A founding champion of the World Health Organization since its founding in 1948, the US has been closely involved in the organisation’s bureaucratic operations in addition to providing indispensable ongoing financial support. As a steady top funder, the US has provided between $200-million and $600-million annually over the last decade.

In 2016, something changed. Since his rise to political prominence, Donald Trump has distinguished himself as a vocal critic of the WHO (among other United Nations’ agencies), frequently expressing dissatisfaction with its policies and practices, a scepticism predating his tenure as president and exceeding the scope of the WHO’s handling of the Covid-19 pandemic.

As early as March 2016, in a speech to the American Israel Public Affairs Committee, he deemed the UN “weak”, “incompetent”, and “not a friend of democracy or even to the United States”.

Facing his first public health crisis as president in 2017 amidst the Zika and Ebola epidemics, Trump initially praised the WHO’s handling of these outbreaks but turned quickly to scepticism of America’s level of funding to the organisation. In 2018, President Trump requested that the US Congress rescind $252-million in residual funding designated to combating the Ebola epidemic.

‘America first’

President Trump’s contentions with US support of the WHO seem a natural conclusion of his signature campaign line, “America First”, a phrase traditionally employed to promote ideas of isolationism and non-intervention, signalling prioritisation of US interests at the expense of international relations.

The slogan was adopted as the official foreign policy doctrine upon Trump’s succession, and despite bipartisan support for foreign aid spending, in 2017 the federal budget plan for the following fiscal year proposed substantial cuts to international health programmes, signalling the beginning of a trend which would intensify over Trump’s tenure.

Throughout his term, President Trump introduced policies aimed at undermining international organisations such as the European Union, while threatening to withdraw or reduce US support for and participation in others, including Nato and the UN.

Read more in Daily Maverick: Once-bitten Europe is better prepared for Trump’s Nato tirades

The administration made a number of notable changes in broader US foreign policy affecting global health, including withdrawal from the Paris Climate Accord. The administration also proposed cutting foreign aid to countries that voted counter to US government wishes at the United Nations, underscoring President Trump’s habit of prioritising national and even personal agendas over global welfare.

Whereas elevating human rights had been a key component of US foreign policy under the Obama administration, the Trump administration downplayed the importance of supporting international welfare initiatives, causing upset in foreign policy and health security communities and garnering letters from members of Congress expressing concern about consequences for global health.

China fall outs

Meanwhile, suspicions about disproportionate influence from the Chinese government on WHO politics seemed to further affect Trump’s perspective, reflecting broader geopolitical tensions between the two nations.

A turning point arrived in April 2020. In an unprecedented move, President Trump, after accusing the WHO of mismanaging the Covid-19 crisis and of ceding to Chinese political motives, declared suspension of US funding while his administration reviewed WHO activities.

In a May 2020 letter, President Trump issued an ultimatum to the WHO Director-General: the US would withdraw all support if the WHO would not “commit to major substantive improvements within the next 30 days”, alleging findings by his administration’s review confirming previous suspicions of mismanagement.

War with WHO

However, before reaching the 30-day deadline, during a May 29 press conference, Trump announced his decision to sever US involvement with the WHO: “We will be today terminating our relationship with the World Health Organization,” an unexpected statement which shocked the global community and Trump administration staffers alike.

On 6 July, the administration gave formal notice of US withdrawal to the UN Secretary-General. Consequently, the US fell from its longtime position as the foremost WHO financial contributor to the third during the 2020-2021 funding cycle.

The decision was widely met with confusion and upset. Many questioned the wisdom of disengaging from a crucial international health body in the midst of a global pandemic, arguing that this could leave a leadership vacuum and hinder international efforts to combat not only Covid-19 but other ongoing and future threats to global health security.

Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University, told The New York Times that the decision would prove “disastrous,” in addition to weakening US influence in matters of international health diplomacy.

“President Trump’s official notice of withdrawal from the WHO is among the most ruinous presidential decisions in recent history,” Gostin, who is also affiliated with the World Health Organization, stated.

On his first day in office, US President Joe Biden, seeking to unify the global response to the pandemic, reversed Trump’s decision to withdraw from the WHO.

“The WHO plays a crucial role in the world’s fight against the deadly Covid-19 pandemic as well as countless other threats to global health and health security,” Biden stated in a letter to UN Secretary-General António Guterres. “The United States will continue to be a full participant and a global leader in confronting such threats and advancing global health and health security”.

Dr Thomas Frieden, a former director of the CDC, emphasises the WHO’s accomplishments. “Without WHO, the world would not have eradicated smallpox, multidrug-resistant tuberculosis would have spread much more widely, and we would have much weaker systems to track influenza and other deadly infections.”

Despite renewed relations between the US and the WHO, we must be prepared for the reverberating implications of a possible second Trump term.

In a re-election campaign seemingly driven by the prospect of political vengeance and an even greater emphasis on “America First”, there is a high probability that a 2024 Trump electoral victory would again place the WHO, a perceived political adversary it seems, in the crosshairs.

Securing the future of the WHO, on which the developing world depends much more than the developed, will be crucial to securing global health and our collective welfare on our planet. DM