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.
Children watch a July Fourth Parade along the Walkway of Heroes and Independence Avenue on July 04, 2026 in Tappan, New York.
The Great American Grumpfest
Our nation’s 250th birthday party didn’t feel especially patriotic and wasn’t as much fun as the 200th anniversary was.
President Trump, who did his best to co-opt our holiday for his personal aggrandizement, was a major reason. The party he threw in Washington, D.C., was crankier than uplifting, and less about celebrating our shared past and a promising future than about reminding us how far we have strayed from our founders’ plan to create a republic that future Americans would keep in good working order.
Credit Trump this much. He has a singular gift for picking at scabs that other politicians would rather ignore and pushing us into reckonings we don’t need.
The thing is, Americans have seen all this before. Sometimes the makeover we were encouraged to undertake was more conservative, sometimes more liberal. Whatever direction we were pushing, however, the reckoning we had in mind this time had to be more forthright and the conclusion more definitive than it was the last time.
Our current discontents, the ones behind the reckoning President Trump has been trying to inspire, are not trivial. Included among them are immigration, birthright citizenship, exploding healthcare costs, election rigging, a gag-inducing national debt, how we educate our children, too many genders, racial differences we can’t move past, a lopsided economy that favors more well-off Americans, and historic levels of political corruption and graft. Add to these the several foreign adventures he has pushed us into or is anxious to undertake, and you have the makings of a national headache the likes of which we haven’t had in half a century.
All the elbow-throwing and overheated rhetoric we’re using today have begun to look almost normal in all the ways that bickering neighbors and feuding family members appear normal. But they have also made us look mean-spirited and have portrayed our differences as irreconcilable. To ourselves, of course, but also to many people outside the United States who might be forgiven for turning their heads and not looking at the national car wreck we Americans show no interest in avoiding.
The good news, as I suggested above, is that Americans have had a great deal of practice dealing with challenges and national car wrecks like these.
This essay begins to lay out the reasons why.
By way of illustration, we have our seemingly insatiable demand for more bad news about race in America.
Sixty years after being released from the legal constrictions that bedeviled both white and black Americans, many white people have come to believe the color that used to make them unassailable is now a sign of a moral inferiority born of a racial animus they can never wash off. Many black people, on the other hand, are insisting that America is as hopelessly stacked against them as the formerly unassailable white people’s ancestors used to tell their black ones.
The result is that many people today are buying into racist nightmares and mumbo jumbo that their black and white ancestors worked hard and effectively to put in each other’s heads.
This might be dismissed as crazy behavior if it weren’t so important to rituals Americans have long used to express their deepest fears about each other while figuring out what move they can make that won’t end with their world crashing down on everybody’s head.
Unfortunately, the kind of cultural sleight of hand we have used to ramp up our racial differences has been appropriated by people who have many other cultural fears and unresolved differences with each other. Their clumsy but culturally prescribed missteps are making all these other issues look as irremediable as our racial problems.
A good place to start an answer to how we back away from ledges is Alexis de Tocqueville’s writing on early-19th-century American democracy. He had an optimistic take on Americans’ unscripted displays of public bravado, recrimination, and payback.
For him, these were occasions when people tried to mitigate the effects of the unfair hand they were dealing someone else or had themselves been dealt by behaving in ways quite at odds with how they would otherwise be expected to act. These inversions of what Tocqueville called “the natural order of conscience” presented themselves as a loud but culturally muted challenge to the hypocrisies that people had built into the world they’d made together.
One of his favorite illustrations of early-American hypocrisy involved slave masters sleeping with their less-than-worthy slaves. To the best of my knowledge, he didn’t pick up on all the ways that slaves messed with their owners. Their well-chronicled and quiet resistance showed that even severely ill-treated people can exercise more control over their lives than outsiders appreciate.
Be that as it may, such inversions of a people’s “natural order of conscience” make a good public show of them wrestling with demons they can’t or may not want to shake off, but in any case, are nowhere close to figuring out how to cast out.
Implicit in these disruptions was the discomforting idea that people might flip the entire script and turn the world on its head in more permanent ways. That kind of flipping worked out better for us in our revolution against England than in our Civil War. These events taught us the value of stepping back from historically unprecedented ledges.
Americans of late have been giving loud expression to a long list of things they don’t like about each other and the last makeover they started but didn’t finish a half-century ago. The outcome of our fights today will be as revealing as they are embarrassing to everyone who imagined they could recast our country in a way that privileged their favorite kind of Americans.
Their disappointment with the accommodations they strike will be palpable, but the middling results they achieve with all their pushing and shoving won’t be anything they can’t live with.
Anthropologists who have written about such moments in other cultures less “advanced” than our own show that people find ways to work around their seemingly irreconcilable differences without ever fully resolving them. Indeed, the patches and repairs people make have the unheralded effect of reinforcing rather than undermining the legitimacy of the practices and values they thought were fundamentally flawed.
For example…
White guilt and black pessimism do more good than putting cash into the pockets of professional shamers and handwringers. They give the rest of us who don’t feel guilty or powerless more time to make the world less racially unequal. Good news.
Regarding illegal immigration, the entrance requirements for future immigrants will remain stringent. Americans will applaud the continued detention and deportation of the few illegal immigrants who commit serious crimes. Good news.
All the people who came to the United States without being legally vetted and were locked up for a time will be released in numbers small enough to avoid serious media attention. Along with the several million other good people who snuck in but avoided capture, the former detainees will go to school, find gainful employment, pay their taxes, and stay out of trouble. Many will eventually become citizens. Good news.
Investigations into election tampering and Donald Trump’s 2020 presidential loss will come to an unceremonious conclusion the day after his second term ends. Many Americans will grumble about this, but there will also be some quiet partying, too. Good and bad news.
Congressional hearings into all the grifting accomplished by people tied to the Trump administration will end without anyone having to pay a dime back to the American taxpayers. Bad news, we’ll learn to live with.
New laws and regulations will be created in the hope that the kind of corruption practiced by President Trump will not be repeated for another 250 years. Good news, I hope we’ll live long enough to enjoy.
Show trials for people who allegedly vandalized the Lincoln Memorial Reflecting Pool, if they happen, will get big television viewer ratings. Good news.
Trials for pardoned Capitol insurrectionists who committed serious crimes after their release should get more attention, but won’t. Bad news.
We will continue to hear nothing from most of the people who were pardoned for crimes they committed in the insurrection at the Capitol on January 6, 2021. They will keep their mouths shut and their heads down for the rest of their life. Good news.
The gold-gilded ornaments that Donald Trump had plastered all over the White House will be shipped to Mar-a-Lago, where the former president will sell them on eBay. Fun news.
American taxpayers end up paying for most of the new East Wing, the removal of the miniature gladiatorial arena that was built behind the White House, and the restoration of the White House rose garden. Bad news.
The Triumphal Arch was never built. Good news.
Trad wives and gay couples raise perfectly lovely children. Good but unsurprising news.
Trans men and women learn that most Americans can’t figure out who they used to be. No one gives a second thought to their use of “family bathrooms” or “unisex bathrooms” in public settings, businesses, and schools. Communities will sponsor athletic teams that have trans boys and girls just to show they can. Good news.
Budget deficits will be kicked down the road for someone else’s children to pay down. Bad news.
Federal agencies that had their budgets and employee ranks slashed during President Trump’s second term are getting some of the money and lost positions back. Good news.
Elite universities will buy their way out of DEI purgatory by competing for conservative scholars whose inflated salaries dwarf those of their liberal colleagues, who will think about suing their institutions for reverse discrimination but won’t be able to figure out who would pay for it or care. More fun news.
Okay. I’ve probably missed some ways that Americans will step back from the ledges they have been making noises about leaping off. But to the extent that my predictions pan out, the best and most important moral of the stories about us stepping away is this: everything we lost and took back, or had returned to us, will have happened without our government collapsing, civic traditions crumbling, or our people beating each other up.
The reason why is that the differences Americans have with each other really weren’t as irreconcilable as we made them out to be. The empty-sounding bromide that Americans have more that unites us than divides us turns out to be true, not just metaphorically but in fact.
Now that is really something to celebrate.
Daniel J. Monti (danieljmonti.com) is Professor of Sociology at Saint Louis University and the author of American Democracy and Disconsent: Liberalism and Illiberalism in Ferguson, Charlottesville, Black Lives Matter, and the Capitol Insurrection.