President Donald Trump’s decision to withdraw the US from the World Health Organization (WHO) will be keenly felt across the globe, with profound implications for health in Africa.
In the executive order putting the withdrawal process in place, Trump also paused the transfer of US funds, support and resources to the WHO.
Trump’s executive order is his second attempt to pull the US out of the agency. He has also complained that the US financial contribution to the international organisation is “onerous”.
The biggest impacts will come from the loss of US funding. The US is by far the WHO’s largest state donor, contributing approximately 18% of the agency’s total funding.
The WHO’s funding is split into two tranches.
There are assessed contributions: countries’ membership fees, to which all WHO members agree and over which the WHO has full control. The US accounts for 22%, or US$264 million of these, for the current 2024/25 budget. The US is yet to pay the WHO its assessed contributions for 2024 and 2025. Withdrawing from the organisation without paying these fees would violate US law and must be challenged in the US courts.
Then there are voluntary contributions: donations by member countries, foundations and other sources, usually earmarked to that donor’s priorities. The US contributes 16%, or US$442 million, of all voluntary contributions.
In the case of the US, these priorities include HIV/AIDS, polio eradication and health emergencies.
As experts in global health law, we are deeply concerned about the impacts of this order, which will be far reaching.
The US withdrawal from the WHO threatens core health programmes in Africa. It will weaken the ability of African countries to respond to health emergencies, and could lead to increases in death and illness on the continent.
It will also have broader implications for leadership and governance in global health.
Impact on core programmes
Trump’s decision to withdraw comes at a time when the WHO’s health priorities in Africa were already underfunded. Eight of 12 areas were funded less than 50% earlier this year.
Twenty-seven percent of all US funding through the WHO for the African region goes to polio eradication, 20% supports improved access to quality essential health services, and much of the balance goes to pandemic preparedness and response.
The WHO/US partnership has long supported the HIV/AIDS response in Africa, but the redirection and reduction in funds could reduce the availability of prevention, testing and treatment programmes across the continent. This threatens progress to end AIDS by 2030.
The funding gap will also have an impact on programmes designed to increase
access to quality essential health services, including the prevention and treatment of tuberculosis and malaria, and child and maternal health services.
If the WHO is forced to cut back on these services due to a lack of financing, it could lead to increases in mortality and morbidity in Africa.