Immediately after assuming office, US President Donald Trump signed the executive order withdrawing from the World Health Organisation (WHO) on Monday (20 th January).
The decision came owing to the global health agency’s Covid pandemic mishandling and other global health crises.
“The United States noticed its withdrawal from the World Health Organization (WHO) in 2020 due to the organization’s mishandling of the COVID-19 pandemic that arose out of Wuhan, China, and other global health crises, its failure to adopt urgently needed reforms, and its inability to demonstrate independence from the inappropriate political influence of WHO member states,” the executive order signed by President Trump reads.
Disproportionate financial burden, surging Chinese influence and more: Why the USA decide to go from being one of the largest contributors to withdrawing from WHO?
The executive order signed by President Trump further pointed out that the United States bears a disproportionate financial burden of funding WHO compared to other countries, particularly China. The executive order says that WHO demands “unfairly onerous payments from the United States, far out of proportion with other countries’ assessed payments. China, with a population of 1.4 billion, has 300 percent of the population of the United States, yet contributes nearly 90 percent less to the WHO.”
In a statement made in the Oval Office on Monday, President Trump said that the US had paid $500 million to the WHO, while China, despite its much larger population, contributed only $39 million. This significant imbalance, according to Trump, was a key factor in his decision to cut ties with the organization.
“We paid 500 million dollars to the World Health Organization, while China, with 1.4 billion people, paid just 39 million. It seemed a little unfair to me,” Trump said.
Interestingly, China has extended support to WHO after Trump signed an executive order to withdraw from the health agency.
The Trump administration also pointed out WHO’s failure to adopt “urgently needed reforms”, hinting at a wider discontent over the global health body’s structure, accountability, and effectiveness in handling health issues worldwide. Besides, political influence of member states on WHO has also been a source of discontent of the newly-inaugurated Trump administration.
Even during his electoral campaign, Trump had emphasised on the necessity for the United States to re-evaluate the country’s commitments to international organisations based whether such bodies are in line with the US’s narrative or serving the country’s interests efficiently or not.
The United States has historically been a significant contributor to both the WHO’s emergency appeal and its overall budget, which is set at $6.8 billion for 2024-2025. According to WHO data, the United States donated approximately 34% of the funding available for health emergencies over the last two years, with previous contributions reaching 50%. It also provides around one-fifth of the WHO’s total funding.
Under the Biden administration, the United States remained the WHO’s top financier, accounting for about one-fifth of the agency’s $6.8 billion annual budget in 2023.
While the US has been a key contributor to World Health Organisation so far, however, the country’s withdrawal from WHO means that it will no longer be contributing huge amounts of funds to the health agency. This would potentially diminish WHO’s influence in global health policy and emergency responses. The US government’s decision to withdraw from WHO can also isolate the country from international cooperation on health issues, however, the country would try to come up with more direct and effective US-led health initiatives outside the WHO framework to curb the adverse impact of withdrawing from WHO.
Meanwhile, WHO has issued a statement lamenting the US’s departure from the organisation. WHO outlined its role in “protecting the health and security of the world’s people, including Americans, by addressing the root causes of disease, building stronger health systems, and detecting, preventing and responding to health emergencies, including disease outbreaks, often in dangerous places where others cannot go.”
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The health organisation expressed hope that the Trump administration would reconsider its decision to withdraw from WHO and indulge 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.”
As a disproportionate financial burden and Chinese influence emerged as major reasons behind the US’s withdrawal from WHO, it is crucial to understand who funds this health organisation and how these funds are utilised.
Who funds WHO?
WHO has two main sources of funding, first, Member States paying their assessed contributions (countries’ membership dues), and second, voluntary contributions from Member States and other partners.
The assessed contributions are a percentage of a country’s gross domestic product (the percentage is agreed upon by the United Nations General Assembly). Member States approve them every two years at the World Health Assembly. They cover less than 20% of the total budget. This implies that 80% of WHO’s funding comes from “voluntary contributions” made by member states, NGOs, philanthropic organisations or other private entities.
As per WHO’s data, the US’s net contributions payable for the years 2024-2025 stood at $ 260,625,940. Meanwhile, India’s net contributions payable for 2024-2025 were recorded at $ 11,989,020.
During the 2022-2023 biennium, the United States contributed US$ 1.284 billion to WHO, followed by Germany and the Bill & Melinda Gates Foundation (BMGF). BMGF has been a major contributor to WHO with its donations making up to 12% of WHO’s total funding.
The BMGF’s increased influence in WHO has been widely debated, particularly, concerns have been raised about a single private foundation being a major donor to WHO allowing Bill Gates to decide the health agency’s priorities if not absolutely become a decision maker setting global health agenda.
WHO’s contributors data for the years 2022-2023
Back in 2020, Lawrence Gostin, faculty director for the O’Neill Institute at Georgetown University had raised alarms about BMGF’s mounting influence in WHO and said, “If a private foundation were to become WHO’s highest donor, it would be transformational. It would enable a single rich philanthropist [Bill Gates] to set the global health agenda. The big concerns are that the Gates Foundation isn’t fully transparent and accountable. By wielding such influence, it could steer WHO priorities.”
Not to forget, Bill Gates who recently sparked criticism for indicating that India is a “laboratory to test new ideas”, had back in 2020 called then-President Trump’s decision to halt WHO funding, “as dangerous as it sounds”.
The other among the top 10 contributors for the year 2022-2023 included the vaccine alliance GAVI, the European Commission, the United Kingdom of Great Britain and Northern Ireland, Canada, Rotary International, Japan and France.
For its next budget spanning 2025-2028, WHO has obtained $1 billion in pledges, as announced by the health agency in October 2024. The financing commitments from various European governments, foundations, and organisations accounted for nearly $700 million of this total. Meanwhile, $300 million was raised from reaffirmed investment commitments. The financing was revealed during the WHO Investment Round Signature Event during the World Health Summit in Berlin in October, which was co-hosted by Germany, France, and Norway.
Germany emerged as a key contributor to WHO funding, investing approximately $400 million over four years, with an additional $260 million in voluntary funding. Wellcome, a UK-based philanthropic foundation, offered $50 million, with the Institute for Philanthropy, Resolve to Save Lives, and the World Diabetes Foundation each committing $10 million. The WHO Foundation also made a large pledge of US$ 50 million, drawing support from the commercial sector, particularly pharmaceutical companies including Boehringer Ingelheim and Novo Nordisk.
Is WHO losing credibility and independence?
The World Health Organisation has been accused of mishandling pandemics over the years. Be it the allegations of alarmism during the H1N1 outbreak in 2009, or the slow and nearly ineffective initial response to the Ebola outbreak in West Africa in 2014 and a delay in declaring it a Public Health Emergency of International Concern (PHEIC) causing a widened scale of the outbreak, or the more recent late declaration of a global health crises when Covid-19 outbreak allegedly due to superfluous trust in China’s narrative, WHO has been receiving flak for its handling of major global health crises.
In fact, a report by a panel set up by WHO called the combined response to Covid pandemic by WHO and global governments a “toxic cocktail”. The report found that the deadly virus killed over 3.3 million people globally with over 159 million infected.
“The situation we find ourselves in today could have been prevented. t is due to a myriad of failures, gaps and delays in preparedness and response,” co-chair Ellen Johnson Sirleaf, a former president of Liberia said.
China’s influence over WHO has been a major concern, particularly after the Covid outbreak. Back in 2020, US Senator from Idaho and Chairman of the Senate Foreign Relations Committee Jim Risch called to form an independent investigation against the World Health Organization alleging that the organization has been a political puppet of the Chinese government and the organization is unwilling to hold Chinese communist party responsible for the pandemic. President Trump had also accused the WHO of being heavily funded by the US but functioning in a more China-centric fashion.
On 14th January 2020, the acting head of WHO’s emerging diseases unit, Maria Van Kerkhove, downplayed the Covid threat, saying there is “limited human-to-human transmission” in Wuhan. Later, it issued a clarification, saying that human transmission was “possible” and “may” be happening. Six days later, Zhong Nanshan, a Chinese epidemiologist and a government adviser confirmed that the virus could actually spread between people. Moreover, when countries began imposing a travel ban on Chinese nationals to prevent the spread of Corona virus, not only China but WHO also opposed this saying that there is no need for steps that “unnecessarily interfere with international travel and trade.”
In 2021, WHO went a step ahead and claimed that the Coronavirus did not originate in China. The WHO joined by a Chinese expert mission claimed that the virus may have originated outside China. Back in 2020, the Trump administration had demanded investigation into WHO and China’s relationship alleging that it poses a threat to the US’s sovereignty.
The shameful episode of Peter Daszak being a part of the UN‘investigation team’that went to Wuhan despite his involvement in the Gain of Fuction research projects in the very same lab, and his earlier attempts to give a clean chit to the Wuhan Institute of virology did not flatter WHO’s image either. Throughout the pandemic, WHO maintained a ‘let’s not offend China’ stand.
Should India withdraw from WHO?
As the United States decided to withdraw from the World Health Organisation, a question arises if India should also consider withdrawing from the global health agency, particularly in the wake of mounting Chinese influence in the global health agency. However, before addressing the question of whether India should stay or withdraw from WHO, it is pertinent to understand WHO’s impact on India.
The World Health Organisation sets international health regulations and standards helping countries, particularly, developing countries like India in managing public health crises, and pandemics and enhancing health infrastructure. Over the years, WHO has provided India with technical guidance, training and resources to help the country in areas such as disease surveillance, outbreak response and health policy development. Besides, India’s membership in WHO allows it to partake in global health research, collaborative studies and data sharing. This has been crucial in tackling diseases like Tuberculosis (TB), malaria and several non-communicable diseases. WHO also supports India’s programmes on HIV, antimicrobial resistance and immunisation.
Notably, while WHO may not be the sole source of funding for India’s various health programmes, the USA’s withdrawal from the agency would have an impact on India’s health initiatives and also prompt other Member States to increase funding to WHO.
In July last year, India committed USD 85 million to the WHO Global Traditional Medicine Centre to support a cross-sectoral program of work to strengthen the evidence base for traditional medicine by providing data and evidence on traditional medicine policies, practices, products, and public use. As per WHO, this agreement was a part of “a US$ 250 million investment from India in support of the establishment of the WHO Global Centre of Traditional Medicine in 2022, which includes financial support for the workplan of the Centre, interim premises and a new building.”
WHO’s data on India’s contribution to the health agency (updated till 11-2024)
In November 2023, India’s Ministry of Ayush and WHO signed the Project Collaboration Agreement to standardise Traditional and Complementary Medical Systems, integrate their quality and safety aspects into the National Health System, and disseminate them at the international level. The first contract was signed in 2016 to take Traditional Medical systems like Yoga, Ayurveda, Unani, and Panchakarma to the global level and the second contract was signed in 2017 to strengthen the system of Ayurveda, Unani and Siddha medical systems.
It is undeniable that WHO’s collaboration with India has benefitted the country in tackling health issues. In 2014, India was declared Polio-free as WHO backed India’s extensive immunisation campaigns. WHO also played a key role in supporting India’s Revised National Tuberculosis Control Program (RNTCP), contributing to the development of strategies for TB control and elimination. The intergovernmental health agency also supports India’s measures to achieve Universal Health Coverage (UHC) which also includes supporting the implementation of the Modi government’s successful Ayushman Bharat scheme. Besides, WHO has also helped India strengthen its healthcare system, improve healthcare service delivery, enhance quality of care, and build healthcare workforce capacity. Its efforts in formulating and developing public health guidelines and standards to enhance healthcare practices across the country have also been significant.
India’s collaboration with WHO also compliments its role in global health governance allowing it to have an influence in shaping global health policies by active participation in discussions and advocacy in specific health agendas especially in the context of developing countries, and colluding with other member states to influence policy decisions at World Health Assembly and other WHO-related forums.
Interestingly, back in 2023, British-Indian cardiologist Dr Aseem Malhotra had alleged that WHO had lost its independence and that the Indian government should “ignore” WHO’s advice on health issues. Malhotra even asserted that India should withdraw from WHO. He pointed out that a major chunk of WHO’s funding comes from commercial entities that have the least interest in people’s health and that their main interest is in minting money by deceiving people.
“Seventy per cent of the funding of the World Health Organisation comes from commercial entities…. As long as the WHO is getting industry funding or funding from vested interests, it should not beconsidered independent and the Indian government should ignore its advice. Those commercial entities are not interested in your health, they will make money by deception,” Malhotra said.
However, just as the United States raised concerns about growing Chinese influence in WHO and allegations against WHO chief Tedros Adhanom Ghebreyesus of being pro-China as well as the alleged role of influential lobbyists for big pharma and private foundations having a significant say in WHO’s decision making and determining its policy, India needs to weigh all the factors if it decides to withdraw from the UN’s intergovernmental health agency.
On one hand, leaving WHO would allow India greater financial autonomy as the funds it allocates to WHO could be invested directly into its healthcare systems or channelled the funds to other less biased global forums outside the WHO framework, on the other, India would risk losing global influence in deciding international health policies and responses to outbreaks. Besides, India would also lose access to vital data and research on global health issues it WHO currently provides to India as a member state. Much like the US, India would also have to face global criticism if it decides to leave WHO especially given the stark differences in the healthcare situation in the two countries.
While the concerns around WHO’s declining credibility and independence are not unfounded, instead of withdrawing from WHO, India should push for reforms within WHO while continuing to benefit from global health cooperation. The country, however, should take measures to reduce reliance on WHO for health strategies as too much reliance on the UN body will detract India from its efforts at developing its indigenous health solutions as per the country’s socio-economic conditions. At this point, it would be more detrimental than beneficial for India to withdraw from the World Health Organisation. Thus, it would be better for India to leverage membership to advocate reforms within WHO while also emerging as a key player in filling the vacuum created by the US’s departure from WHO.
China and Europe would also want to fill the void created by the US, however, since Europe’s resources are mostly engaged in the Russia-Ukraine war, India would not want to miss this opportunity even though private foundations and philanthropies like the Bill and Melinda Gates Foundation will also step up efforts to fill the lacuna created by US’s exit. This could be India’s chance to bolster its position as the leading voice of the global south.
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