On Donald Trump's first day in office, the USA initiated the process of withdrawing from the World Health Organization (WHO), marking a seismic event for both this organisation and the entire UN system, of which the WHO is a part.
The WHO will take years to recover from Trump's blow, considering that the US is by far its largest donor, but the consequences of this decision for the US will not be insignificant either.
Among the dozens of decisions he signed on his first day in the White House, withdrawing from the WHO as well as the Paris Agreement on climate change (also within the UN framework) were Trump's theatrical expressions of a policy of shifting away from multilateralism, which was forcefully supported by his voters.
"That's a big one," Trump said as he prepared to sign the decision for the US to withdraw from the WHO. And it is big, especially for the WHO, which, with the new US president's signature, is left without USD 1.28 billion, which is the size of the US donation in the period 2022–2023 and accounts for a fifth of the UN health organisation's total funding.
The next two largest donors are Germany and the Bill and Melinda Gates Foundation with around USD 850 million and USD 830 million respectively.
China is not among the top ten contributors to the WHO, and this is an important driver of Trump's decision to withdraw from the WHO.
Second attempt
Trump already initiated the process for the US to exit the WHO once, in July 2020, during his last term in office, and at that time, China was the main motive for the withdrawal.
He believed that the UN agency was heavily influenced by China, especially when it came to covering up the extent of the COVID-19 epidemic, which originated in China. At the time, Trump was not the only one who suspected Beijing of hiding crucial information about the origin and spread of the virus.
Trump's decision will apply starting 1 January 2026. The US Congress must confirm it by then
Australia has called for a global investigation into the authorities in Beijing, blaming them for withholding crucial information that could have prevented the infection from spreading worldwide. China has responded angrily, even imposing some trade sanctions on Australia.
While Trump's previous attempt to leave the WHO was thwarted by the expiration of his term and the return to membership signed by Joe Biden, the second attempt has a much better chance of being successful.
Trump's decision will apply starting 1 January 2026. The US Congress must confirm it by then, a likely outcome given the Republican majority in both houses.
Pressure on China
Trump will achieve several goals with this decision. He will prove to voters in the US that he has saved hundreds of millions of dollars, thereby demonstrating the soundness of his policy of focusing on the domestic economy.
What's more, his decision to leave the WHO will be used to exert pressure on China in the complex relationships ahead, where trade and involvement in solving global problems will be at the centre for American negotiators.
With this step, President Trump is sending a very clear signal to the UN that it must expect new American tensions if comprehensive reforms of the global organisation are not carried out naturally, according to US standards.
This is a long-term strategy that they (China) have at the United Nations, and we need to have strong American leadership working with our allies to push back on this - Elise Stefanik
The main direction of US activities in the UN will be to reduce anti-Israeli decision-making and suppress the increased influence of China.
"This is a long-term strategy that they have at the United Nations, and we need to have strong American leadership working with our allies to push back on this," said Elise Stefanik, Trump's nominee for US ambassador to the UN, in the context of the future American suppression of Chinese influence in the work of the UN.
Withdrawal of US funding will undoubtedly harm WHO's irreplaceable activities, particularly in the prevention and control of infectious diseases.
Bargaining chip
The USA will not remain unaffected, as the withdrawal from the WHO will also disrupt the channels that crucial American agencies like the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) rely on to obtain important information for their operations.
Withdrawing from the WHO will leave the US more vulnerable, said virologist Marion Koopmans, an expert on emerging infectious diseases at Erasmus Medical Center in the Netherlands. "It would isolate the CDC from a lot of intelligence that is crucial for our global security."
Withdrawing from the WHO and the Paris Climate Agreement will not be Trump's last decision against the UN system
However, it is a risk that President Trump and his administration are clearly prepared to take. The priority is placed on political pressure on the UN, then on China, but also on US partners—the Europeans, for example—to correct their own policies regarding global challenges in the direction outlined by Trump's isolationist decisions.
Withdrawing from the WHO and the Paris Climate Agreement will certainly not be Trump's last decision against the UN system. It is expected that the US will withdraw support from the UN Relief and Works Agency for Palestine Refugees (UNRWA) in light of its general policy of supporting Israel.
However, Trump's confrontational approach to multilateral mechanisms is by no means an indication of the US's complete withdrawal from the UN system and other global structures.
His moves are primarily aimed at reshaping these structures so that they work in favour of US interests as much as possible while also being a form of pressure on partners to join them.
"The U.S. may well leverage its support for certain institutions to entice reengagement and secure cooperation from governments eager to offer the U.S. "wins" to forestall broader confrontation," wrote Brett Schaefer, UN expert at the Heritage Foundation.
