The World Health Organization imposed a freeze on hiring and other cost-cutting measures as it grapples with the imminent withdrawal of its largest donor, the United States, due to President Donald Trump's executive order.
WHO Director-General Tedros Adhanom Ghebreyesus put an immediate hold on new recruitment, ordered almost all meetings to be held virtually, and limited technical support missions to countries in the greatest need.
Another Trump directive to federal health agencies to pause all external communications also poses risks if a new outbreak or emergency occurred in the United States and no U.S. information about it were provided, according to WHO spokesperson Christian Lindmeier.
"That would really cause a problem, both for the U.S. and as much for the citizens of the world, because if vital data for any outbreak anywhere around the world is not shared, that has been hampering response efforts all the way along," Lindmeier told a press briefing on Friday.
WHO's emergency moves follow months of warnings by top officials that the U.N. health agency will dramatically suffer if U.S. funding is pulled.
“This announcement has made our financial situation more acute, and we know it has created significant concern and uncertainty for the WHO workforce,” Tedros wrote staff in an email reported by news agencies.
On Monday, the day of his inauguration, Trump authorized the second U.S. withdrawal from the U.N. health agency. In July 2020, Trump delivered a one-year notice that the U.S. would withdraw. President Joe Biden's election win that year enabled him to reverse the withdrawal in Jan. 2021.
Tedros told staff he hoped the second Trump administration would "reconsider" its decision, but that still other measures to prepare for the budget hit would be taken, including fewer replacements of IT and office equipment and cutbacks in renegotiating major contracts.
“This set of measures is not comprehensive, and more will be announced in due course,” he added.
A crisis of funding
The United States provides 18% of WHO's budget, with the Gates Foundation the next largest donor. Germany is the next largest government donor, providing 3% of the organization's funding.
The U.S. withdrawal would strip approximately US$1.3 billion from WHO's budget over the next two years, exposing the precarious nature of the organization's funding structure. With a biennial budget of US$6.8 billion – approximately 42 cents per person globally per year – WHO operates on roughly the same budget as a mid-sized hospital while serving as the world's leading public health agency. In stark contrast, the Gates Foundation spent more than US$15 billion during the same period.
In the past year alone, WHO teams responded to over 70 global health emergencies, including Ebola in Uganda, cholera outbreaks across two dozen countries, and the continuing health crisis in Gaza. Despite this global mandate, over 80% of the agency's annual funding is earmarked for specific programs dictated by donor countries and organizations, meaning WHO itself has no say over how the money is spent.
From 2022 to 2023, only 4.1% of voluntary donations, worth US$320 million, were fully flexible, severely limiting WHO's ability to direct resources where they're most needed. Half of WHO's voluntary donations come as one-year grants, leaving the organization heavily reliant on short-term staff lacking job security year-to-year.
In a bid to increase flexible funding for the organization, WHO's 194 member nations recently agreed to increase their mandatory fees to fund up to 50% of the organization's annual budget by the end of this decade, up from the current 30%, aiming to reduce dependence on unpredictable voluntary contributions.
The timing of the U.S. withdrawal is particularly challenging as WHO recently concluded a major fundraising campaign that fell far short of its targets. The U.N. health agency received US$1.7 billion in new commitments toward its US$11.15 billion budget for for 2025 to 2028, just half what the organization hoped to raise in the funding blitz.
Several emerging powers, including Brazil and Saudi Arabia, that co-hosted the "investment round" made no pledges, while China contributed just US$20 million. The U.S. also made no new commitments as the shadow of Trump's impending return to the presidency blocked the country's ability to provide new finance.
Retreat from global commitments
In his executive order, Trump accused WHO of "mishandling" the pandemic and "other global health crises" and not adopting needed reforms or demonstrating independence from "inappropriate political influence" by some member nations, which he did not specify.
He also complained the U.S. pays too much to WHO while China, with a far greater population, pays 90% less. At the signing ceremony, Trump further lambasted the agency. "World Health ripped us off, everybody rips off the United States," he said. "It's not going to happen anymore."
At US$260 million, the U.S. assessed contribution – WHO's term for membership fee – represents just 0.07% of what its government spends on its health and human services budget each year.
The rest of the U.S. funding for WHO is disbursed voluntarily to combat global health epidemics such as HIV, tuberculosis, polio, and other health concerns viewed as threats to U.S. national security.
The U.S. exit is part of a broader retreat from international commitments announced by Trump this week. The president terminated U.S. participation in climate finance initiatives, cutting off US$9.5 billion in annual funding – just 0.147% of the US$6.2 trillion U.S. federal budget.
He also froze foreign development aid for 90 days, affecting critical programs like the World Food Program during escalating global crises.
Trump's order also halts U.S. participation in negotiations over a new global pandemic preparedness agreement and directs officials to rescind the 2024 U.S. Global Health Security Strategy – a framework designed to protect Americans and others from future health security threats.
Recent modeling from the Lancet journal indicates a 23% chance of another pandemic as severe as COVID-19 within the next decade, with potential deaths averaging 2.5 million annually over the long-term. A separate forecast by modelling firm Airfinity projects a 27.5% chance that a pandemic as deadly as COVID-19 could occur in the next 10 years.
"This is the darkest day for global health I've ever experienced," said Lawrence Gostin, a professor of global health at Georgetown University. "Along with withdrawing from WHO, Trump is likely to slash global health funding. That means for HIV, sexual health, polio eradication & health emergencies. Trump could be sowing the seeds for the next pandemic."
China's growing influence and pandemic origins
The political backdrop centers largely on disputes over China's role in the COVID-19 pandemic. While Republicans accused WHO of "caving" to Chinese influence, experts note the organization – with its limited budget and lack of enforcement powers – has no ability to compel information sharing from the world's second-largest economy.
Ironically, U.S. withdrawal may strengthen Beijing's position within WHO. China's foreign ministry pledged to "continue to support the WHO in fulfilling its responsibilities," positioning itself to fill the vacuum left by American departure.
Critical questions about the pandemic's origins remain unanswered. No infected animal has ever been confirmed at the Huanan Seafood Market. Information about dozens of early cases from Nov. and Dec. 2019 remains inaccessible, and China has not shared its database of 22,000 wildlife samples collected before the pandemic
The Wuhan Institute's virus database was taken offline in fall 2019 and never restored, even as the pandemic emerged, leaving it unclear whether the Wuhan lab possessed a precursor of the pandemic virus.
The withdrawal faces potential legal hurdles. Since the U.S. joined WHO through a joint resolution of Congress in 1948, legal scholars argue that presidential authority to unilaterally withdraw may be limited. The process requires a one-year notice period and payment of outstanding dues – which Trump's order to freeze funding may complicate.
Moussa Faki Mahamat, chair of the African Union Commission, said he was "dismayed" by the executive order and hoped the Trump administration would reconsider.
The U.S. was "crucial in shaping global WHO instruments and norms on public health security and well-being over the past seven decades," he said. "Now more than ever, the world depends on WHO to carry out its mandate to ensure global public health security as a shared common good."
