Nearly two weeks have passed since President Trump announced he was withdrawing the United States from the World Health Organization. To date, none of the levers that would need to be pulled to follow through on that decision has been pulled.

The Trump administration has not formally notified the WHO that it is withdrawing, a spokesman for the agency told STAT. The administration has also not paid outstanding financial obligations to the WHO, a step that would be required before the United States could pull out under a joint resolution signed by Congress.

Instead, the president’s May 29 announcement — in which he declared that, “We will be today terminating our relationship with the World Health Organization” — has been followed by virtual silence from both top health officials in his administration as well as WHO officials in Geneva. Some legal experts find themselves wondering whether a withdrawal will happen at all.

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“I think now in the calm of day, WHO isn’t their biggest target and [U.S. officials] will be pretty silent on it,” said Lawrence Gostin, the faculty director at Georgetown’s O’Neill Institute for National and Global Health Law. “And it probably is a good strategy.”

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The State Department, asked by STAT whether official notice had been served to the WHO or whether U.S. officials were drafting such a notice, reiterated the president’s complaints against the agency and his intention to withdrawal.

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“The fact is, the very political nature of the WHO — and the constant interference by member states for political reasons — makes it ill-equipped to handle fast-moving pandemics,” a spokesperson said in an email.

Behind the scenes, talks between the WHO and the United States appear to be ongoing. WHO Director-General Tedros Adhanom Ghebreyesus is reportedly in discussions with the U.S. ambassador to Geneva about the Trump administration’s concerns about the agency.

Tedros also said Wednesday that he continues to speak directly with health secretary Alex Azar, most recently about a new Ebola outbreak in the western part of the Democratic Republic of the Congo.

“We had a very good discussion with Secretary Azar last week. And he assured me of U.S. continued commitment to support in the fight, especially against Ebola,” Tedros told reporters.

An HHS spokeswoman said the U.S. “will provide assistance that is needed to those countries to end the outbreak at its source to protect the American people,” adding the U.S. “will not be contributing funding to WHO, but is happy to provide technical expertise or guidance to help end this outbreak.”

Trump’s announcement that the U.S. would be leaving the WHO came on day 11 of a 30-day period he had given the agency to make a number of reforms, some of which relate to perceived failings of the WHO in the early days of the coronavirus pandemic. The president has accused the agency of having been too accepting of China’s word on how the outbreak was playing out — though he himself praised the Chinese response and claimed more than once that the new virus would not pose a problem to the United States.

Vanity Fair reported earlier this week that there is a mad scramble within the administration to figure out a way to walk back the withdrawal threat.

Azar has said nothing publicly about Trump’s decision. When asked about the matter at a House hearing last week, Robert Redfield, the director of the Centers for Disease Control and Prevention, did not close the door to cooperation with the WHO, saying instead that he was “confident that the public health partnership that we have” won’t be “modified in terms of our public health efforts.”

The CDC director allowed that the relationship might be “modified, in some way, at a political level.”

Members of the global health community are divided in terms of how to respond to the threat, which would deprive the WHO of about $450 million or about 20% of its funding and potentially also a deep bench of public health expertise from which it draws, in the form of U.S. staff on loan from agencies like the CDC.

Some question whether the president has the legal authority to pull the country out of the WHO — whose own constitution includes no mechanism for withdrawal by a member state. Others argue that the only way the U.S. can withdraw was prescribed in the joint resolution of Congress that passed in 1948, meaning the U.S. would have to file a formal notice of its intention to leave and pay its outstanding financial obligations.

Ashish Jha, director of the Global Health Institute at Harvard University, said he was inclined to think the threat to withdraw was only that. But even if the administration doesn’t follow through, the episode carries a cost.

“Just the bluster of it is really harmful — even if nothing comes of it. It’s a distraction. It makes people in the agency feel less secure. It takes them away from work that they’re already so stressed to do,” he said.

Like the other global health experts to whom STAT spoke, Jeremy Konyndyk, a senior policy fellow at the Center for Global Development, hopes the United States does not carry through on Trump’s threat. But he said he’s not sure that back-channel talks between the administration and the WHO can forestall that outcome.

“I really hope they can find a way to do that. The challenge is … just the president didn’t make this decision based on something that came out of that diplomatic engagement. So it remains to be seen whether something coming out of diplomatic engagement could reverse it,” Konyndyk said. “I think he made it based on a domestic political calculus. And unless it serves his domestic political calculus, I’m not optimistic we’ll reverse it.”

  • This man is all about money. The USA should get a new president who cares about the people , all different cultures of people .

  • The threat to exit the WHO came from an un-fit absurd political “leader” who is known globally for totally off-the-wall tweets laced with accusations, insults, offensive vitriole, fear-mongering, racism, dis-respect, chaos stoking, and un-informed reactions : he likely was not aware of the outstanding bill due to the WHO …. This bully needs to be muzzled and replaced, otherwise the damage in his wake will keep building – and that includes US dollar devaluation & crash, for which he can take full Debit.

  • Whether Obamacare or WHO prevention activities, the administration has no better, safer replacement and the sick uninsured remain and infections quickly become global. Just like Corona virus political fantasies don’t change biology facts on the ground.

  • Is it just me or is Trump sounding more and more like that drooling hobbit Gary Stone every day, spouting off conspiracy theories, taking alt-right opinions over his own staff. It’s like Gary Stone is writing his tweets now, or maybe Gary is one of the main sources of his media these days. Either way it is frightening.

  • That’s because President Trump never intended to leave. He threatens to leave as a negotiation strategy – he’s not a politician, he’s a businessman. Works great for some things, disastrous for others. But, for better or worse, no one can accuse him of being a pushover.

    • I think his goal is to point out to the world that the US – and our financial support – is entirely taken for granted. There are probably better ways to finesse this, but he makes a valid point.

    • He’s just following Putin tactics – distract from criticism, find scapegoats, revise well documented realities, do not negotiate.

  • I wonder if they just don’t have anyone competent or knowledgeable enough to understand the mechanics of actually leaving.

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