Newly inaugurated, President Trump took a set of thick, black sharpies on Monday and signed a flurry of executive orders — including one that has people in the global health community deeply concerned. That order would withdraw the United States from the World Health Organization, a U.N. global health agency the U.S. helped found in 1948.
As he penned his name to the order, Trump began by saying, "Ooh, that's a big one." He then offered a set of spontaneous remarks about the rationale behind the withdrawal, which focused on what he and his team perceive as an unfair allocation of dues.
He noted that the U.S. pays WHO $500 million annually compared to China's $39 million contribution. But Trump raised the point: Should the U.S. pay so much more than China when its population (1.4 billion people) is way larger than the American population (341 million estimate by the Census Bureau).
"Seemed a little unfair to me," he said.
The executive order offered a couple of additional rationales for the withdrawal, including an assertion that WHO mishandled the COVID-19 pandemic as well as other global health crises, that member states leverage worrisome political influence and that the body "fail[ed] to adopt urgently needed reforms."
Were Trump's numbers accurate? And did they capture the full picture of the organization's financing?
Who's giving to WHO
The World Health Organization receives funding from two pots. The first is a set of assessed contributions from its nearly 200 member states. Each assessment is determined by the United Nations and based on a country's "capacity to pay," which involves both the size of its population and wealth. Member states vote to approve the assessments at the World Health Assembly every other year. For the years 2024-2025, WHO says that number has been set at $264 million for the U.S. and $181 million for China.
These assessed contributions constitute less than 20% of WHO's total budget.
The second, larger pool of funding involves voluntary contributions that originate from member states, philanthropic foundations like the Gates Foundation (which is a funder of NPR and this blog), corporations, nongovernmental organizations and private citizens. This voluntary basket is where the discrepancy between countries is more apparent. Across the same 2024-2025 time period, WHO says the U.S. is projected to provide $442 million (the largest voluntary contribution by far) whereas China is set to contribute just $2.5 million.
Adding up those numbers, the U.S. had been on track to pay $706 million (not quite 10% of WHO's budget) and China $184 million (almost 3% of the budget).
In other words, Trump correctly captured a difference in what the U.S. and China pay WHO but didn't get the numbers or proportions right. If he were referring to a combination of assessed and voluntary contributions, he asserted that China pays not quite 8% of what the U.S. pays. In fact, that number is closer to 26%.
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What Trump's withdrawal means
Beyond the finances, there's the message that a U.S. withdrawal from WHO would send.
"It would signal an attack by the largest and most economically powerful country in the world on international health cooperation," says David McCoy, a public health researcher at the United Nations University International Institute for Global Health based in Kuala Lumpur, Malaysia.
That cooperation, he argues, is essential for managing pandemics and other cross-border health threats.
In a statement, WHO expressed regret over the Trump administration's announcement to withdraw.
"We hope the United States will reconsider," the agency said, "and we look forward to engaging in constructive dialogue to maintain the partnership between the USA and WHO, for the benefit of the health and well-being of millions of people around the globe."
Any potential WHO shortfall because of the U.S. withdrawal will have an impact of course, one felt mainly by low- and middle-income countries that "are attracting more than their fair share of conflict and disaster," says Andrew Harmer, a global health policy researcher at Queen Mary University of London.
And it's challenging for a complex intergovernmental organization to shift its operations when it loses a significant slice of its operating budget.
"WHO's responsibilities to promote and protect public health should be as much as possible safeguarded from the kinds of tensions and conflicts and politics that go on between countries," says McCoy.
The effect will not be immediate, however. WHO's funding for 2025 is already secured, including from the U.S. The question is whether the organization will have to adjust its priorities according to a much-reduced budget starting in 2026.
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