have plagued its credibility. Without U.S. dominance, the organization could regain autonomy and credibility by making decisions less influenced by superpower politics.
Currently, the WHO relies heavily on voluntary contributions from a few primary donors, making it vulnerable to political pressure. The U.S. exit forces the organization to seek long-term funding agreements with a broader group of nations, increase mandatory contributions from all member states, and expand partnerships with philanthropic organizations like the Gates Foundation. Additionally, global health governance has historically been Western-centric. The U.S.’s withdrawal presents an opportunity to increase leadership representation from Africa, Latin America, and Asia, shift policy focus toward regional health priorities rather than the interests of global superpowers, and create a model of governance where no single country dominates the decision-making process. If managed well, this could lead to a more balanced, equitable, and democratic approach to combating global health challenges.
For the WHO to remain effective without the support of the U.S., major reforms are necessary. Historically, experts in the international community have called for funding reform in response to crises exposing weaknesses, like the WHO’s handling of the Ebola outbreak and the COVID-19 pandemic. More urgently than ever, the WHO may need to pursue new and sustainable funding mechanisms; by increasing contributions, creating a multilateral health fund, and encouraging private sector investment, the WHO could reduce dependence on any single donor while stabilizing its budget. Additionally, efforts to strengthen regional control within the WHO have been discussed in previous assemblies but remain limited due to Geneva-centric governance. With America’s exit, the WHO could completely decentralize its governance by strengthening regional WHO offices, reducing reliance on Geneva-based decision-making, and implementing means of independent oversight. Finally, the WHO must ensure that the Director-General’s election process includes broader global representation and increases available leadership roles for non-Western nations, diversifying the control of the organization. Indeed, calls for increased representation have long been made by developing countries and global health advocates. The only action left for the WHO to follow through on is ensuring equitable decision-making in drafting health policies.
These solutions are not just important for the sustenance of the WHO; they are important for the future of global health governance and safety. Every dramatic breakup comes with two choices: spiral into crisis or embrace reinvention. The WHO, long entangled in superpower politics, now has an opening to shake off external control, diversify its funding, and make global health policy truly global. If the WHO seizes this chance to chart its own course, it could prove that this time, it’s better off alone.
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