One of the first executive orders signed by President Trump on the evening of his inauguration was to immediately withdraw the U.S. from the World Health Organization (WHO), the United Nations agency tasked with coordinating a wide range of health activities around the world. This did not come as a surprise. President Trump tried to pull this off in 2020 amidst the COVID-19 pandemic.
Upset at how WHO handled the pandemic, President Trump accused it of succumbing to the political influence of its member states, more specifically to China. However, the structure of the WHO, which is made up of 197 member states, prevents it from enforcing compliance or taking any decisive action without broad consensus. Despite its flaws, the WHO is the backbone of global health coordination. When President Joe Biden came into office, he reversed the decision and re-engaged the US with the WHO.
WHO’s mission is to promote health, keep the world safe, and serve the most vulnerable. Besides taking the lead in coordinating the world’s response to health emergencies, WHO works with member states and partners to eradicate polio, deliver essential health services, set international guidelines for medicine and vaccines, and promote universal health coverage. Its mandate is broad and ambitious.
Like all large bureaucratic institutions, the WHO could benefit from reform and improved management practices. But to unilaterally pull out of the largest coordinating body on everything global health, is like throwing the baby out with the water. It is a draconian move that undermines everyone’s health in a globalized world where people, goods, and services move around and can become vehicles for diseases.
Stephanie Psaki, a former U.S. coordinator for global health security at the National Security Council, said in a January 28 op-ed on STAT that WHO withdrawal “will sever ties with critical partners, cut our resources to stop outbreaks before they reach our shores, diminish our access to vital early warning data, slash the pipeline of innovative vaccines and treatments that could be used in an emergency, and hamper the ability of federal agencies to act quickly to warn Americans about emerging threats.”
“Unfairly onerous payments from the United States” are cited in President Trump’s executive order to withdraw from WHO. Though the U.S. is the single biggest donor to this UN agency, giving $1.284 billion in the 2022 and 2023 fiscal years, it is critical to understand that mandatory contributions are assessed on a country’s domestic product and population size and only represent 20% of WHO’s total budget.
The rest of WHO’s budget comes from voluntary contributions earmarked for specific health programs. In fact, mandatory contributions from the US to the WHO are not much higher than those from China, which are $218 million versus $115 million. Funds for the WHO represent 4% of America’s budget for global health. For a detailed breakdown of the U.S. global health budget, consult this resource.
Reforming WHO is a process that is already in progress, said Elisha Dunn-Georgiou, President and CEO of the Global Health Council, in an email to the Fulcrum. “In recent years, under the direction of the U.S. and other member states, the WHO has made several changes to improve financial management and operational performance,” she explains. Withdrawing from the WHO also means having less influence in creating a more efficient agency. This resource from the BetterWorld Campaign, shared by Dunn-Georgiou, provides some insight into WHO reforms, which include how member fees are calculated.
Katelyn Jetelina, an adjunct professor at the Yale School of Public Health and the publisher of Your Local Epidemiologist, a newsletter on Substack, says that self-interest is one reason all Americans should care about the WHO withdrawal executive order. “Infectious diseases don’t respect borders. Covid-19, flu, Ebola—you name it. Even if the U.S. is well-equipped to handle its own health challenges, our safety depends on the rest of the world being equipped, too.”
This executive order comes at a time when the country is facing one of the largest recorded tuberculosis outbreaks in U.S. history in the state of Kansas and an Avian influenza outbreak in poultry and dairy farms that has already caused one human death. To make matters worse, a gag order was imposed on the U.S. Center for Disease Control and Prevention (CDC) to stop communicating with the WHO immediately. This hinders data exchange on current disease outbreaks to protect all Americans.
Another reason Americans should care about WHO withdrawal, Jetelina says, includes geopolitical implications and the likelihood that others, especially China, will step in to fill the public health leadership vacuum left by the United States.
Technically, countries cannot withdraw from the WHO without giving a year’s official notice. However, a story published in KFF Health News reports that in his order, President Trump cites the termination notice he gave to WHO back in 2020. If Congress or health experts push back, his administration can argue that more than a year has passed. This is a calculated move rooted in Project 2025 priorities.
A week after the WHO executive order, a State Department memo issued a 90-day Stop Work Order on all U.S. foreign assistance—less than 1% of the federal budget. For comparison, defense spending accounted for 13.3% in 2023. Halting these life-saving health programs in the world's poorest nations will have devastating consequences.
Former USAID global health administrator Atul Gawande warned on X that the order disrupts critical programs, including HIV drug distribution for 20 million people, polio eradication, and containment of deadly outbreaks like Marburg in Tanzania and an mpox variant killing children in West Africa. "Make no mistake—these essential, lifesaving activities are being halted right now," he stressed. "Consequences aren’t in some distant future. They are immediate."
Atul Gawande's social media post
Being part of the WHO is a strategic U.S. investment, a “soft diplomacy” tool, health experts say. “The investments the U.S. government makes in global health results in enormous returns, providing both economic and national security rewards as well as improving our standing throughout the world,” said Dunn-Georgiou. “They result in job creation in, among other sectors, biotechnology, medical devices, and pharmaceuticals. It also bolsters local economies through new contracts.”
On Tuesday, January 28, a State Department memo signed by Marco Rubio temporarily lifted the Stop Work Order for select life-saving activities overseas, including core life-saving medicines, medical services, food, and shelter. However, withdrawal from the WHO remains in place and blocks data exchange and disease surveillance with this global institution, potentially resulting in dire consequences for Americans.
Beatrice Spadacini is a freelance journalist for the Fulcrum. Spadacini writes about social justice and public health.
image of U.S. President Donald Trump is displayed on a digital billboard in Times Square in New York on April 8, 2026.
Trump is stuck between two realities. Neither serves the American people
Normally, I worry that events may overtake a column. But not so with the Iran war.
I don’t worry about running afoul of a headline or Truth Social post from the president because what is said about the situation is no longer very relevant to the reality.
On April 8, Nick Catoggio, my Dispatch colleague, dubbed an earlier stoppage with Iran “Schrödinger’s ceasefire.” This was a reference to the famous thought experiment by the physicist Erwin Schrödinger, who was trying to explain the weirdness of “superpositionality” in quantum physics. A cat in a box is both dead and alive at the same time until you open the box. Schrödinger meant to illustrate the absurdity of the idea that particles aren’t any one thing, but a “cloud of probabilities.”
The Trump administration is stuck in a word cloud of probabilities of his own making. The war is over. The war is on. The war isn’t a war. We have a deal, but we don’t have a deal, but we’re about to have a deal. We destroyed Iran’s military. No, we left it intact. We want regime change. No we don’t. We already accomplished it. We “obliterated” Iran’s nuclear program a year ago. We had to go to war in February to prevent nuclear war. The Strait of Hormuz is open, closed, or something in-between. No deal without “unconditional surrender.” Let’s make a deal!
This everything-all-at-once vibe can be disorienting, particularly since most Americans didn’t have a war with Iran on their bingo cards until the shooting had already started. President Trump didn’t prepare the country or consult with Congress beforehand because he thought it would all be a smashing success in a matter of weeks.
The miscalculation that started it all: killing Iran’s Supreme Leader, Ayatollah Ali Khamenei, and much of Iran’s senior leadership, on the first day of the war. To “the great proud people of Iran, I say tonight that the hour of your freedom is at hand,” Trump announced on Feb. 28. “When we are finished, take over your government. It will be yours to take. This will be probably your only chance for generations.”
I support regime change in Iran and shed no tears for Khamenei or his goons. But when you start a war by killing the regime’s top leaders, it’s not unreasonable for the remaining ones to conclude that you really intend regime change.
Khamenei was a murderous fanatic, but he was a fairly cautious one. He liked to threaten closing the Strait of Hormuz or attacking our regional allies, but he was reluctant to actually do it, fearing it would invite a regime change war. The mullahs and IRGC goons believed, not unreasonably, that if they lost their grip on power, they’d be lynched by the Iranian people they’ve brutalized for decades.
By starting with a regime change war, Trump removed any reason for the regime not to go for broke. When you have nothing to lose — particularly when you are a millenarian religious fanatic — a Persian Alamo strategy makes a lot of sense.
So Iran closed the Strait of Hormuz and attacked its neighbors.
But it turns out this wasn’t the Alamo. In the contest of wills, Trump blinked. The Iranian regime’s tolerance for punishment proved — so far — to be greater than Trump’s and that of our gulf allies. Militarily we could finish the job, but that would require ground troops and much greater economic turmoil. In a conflict Trump launched unilaterally without the prior support of Congress, NATO or the American people, Trump doesn’t have the political capital for that.
But that’s only half the problem. Trump wants the war over, but he doesn’t want to pay — militarily, economically, politically — what that would cost. So he wants to make a deal that ends it. But there is no deal available that wouldn’t come at an equally undesirable cost. Any deal that looks like what President Obama struck with the Iranians would be too embarrassing to bear. But the Iranians are convinced that they can get just such a deal, and they’re willing to drag things out as long as it takes.
The result: Trump’s in a box of his own making. He thinks he can talk his way out by simply asserting a reality that doesn’t exist. When the financial markets get nervous, he announces a breakthrough that is, at best, a possibility. When the Iranians agree to a deal that looks similar to one Obama might negotiate, Trump goes back to his threats.
It can’t go on forever. But I’m sure it’ll last until long after this column is forgotten.
Jonah Goldberg is editor-in-chief of The Dispatch and the host of The Remnant podcast. His Twitter handle is @JonahDispatch.