The United States withdrawal from the world health organization (WHO), its implications for global health governance

Abstract

On January 20, 2025, the United States initiated its withdrawal from the World Health Organization (WHO) through an executive order, citing concerns over the organization’s handling of global health crises, political influences, and financial inequities. This commentary explores the historical context of the U.S.-WHO relationship, provides an analysis of the justifications for withdrawal, and examines the global and domestic consequences of this decision. Historically, the U.S. has been a significant player in the WHO, contributing substantial funding and advancing global health initiatives. However, tensions have arisen, particularly following the COVID-19 pandemic, where accusations of inefficiency, political bias, and financial disparities became more pronounced. The withdrawal highlights a call for WHO reform, particularly in enhancing transparency, accountability, and efficiency. On a global scale, the U.S. departure threatens to destabilize WHO’s funding, weaken leadership, and hinder future pandemic preparedness. Domestically, the U.S. plans to redirect resources to alternative organizations and enhance national health capacities. Critics argue that this move could weaken international collaboration, erode trust, and damage U.S. influence in global health governance. This commentary ultimately underscores the complexities and potential risks associated with disengagement from multilateral health initiatives and the broader implications for global health security.

Background

On January 20, 2025, the President of the United States took a monumental step by issuing an executive order to formally withdraw the U.S. from the World Health Organization (WHO) [1]. This decision marks a significant shift in global health policy, rooted in multiple concerns surrounding the WHO’s performance and management. Among the main reasons cited for this drastic move were the organization’s handling of global health crises, particularly the COVID-19 pandemic, as well as allegations of political influences within the WHO’s decision-making processes [1–4]. Additionally, the U.S. government raised concerns over perceived financial inequalities among WHO member states, which it argued undermined the efficacy of global health efforts [2].

The U.S.-WHO relationship has been historically complex, with the United States playing a pivotal role in both the founding and financing of the organization [3, 5]. Over the years, tensions have occasionally surfaced due to differences in priorities, political interests, and governance issues within the WHO [6]. Rather than representing a culmination of these tensions, the executive order should be seen as one expression of a particular vision of international relations held by a specific U.S. administration. This reflects a longstanding dynamic in which the United States, while supporting global health efforts through multilateral institutions, has consistently been cautious about ceding sovereignty to international agencies which is an ongoing theme in U.S.-WHO relations [1].

This commentary delves into the historical dynamics between the U.S. and the WHO, exploring the factors that led to the U.S. decision to withdraw. It also critically analyzes the justifications provided in the executive order, considering both the domestic and international impacts. While the U.S. withdrawal could potentially reduce its global health leadership, it raises critical questions about the future of international health cooperation. Furthermore, the commentary will examine the criticisms surrounding the decision, with a focus on how the absence of U.S. leadership may alter the trajectory of global health governance moving forward.

Historical Context of U.S.-WHO Relations

The United States has played a pivotal role in the development and operations of the World Health Organization (WHO) since its founding in 1948. As the largest financial contributor to the organization, the U.S. has provided substantial funding for key global health initiatives, including polio eradication, HIV/AIDS programs, and pandemic preparedness [3–5]. In recent years, the U.S. voluntary contributions to the WHO have consistently accounted for around 20% of the organization’s total budget, far surpassing those of other major donors such as the United Kingdom and Germany, who each contribute around 4–5% [3–5]. Through its partnership with the WHO, the U.S. has advanced health diplomacy, contributed to scientific research, and supported capacity-building efforts, particularly in low- and middle-income countries [3–5]. Despite this, tensions between the U.S. and the WHO have been a recurring theme over the years. A significant point of conflict arose during the HIV/AIDS crisis in the 1980s and 1990s when critics accused the WHO of failing to adequately address the scale of the epidemic or provide sufficient resources for an effective response. Similarly, during the Ebola outbreak in West Africa (2014–2016), the WHO’s response was widely criticized as slow and ineffective, raising questions about the organization’s ability to mobilize resources and coordinate a timely international response. The most notable instance, however, occurred during the COVID-19 pandemic, which exposed serious flaws in the WHO’s response mechanisms. Accusations arose regarding the delayed identification and communication of the virus’s spread, as well as the organization’s perceived deference to member states, especially China. These issues led to the U.S.‘s 2020 notification of withdrawal from the WHO, a move that was later rescinded in 2021.

However, this was not the first time the U.S. considered severing its ties with the WHO. A similar situation occurred in the 1970s during the administration of President Richard Nixon. At that time, the U.S. withdrew its funding from the WHO, a decision driven by frustrations with the organization’s approach to global health. This led to the U.S. championing a shift in global health leadership, notably empowering the World Bank. As a result, the World Bank became the primary institution for global health initiatives, and the U.S. influenced global health priorities, steering them towards structural adjustment programs and selective primary health care, which focused on cost-effective, targeted interventions rather than broad, comprehensive healthcare strategies [6, 7]. The legacy of this shift is still evident today, as the World Bank continues to wield significant influence in global health governance, often prioritizing economic considerations in its health initiatives. Historically, the U.S. has turned to the World Bank as an alternative platform for exerting leadership in global health, particularly when its alignment with the WHO has faltered. This pattern suggests that recent actions by the U.S. government, including the possibility of reinitiating withdrawal from the WHO in 2025 could once again reshape the global health landscape. A notable precedent occurred in the 1970s when the U.S. temporarily withdrew financial support from the WHO, objecting to the organization’s growing focus on health equity and redistribution [6]. In the aftermath, countries in the Global South, alongside international partners such as Sweden and non-governmental organizations, coalesced to promote a more equitable and people-centered approach to global health. These alliances materialized through initiatives such as the Alma-Ata Declaration of 1978, which was championed by the Soviet Union and endorsed by WHO member states from both the Global South and North. This declaration established the “Health for All by the Year 2000” agenda and emphasized primary health care, universal health coverage, and the social determinants of health as central pillars of public health policy. The shift marked a significant departure from the technocratic and disease-specific approaches often favored by Western donors, ushering in a broader, equity-focused global health paradigm that influenced national health policies in many low- and middle-income countries.

Moreover, after the 2020 U.S.-WHO crisis, new alliances again began to take shape. This time, countries in the Global South, including those in Africa, Asia, and Latin America, grew more vocal in their demand for a greater say in global health decision-making processes. This led to the creation of coalitions such as the Africa CDC, which began to play a more prominent role in addressing regional health challenges, including the COVID-19 pandemic and disease outbreaks like Ebola. These alliances highlighted the necessity for multilateral approaches that are not solely driven by the economic and political interests of powerful countries like the U.S. As new partnerships and coalitions gained traction, they worked together to influence global health priorities and advocate for fairer health resource distribution, particularly in relation to vaccines, medical treatments, and pandemic preparedness. These shifts in global health governance, driven in part by tensions between the U.S. and the WHO_ demonstrate the complex nature of international health politics [8–10]. While the U.S. has historically been a dominant player, the emergence of new alliances in response to its actions has led to a more decentralized global health governance model. This evolution suggests that global health may, in some ways, be better positioned without U.S. dominance, as new alliances may prioritize equitable access, regional solutions, and inclusivity, potentially leading to more innovative and contextually appropriate approaches to health challenges [8–10].

As global health governance continues to evolve, it is essential to consider the lessons from past crises and how emerging alliances, such as those formed after previous U.S.-WHO tensions, may shape the future of global health. These new alliances and their impact on global health policies will be crucial in determining whether the global health system can remain resilient and responsive to the needs of vulnerable populations, especially in the face of potential shifts in U.S. involvement.

Justifications for Withdrawal

The executive order outlining the reasons for the United States’ withdrawal from the World Health Organization (WHO) represents a pivotal moment in global health governance [1]. This decision is grounded in four key criticisms: the mishandling of global health crises, political influence, financial disparities, and the need for reform [1, 6] – [7]. Together, these factors form the rationale behind the U.S. government’s assertion that the WHO’s current structure and operations are insufficient to address the evolving landscape of global health challenges.

One of the primary reasons cited in the executive order is the WHO’s perceived mishandling of the COVID-19 pandemic [6] – [7]. Critics have pointed to delays in declaring a Public Health Emergency of International Concern (PHEIC), which they argue undermined efforts to contain the virus in its early stages. The organization’s initial reliance on incomplete or inaccurate information from member states, particularly during the early months of the pandemic, further hindered global response efforts [7]. This delayed reaction is seen as having allowed the virus to spread unchecked, resulting in devastating health, economic, and social consequences worldwide. The U.S. government’s critique centres on the WHO’s limited capacity to enforce accountability among its member states, which it argues contributed to inconsistencies in the quality and timeliness of information shared during the crisis. However, this criticism is not without irony. The United States itself has on multiple occasions, including during the H1N1 and Ebola outbreaks disregarded WHO guidance, particularly in relation to the International Health Regulations (IHR), such as recommendations against imposing travel restrictions. These actions have gone largely unchallenged by the WHO, highlighting the broader issue: while the organization struggles to hold powerful member states accountable, those same states often exploit this limitation to justify disengagement. These dynamic underscores the complex, and at times contradictory, nature of U.S.-WHO relations and raises important questions about equity and power in global health governance. This lack of uniformity in data reporting and transparency, according to the executive order, compromised the organization’s capacity to coordinate an effective global response. The pandemic thus became a stark example of the WHO’s structural and operational weaknesses, fuelling calls for significant reform [7].

The executive order also alleges that the WHO has failed to maintain independence from the political agendas of its member states. Central to this criticism are accusations of undue influence by China, particularly in shaping the organization’s narrative and response during the early stages of the COVID-19 outbreak [2]. The U.S. government has argued that this influence compromised the impartiality and credibility of the WHO, undermining its ability to function as an unbiased arbiter of global health information and policy. Specific examples of this alleged influence include the WHO’s initial reluctance to question China’s handling of the outbreak and its delayed acknowledgment of human-to-human transmission of the virus. These actions, the executive order contends, created a perception that the WHO prioritized the interests of certain member states over the global community. This perception has led to broader concerns about the organization’s susceptibility to political pressures, which could jeopardize its mission to protect and promote global health.

Another significant point of contention highlighted in the executive order is the perceived financial inequities within the WHO [11–13]. The United States has historically been the largest contributor to the organization’s budget, providing approximately 22% of assessed contributions and substantial voluntary funding [11]. In contrast, China’s contributions have been significantly smaller despite its larger population and growing economic influence. This disparity, the executive order argues, places an undue financial burden on the U.S. while allowing other nations to benefit disproportionately from the WHO’s programs and initiatives [1]. The U.S. government has expressed frustration with what it perceives as an imbalance in financial responsibility, particularly given the organization’s failure to meet expectations for transparency and accountability. This concern has fuelled calls for a more equitable distribution of financial contributions among member states, alongside greater oversight of how funds are allocated and utilized. By addressing these disparities, the U.S. contends, the WHO could ensure a fairer and more sustainable approach to global health funding.

Underlying these criticisms is a broader call for structural reforms within the WHO. The executive order emphasizes the need for greater transparency, accountability, and efficiency in the organization’s operations. Specific recommendations include improving data collection and dissemination processes, enhancing mechanisms for enforcing compliance among member states, and streamlining decision-making structures to respond more effectively to health emergencies. The U.S. has also advocated for reforms aimed at increasing the representation of diverse perspectives within the WHO, particularly from underrepresented regions and populations. This would ensure that the organization’s policies and programs are more inclusive and reflective of global health needs. Additionally, the executive order highlights the importance of leveraging technology and innovation to improve the WHO’s capacity to address emerging health challenges. However, critics of the U.S. withdrawal have argued that disengaging from the WHO could undermine efforts to drive these reforms from within [14] – [15]. They contend that the U.S., as a major contributor and influential member, is uniquely positioned to advocate for change and shape the organization’s future direction. By stepping back, the U.S. risks ceding its leadership role in global health governance, potentially leaving a vacuum that could be filled by other actors with differing priorities and agendas [14] – [15].

Global Implications of the U.S. Withdrawal

The WHO’s reliance on U.S. contributions for a substantial portion of its budget highlights the gravity of the financial implications stemming from the potential withdrawal of the U.S [11]. – [12]. Historically, the United States has been one of the largest contributors to the organization, accounting for approximately 22% of assessed contributions alongside significant voluntary funding [12]. This departure would leave a considerable financial shortfall that could jeopardize several critical health programs. Initiatives addressing infectious diseases such as malaria, tuberculosis, and HIV/AIDS, as well as maternal and child health programs and emergency response efforts in vulnerable regions, would be at risk of being underfunded. The reduced budget could hinder the WHO’s ability to carry out its mission effectively, potentially stalling progress on global health goals. The U.S. has long served as a leading force in global health initiatives, setting priorities, shaping policies, and fostering international collaboration [12]. The withdrawal creates a leadership vacuum that could weaken the coordination of global health responses. In the absence of U.S. leadership, other nations or entities may step in to fill the void, but this could lead to fragmented leadership and a lack of unified direction. For example, China, which has already sought to expand its influence within the WHO, could use this opportunity to reshape the global health agenda to align with its interests. This shift in dynamics could lead to a more China-centric approach to global health, altering policies and priorities to better reflect China’s geopolitical aims [13–17].

One of the most critical roles of the WHO is coordinating international responses to pandemics and public health emergencies. The U.S. withdrawal would further fragment these efforts, building on the already fragmented response to the COVID-19 pandemic. During the COVID-19 crisis, the WHO was marginalized by several countries, including the U.S., which criticized the organization’s perceived delays and its deference to China. The U.S. withdrawal could exacerbate these issues, undermining global capacity to detect, prevent, and respond to future outbreaks. For instance, the COVID-19 response demonstrated how critical international collaboration is to effectively manage health crises. The fragmented response led to delays in vaccine development, uneven distribution of resources, and challenges in sharing vital information and data. Without U.S. support and participation, the WHO would face greater difficulty in mobilizing resources, coordinating research efforts, and ensuring equitable access to healthcare and vaccines across the globe.

The U.S. withdrawal also has significant geopolitical implications, straining relationships with allies and reshaping global power dynamics. Many U.S. allies view multilateralism as essential for addressing transnational health challenges. The decision to withdraw may be perceived as a retreat from global cooperation, potentially leading to diplomatic rifts. Conversely, countries like China, which have already increased their influence in international health forums, could seize the opportunity to further enhance their standing within the WHO. By increasing their financial contributions and expanding their presence, these nations could alter the organization’s priorities and policies, which could shift the global health landscape in ways that align more with their strategic interests, rather than maintaining a balanced and inclusive approach to global health governance.

Domestic Impacts on U.S. Health Policy

While the global implications of the withdrawal are profound, the decision also prompts significant shifts in U.S. domestic health policy [17]. The executive order outlining the withdrawal includes several measures aimed at reallocating resources and strengthening national health initiatives. The executive order mandates the redirection of funds previously allocated to the WHO to “credible and transparent” alternatives. These alternatives include U.S.-based and international organizations capable of assuming the functions previously carried out by the WHO. This reallocation reflects a strategic pivot towards ensuring that U.S. resources are utilized in a manner aligned with national interests and values. However, the effectiveness of these alternative mechanisms in addressing global health challenges remains to be seen.

The withdrawal places increased emphasis on strengthening biosecurity and public health coordination within the National Security Council (NSC). This strategic shift underscores the U.S. government’s focus on building domestic capacity to address global health challenges unilaterally. By enhancing coordination and preparedness within the NSC, the U.S. aims to mitigate the potential risks associated with reduced international collaboration. This approach, however, raises questions about the sustainability and effectiveness of unilateral strategies in addressing complex global health issues. The U.S. withdrawal from the WHO may disrupt longstanding partnerships and collaborations that have been instrumental in advancing public health. U.S. agencies such as the Centers for Disease Control and Prevention (CDC) have traditionally worked closely with the WHO on initiatives including disease surveillance, vaccination campaigns, and health education. These partnerships have facilitated the sharing of expertise, resources, and data, contributing to significant advancements in global health. The withdrawal risks severing these ties, potentially affecting the implementation and outcomes of critical public health programs. Additionally, the reduced engagement with international health organizations could limit the U.S.’s access to valuable global health data and insights.

Criticisms and Challenges to Withdrawal

The decision to withdraw from the World Health Organization (WHO) has generated significant debate, with critics emphasizing the far-reaching implications of such a move. At the forefront of this discourse are concerns voiced by public health experts, who argue that global health challenges necessitate collaborative efforts. They contend that disengaging from the WHO undermines not only global health security but also the national security of the United States [17–20]. In an era marked by frequent and unpredictable health crises, collective action through multilateral platforms like the WHO remains a cornerstone of effective global response. By stepping away, the U.S. risks isolating itself and diminishing its capacity to address transnational threats, such as pandemics and emerging infectious diseases, that require coordinated international strategies.

The decision to withdraw is further complicated by the legal and logistical hurdles associated with such a move. The process involves notifying the United Nations and terminating agreements that govern U.S. engagement with the WHO. These steps demand significant administrative and diplomatic resources, which critics argue could be better allocated to addressing immediate health priorities. For instance, the resources and attention devoted to navigating the intricacies of withdrawal could detract from efforts to strengthen domestic and global health systems. Furthermore, the transition to alternative mechanisms for global health engagement would likely be fraught with challenges, including establishing new partnerships, negotiating funding agreements, and ensuring continuity in critical health programs.

Beyond the operational complexities, the U.S. withdrawal from the WHO poses risks to its international reputation [16]. For decades, the United States has been a leading advocate for global health, championing initiatives to combat diseases, improve healthcare access, and promote health equity. This legacy has established the U.S. as a reliable and influential partner in the global health arena. However, the decision to withdraw could erode this trust and goodwill among international allies and stakeholders. It signals a departure from the principles of multilateralism and shared responsibility that underpin global health governance [20] – [21]. Allies who value collaborative approaches to transnational challenges may view the withdrawal as a retreat from global leadership, potentially straining diplomatic relations and diminishing U.S. influence in shaping global health policies. Critics also highlight the broader implications of reputational damage for the U.S. role in international affairs. The perception of unreliability could extend beyond the realm of health, affecting partnerships in other critical areas such as climate change, security, and trade. As global challenges increasingly require unified efforts, the willingness of other nations to engage with the U.S. on equal footing could be undermined by doubts about its commitment to sustained cooperation. This reputational impact is not easily reversible and could have long-term consequences for U.S. standing in the international community.

Moreover, the withdrawal raises important questions about the future of U.S. contributions to global health and what its absence might mean for the global health landscape, particularly in the Global South. For African countries, many of which have historically relied on U.S. funding and technical support through bilateral and multilateral initiatives, this uncertainty presents both a challenge and an opportunity. In recent years, African nations have increasingly taken steps to assert greater leadership in shaping health priorities on the continent. Initiatives such as the Africa Centres for Disease Control and Prevention (Africa CDC) and the African Union’s New Public Health Order reflect a growing commitment to self-reliance and regional coordination in public health. Leaders across the continent have emphasized the importance of reducing dependence on external donors and building resilient health systems driven by African priorities. The U.S. withdrawal from the WHO, therefore, while disruptive, may accelerate efforts by African states to forge new alliances, invest in indigenous capacity, and amplify African voices in global health governance. It also opens space for other actors at both the regional and global levels to play a more prominent role in defining the future of health cooperation in Africa. The WHO relies significantly on funding from member states, with the U.S. historically being one of its largest contributors. The absence of U.S. funding creates a substantial budgetary gap, jeopardizing programs that address pressing health issues, such as infectious disease control, maternal and child health, and emergency response efforts. Critics argue that while the U.S. may redirect its financial contributions to other organizations, the effectiveness and reach of these alternatives remain uncertain. The potential fragmentation of global health efforts could weaken the overall capacity to respond to health emergencies, particularly in vulnerable regions that depend on WHO-led initiatives.

Ultimately, the criticisms and challenges surrounding the decision to withdraw from the WHO reflect a broader debate about the role of the United States in global health governance [21]. Advocates for continued engagement emphasize the interconnectedness of global health and the need for strong, unified leadership to address shared challenges. They argue that withdrawing from the WHO not only undermines the organization’s capacity to fulfil its mandate but also weakens the collective ability to safeguard global health. In this context, the decision to disengage from the WHO is seen by many as a step backward, with far-reaching implications for both the United States and the international community.

Future of Global Health Governance Without U.S. Leadership

The United States has historically played a central role in shaping global health governance, providing substantial funding, technical expertise, and leadership to tackle a range of health challenges across the globe [16]. However, recent developments, such as the potential withdrawal of U.S. leadership in global health through its actions with the WHO and USAID, suggest that the global health landscape may be undergoing a significant transformation. If the U.S. indeed steps back, the global health architecture will need to adapt to address emerging gaps while ensuring continued progress on critical health initiatives. Importantly, the idea that the U.S. would completely withdraw from global health leadership is more complex. Past crises, such as the 2020 U.S. withdrawal from the WHO (which was later rescinded), and the shift in focus to empowering institutions like the World Bank, have shown that while the U.S. may scale back from certain roles, it still asserts leadership through alternative avenues [17–19]. Nevertheless, this shift marks a departure from its traditional model of engagement, signalling the possibility of a reimagined global health governance system that may operate with less U.S. influence.

It is important to differentiate between “withdrawing from the WHO” and “withdrawing from global health leadership.” The former refers specifically to the U.S. distancing itself from one prominent international health body, while the latter implies a broader retreat from setting the global health agenda, which may not occur simultaneously. The decision to reallocate leadership from the WHO to organizations like the World Bank in the aftermath of the HIV/AIDS crisis reflects the U.S. strategy of reshaping global health governance rather than abandoning it entirely. Similarly, the closing of USAID offices in certain regions indicates that the U.S. may be withdrawing from specific areas but does not necessarily signal a total abandonment of its global health leadership role. However, these shifts raise the critical question of whether global health could be better off without the U.S. holding such a central role. The U.S. withdrawal from direct WHO involvement in 2020, for example, prompted increased reliance on regional actors and new collaborations, which may have, in some cases, offered more agile and contextually appropriate responses to health crises [8–10].

One significant consequence of diminished U.S. leadership could be the increased prominence and autonomy of regional health organizations. For instance, the Africa Centres for Disease Control and Prevention (Africa CDC), established to lead public health initiatives across the continent, has already begun to play a more assertive role in shaping health strategies that reflect African priorities and realities. This is not merely a possibility, but a trend backed by precedent. During previous moments of diminished U.S. engagement in global health such as during the early response to the Ebola outbreak in West Africa, African institutions and regional collaborations, including the Africa CDC and the West African Health Organization (WAHO), mobilized to coordinate responses, build surveillance systems, and establish emergency operation centres. More recently, in the face of COVID-19 and uncertain global leadership, the Africa CDC led continent-wide vaccine procurement through the African Vaccine Acquisition Task Team (AVATT), developed pandemic response guidelines, and pushed for local vaccine manufacturing capacity. These actions signal a broader shift toward regional health autonomy and strategic agency. As the future of U.S. involvement in the WHO remains uncertain, the Africa CDC and allied institutions are well-positioned not just to fill gaps, but to redefine the next phase of global health governance from a distinctly African perspective which keeps equity, sovereignty, and regional solidarity at its central focus [22]. Without U.S. guidance, these organizations could expand their scope and spearhead continent-wide initiatives to improve healthcare infrastructure, combat infectious diseases, and respond to emerging health crises. Decentralized governance could empower regions to design and implement health strategies more closely aligned with their unique challenges, fostering greater innovation and resilience. The COVID-19 pandemic, for instance, showed how critical regional coordination could be in enhancing preparedness and response, as countries in Africa rallied around Africa CDC to provide timely guidance and support. This trend could extend to other regions, with similar efforts being made by organizations such as the Pan American Health Organization (PAHO) in Latin America and the Asia Pacific Leaders’ Malaria Alliance (APLMA) in Asia.

The possible absence of U.S. leadership could also catalyse the formation of new global health alliances, particularly from nations in the Global South, who might advocate for more inclusive and equitable decision-making. These alliances could prioritize fairer health resource distribution, focusing on addressing health disparities that disproportionately affect low- and middle-income countries. Countries in Africa, Asia, and Latin America may unite to create coalitions aimed at influencing global health policies, ensuring that decisions consider the needs of the most vulnerable populations. These partnerships could also lead to increased investment in areas such as vaccine distribution, telemedicine, and digital health solutions. For example, the African Union’s recent partnerships to improve vaccine access have shown the potential for self-reliance in global health governance, and similar collaborations could emerge across other regions, with nations pooling resources, sharing knowledge, and creating regional hubs for research and innovation.

With the potential retreat of U.S. funding, non-state actors such as philanthropic organizations and private companies may step in to fill the funding gaps left by the United States [23]. As seen with organizations like the Bill & Melinda Gates Foundation and other global health philanthropies, private actors can play a significant role in driving innovation, funding health programs, and expanding access to life-saving resources. Global pharmaceutical firms and tech companies might also contribute by improving the supply chain, advancing diagnostic tools, and supporting healthcare infrastructure. However, while increased private sector involvement offers opportunities for scaling up health interventions, it raises critical concerns about accountability and equity [23] – [24]. The reliance on private interests could lead to interventions prioritizing commercial viability over public health needs, further exacerbating health disparities. To address these risks, frameworks for public-private collaboration should be established that emphasize transparency, inclusivity, and alignment with global health priorities. This would ensure that efforts to improve health outcomes are directed towards underserved populations, without compromising equity for the sake of profit.

Ultimately, the question of whether global health is “better off” without U.S. leadership deserves not just reflection, but critical engagement, particularly in the context of shifting power dynamics and emerging regional leadership. While the U.S. has historically provided substantial funding and technical support, its leadership has often been accompanied by geopolitical interests that do not always align with the priorities of low- and middle-income countries. The recent assertiveness of actors like the Africa CDC, the growing influence of countries such as China and India in global health, and renewed South-South collaborations suggest that a more multipolar approach to global health governance is both possible and perhaps preferable. A global health architecture less dominated by any single country may open space for more equitable, locally driven solutions. However, the risks of fragmentation, reduced funding, and weakened coordination also remain real. The challenge and opportunity lie in reimagining global health leadership not as the purview of one powerful actor, but as a shared responsibility rooted in collaboration, accountability, and mutual respect. While the U.S. has been a major force in advancing public health, its partial retreat could open space for new leadership models that may better reflect the diverse needs of the global health community. Regions and non-state actors could fill some gaps, but they would need to ensure that global health governance remains unified, responsive, and focused on the most vulnerable populations. By leveraging the strengths of regional organizations and non-state actors, global health governance could become more decentralized, more inclusive, and potentially more resilient in the face of future global health crises.

Conclusion

The U.S. withdrawal from the World Health Organization (WHO) marks a profound shift in the dynamics of global health governance, underscoring the complex tensions between national interests and multilateral cooperation. This move highlights dissatisfaction with the WHO’s handling of global health crises, such as the COVID-19 pandemic, and reflects concerns over the organization’s perceived inefficiencies, political influences, and financial disparities. While the withdrawal emphasizes the need for reforms within the WHO, particularly in areas like transparency, accountability, and resource distribution. It also casts a spotlight on the challenges of tackling global health issues in the absence of unified leadership. The U.S. has been a key player in shaping global health policies, contributing significant funding, and leading health initiatives. Its departure could weaken WHO’s leadership, destabilize its funding, and hinder future efforts to address public health emergencies. As the global community navigates this new reality, there is an urgent need to explore innovative models of collaboration that do not rely on a single dominant actor. This could involve strengthening regional health organizations, fostering cross-border partnerships, and ensuring that health security remains a priority in international relations. The future of global health depends on the ability to adapt, maintain cooperation, and safeguard public health despite the shifting landscape of international health governance.

Author contributions

Contributions of AuthorsSOA and AIA conceptualized this study. SOA, AIA, OKO, DOI, SAM, MAO, and AAB conducted a literature search to put together relevant studies. All authors wrote the initial draft, which SOA and AIA edited. AAB is the primary corresponding author, and AAB and SOA are responsible for the work’s credibility.

Funding

This study did not receive any specific grant from any funding institution.

Data availability

Data AvailabilityThe datasets generated and analyzed during the current study are not publicly available due to privacy considerations of the participants but are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Clinical trial number

Not applicable.