The United States has formally notified the United Nations that it is withdrawing from the World Health Organization, following through on an announcement President Trump made in late May.

The move, however, would not be effective until July 6, 2021, officials said — leaving open the possibility that, should Trump lose reelection, a Biden administration could reverse the decision. The former vice president promptly indicated he would do so.

“Americans are safer when America is engaged in strengthening global health. On my first day as President, I will rejoin the WHO and restore our leadership on the world stage,” Biden announced Tuesday on Twitter.

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The withdrawal of the United States would plunge global health governance into the unknown, creating questions about the economic viability of the WHO, the future of the polio eradication program, the system for reporting dangerous infectious disease outbreaks, and myriad other programs that are as pertinent to the health of Americans as they are to people from countries around the world, such as efforts to combat the spread of antibiotic-resistant bacteria.

STAT reached out to WHO Director-General Tedros Adhanom Ghebreyesus for comment, but received no reply. Spokesman Tarik Jasarevic said the Geneva-based agency had been informed the official notice had been filed, but had no further information.

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But Jeremy Konyndyk, a fellow at the Center for Global Development, called the move “reckless and entirely unjustified.”

“The disastrous state of the outbreak in the United States is not the result of following WHO guidance but rather is the result of ignoring the agency’s increasingly urgent warnings from late January onward,” he said in a statement. “Had the U.S. followed WHO’s advice on early preparedness, aggressive testing, contact tracing, and other response measures, we would be in a far better place today than we are.”

Lawrence Gostin, the faculty director at Georgetown’s O’Neill Institute for National and Global Health Law, called the move “ruinous” — both for United States and for the world.

“This is the end of an era of United States global health leadership,” he said.

Gostin and more than 750 public health leaders, deans of schools of public health, even former heads of the Centers for Disease Control and Prevention and the Food and Drug Administration have signed a letter asking Congress to block the withdrawal. They argue the president does not have the unilateral authority to cancel the country’s membership in the global health agency.

The WHO’s constitution does not include provisions for members to withdraw. But in 1948, after the United States joined the United Nations’ global health agency, Congress passed a joint resolution outlining the circumstances under which withdrawal could be achieved. It requires a member country to give the WHO one year’s notice of its intention to withdraw. It also stipulates that all outstanding dues must be paid before withdrawal.

In a recent speech, Joe Biden pledged to rescind the withdrawal notice, if he is elected in November.

“We must immediately restore our relationship with the World Health Organization,” he said on June 30.  “For all its shortcomings and missteps around COVID-19, this is why the WHO was created.  It is essential to coordinating a global response during a pandemic.  And the United States should be leading the way.”

The United States is the WHO’s largest funder, contributing $426 million a year in the 2018-2019 budget period. The U.S. currently owes the WHO $203 million for 2020 and previous years.

The notice of withdrawal, signed by Secretary of State Mike Pompeo, made no mention of funds the country owes to the WHO and the State Department did not immediately reply to a question on whether the United States will pay the outstanding dues.

The U.N. also appeared uncertain of the U.S. intent. “The Secretary-General … is in the process of verifying with the World Health Organization whether all the conditions for such withdrawal are met,” Stephane Dujarric, a spokesman for Secretary-General António Guterres, said in an email.

The administration has said it will work with other partners to achieve its global health goals. But experts have warned the country will lose influence internationally and its efforts may lose momentum, as other countries come to view the U.S. as an unreliable partner.

“There will be no incentive to take U.S. needs into account,” said Jimmy Kolker, a longtime U.S. diplomat and former assistant secretary for global affairs at the Department of Health and Human Services in the Obama administration.

“It will be much harder than some might assume to find alternate channels for us to engage in global health activities,” Kolker warned. “Our investment will no longer leverage others’ and experts in other countries will have to diversify their partnerships away from the CDC, the NIH or USAID, as these may not be sustainable. Once deals are struck and arrangements made without U.S. involvement, it will be an uphill struggle to retrofit them if the U.S. has an interest in getting involved and decides (as we inevitably will) to halt our withdrawal or rejoin.”

Trump has moved to blame the WHO for the Covid-19 pandemic, insisting that had it been more aggressive with China in January the outbreak might have been averted. While analysts have acknowledged the agency’s lavish praise of China’s handling of the outbreak may have struck the wrong note, they also noted the WHO does not have the power to force a country to let inspectors visit to assess the situation on the ground — something Trump insisted the agency should have done.

Critics of the administration’s handling of the Covid-19 pandemic also note that in January and February, when the WHO was vociferously urging countries to prepare for spread of the virus, Trump himself was praising China’s handling of the outbreak and predicting the virus would stop spreading on its own.

The president announced in mid-May that the administration was giving the WHO 30 days in which to address a list of concerns or the United States would withdraw from the agency. But 11 days after he issued the ultimatum, Trump declared that the U.S. was pulling out of the organization immediately.

Even members of his own party have questioned the move and the timing of it, coming as the WHO leads the global response to Covid-19, the worst health threat in a century.

“Certainly, there needs to be a good, hard look at mistakes the World Health Organization might have made in connection with coronavirus, but the time to do that is after the crisis has been dealt with, not in the middle of it,” Sen. Lamar Alexander (R-Tenn.) said after Trump’s announcement. “Withdrawing U.S. membership could, among other things, interfere with clinical trials that are essential to the development of vaccines, which citizens of the United States as well as others in the world need.”

  • The worst health threat in a century?
    Did everyone forget H1N1???? The word worst is a bit extreme.
    Fear mongering.

    • H1N1 had an effective treatment when it was spreading in 2009 because of already-existing flu antivirals (ie tamiflu), so I don’t think that’s a great example of something that’s “worse” as we weren’t completely helpless while trying to combat it.

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