“President Trump is trying to reduce the size of the WHO, and the question is whether other high-income nations, such as those in Europe, Australia, Japan and elsewhere, will take up some of that work,” Vermund says. “Will the Gates Foundation, which has been a very generous donor, pick up anything? It is conceivable that others will improve things until we have a new administration that is more WHO-friendly, but I doubt they can take over the entire portion of the WHO budget that the United States pays.”
And it’s not just money that the United States provides to the WHO, but also personnel and expertise. “The Centers for Disease Control and Prevention has seconded a number of staff to the WHO, and I would predict that the Trump administration, with a new CDC director, will call those people home,” Vermund says. “That would create a big gap, because WHO funds don’t pay for those people. “So I think there would be an almost immediate reduction of the workforce and the elimination of critical professionals within the WHO organization.”
According to Gostin, much of the money the United States provides to the WHO is mandatory core funding, which all members must contribute, but some funds are specifically earmarked for causes in which the United States has a vested interest, such as polio eradication. HIV/AIDS and the process of identifying and controlling disease outbreaks before they spread and reach American shores. Without US funding, Gostin says these programs would not disappear completely, but they would be significantly weakened.
“Polio could come back,” says Gostin. “Remember, just a couple of years ago we had polio in New York sewage and our children are not being vaccinated. And we’ve had other real health problems in America, not just Covid-19, which killed more than a million people. We’ve had Zika and the next health emergency could be just one or two mutations away. Maybe it is already here in the form of avian influenza, and we are going to need the WHO to help us with that.”
Both Gostin and Vermund fear that withdrawing from the WHO will put the United States at the back of the line when it comes to receiving critical information, such as pathogen samples and genomic sequencing data, that pharmaceutical companies need to generate effective vaccines. Gostin cites how the United States relies on WHO data each year to effectively update the seasonal flu vaccine, while Vermund explains that, financially, it is much more efficient for the United States to fund the WHO to help to “extinguish” diseases at their source, rather than trying to address them when they arrive in the country.
“We spent over $2 billion preparing for Ebola to arrive on American shores in 2014 and 2015, and because we only had five or six cases, that was very cost-ineffective,” Vermund says. “So that’s a typical example of how when the United States acts alone, it will be very inefficient compared to contributing to a multinational response to control a disease in the country of origin.”