Above photo: Gage Skidmore/Flickr.
What comes next?
Donald Trump’s push to withdraw from the WHO raises budgetary concerns, but signals cautious hope for strengthening Global South voices in the forum.
In January 2026, the World Health Organization (WHO) is poised to lose a member state, following US President Donald Trump’s executive order to withdraw from the UN health agency. Should this plan go ahead, it will mark the end of US participation in the world’s main global health forum and bring budgetary headaches to the WHO, given that the US remains its top financial contributor.
The WHO’s rather dry response to the announcement suggests it was expected and that the agency has likely begun preparing to navigate a second Trump presidency on reduced resources. On the other hand, US health programs and personnel might be less prepared. The president’s decision is set to disrupt international initiatives in which the US has invested time and money, such as polio eradication, and will strain cooperation in health. Trump’s stated intention to find more “credible and transparent” alternatives to the WHO will be near impossible to realize. The WHO remains unparalleled in its scope, and shifting to bilateral cooperation—Trump’s preferred approach—will not bring comparable results. Analysts cautioned already during Trump’s 2020 attempt to exit the WHO that it would be naive to assume countries in the Global South would embrace such a shift just to please him.
The situation is more nuanced than early reports predicting disaster for the WHO suggested. As the agency’s top donor, the US contributes roughly half a billion dollars annually, excluding pandemic-related spikes, as highlighted by global public health expert Andrew Harmer in December 2024. While Director-General Tedros Adhanom Ghebreyesus would undoubtedly prefer this funding to continue, Harmer’s calculations indicate that the other 193 member states could cover the shortfall of a US exit. By adding less than USD 3 million each to their standard contributions, they could prevent a significant disruption. High-income countries could even give more money to ease the burden on the Global South—although that is difficult to imagine.
However, this optimistic scenario is far from guaranteed. Other WHO members could just as easily avoid addressing the budget deficit, leaving the agency increasingly reliant on the private sector. The influence of private entities within the WHO has already grown under the agenda of multistakeholderism—a path the US has strongly supported in this forum. David Legge from the People’s Health Movement (PHM) warns that even if some donors step up their contributions, it would be unlikely to fully cover the shortfall. In this case, the WHO would likely face cuts in staffing and programs and be forced to cede more ground to philanthrocapitalist actors like the Bill and Melinda Gates Foundation.
Considering the WHO’s history of budgetary challenges, which has left the organization relying on resources allocated to specific programs rather than flexible funds, the threat is far from hypothetical. For decades, pressure from the US and its allies has resulted in member contributions to the WHO being frozen at a fraction of what high-income countries allocate annually to their own national health expenditure. Despite this limited funding, the WHO is expected to operate on a global scale, and is then criticized by Global North countries for perceived inefficiencies. “The freeze on assessed (mandatory) contributions and the earmarking of voluntary contributions has the effects of leaving the de facto agenda of the WHO in the hands of the donors rather than the member states,” Legge told People’s Health Dispatch. “This is an expression of colonial arrogance.”
While the WHO was envisioned as a space for equal participation, in practice, high-income members exercise more influence. This is reflected not only in the amount of financial contributions but also from the resources countries can dedicate to engaging in WHO discussions. For example, while the US can afford delegations of dozens to the World Health Assembly, most Global South nations struggle to send more than a handful of representatives. This imbalance affects their ability to attend multiple discussions during governance meetings and can undermine preparation. Finally, Western delegations often use their privilege to dilute the content and language of key documents to protect corporate interests. “Coloniality is alive and well in the World Health Assembly (WHA),” Legge says. “The determination to deny the sovereignty of the WHA majority is shared across the Western Bloc. While the US leads, it has the support of the rest of the West.”
This is particularly ironic, given that one of President Trump’s stated reasons for leaving the WHO was the agency’s supposed “inability to demonstrate independence from the inappropriate political influence of WHO member states.” From his viewpoint, this means China, which has shown no aspiration to take over as the WHO’s top financial contributor. For most observers, the label of undue political influence is far more easily attributed to the United States.
Despite pressure by powerful member states like the US, the WHO has managed over the years to adopt several key decisions that have curtailed the dominance of corporate actors in global health. These include the International Code of Marketing of Breastmilk Substitutes and resolutions related to trade and health. However, as PHM pointed out during Trump’s previous attempt to exit the WHO, the US has historically been “a major promoter of a corporate presence in decision-making bodies within WHO.”
“The US also has a history of hard bargaining to dilute many key resolutions and treaties and then finally refusing to sign on,” PHM stated. Amid ongoing discussions about constructive reform of the WHO and the US’s documented obstruction of the organization’s work, some observers see Trump’s decision coming with silver lining. The departure could create space for other member states to amplify their voices in ongoing negotiations, such as those on a new pandemic instrument. With the WHO’s Executive Board meeting scheduled for early February, the early signs of what is to follow may begin to emerge, offering a glimpse into the dynamics that will impact global health in the coming year.