The United States formally withdraws from the World Health Organization (WHO) on January 22, leaving the leading United Nations health agency without its largest historical funder and most capable public-health partner. Much commentary has framed the move as reckless disengagement. That misunderstands both the rationale for withdrawal and the opportunity it creates. As detailed in a American Enterprise Institute working paper, withdrawal should be understood not as abandonment, but as the beginning of a new strategy.
The question is not whether the United States still has global health interests—it plainly does—but whether they are best advanced through an institution that failed its most important test and then sought to expand its authority without a serious reckoning.
The U.S. withdrawal notice identifies concerns that other governments quietly share. It criticizes the WHO’s “mishandling of the COVID-19 pandemic,” its “failure to adopt urgently needed reforms,” and its “inability to demonstrate independence from the inappropriate political influence of member states.” Those judgments are difficult to contest. COVID-19 was the crisis the WHO was built to confront, yet early warnings were delayed, political sensitivities constrained transparency, and institutional deference replaced independent judgment. When criticized, the WHO deflected and excused.
Institutions that cannot identify and correct error tend to entrench it. Rather than conducting a rigorous institutional autopsy, the WHO seized an opportunity to expand its authority by negotiating greater powers through amendments to the International Health Regulations and a new Pandemic Agreement. This expansionist reflex raises legitimate concerns about institutional accountability, self-correction, and humility.
Over time, WHO processes have increasingly privileged precautionary consensus and advocacy-aligned narratives over contestable hypotheses and comparative evidence. This pattern is familiar from other WHO policy domains, notably tobacco control, where policy became insulated from real-world outcomes.
Financial distortions compound the problem. For years, the U.S. supplied one-sixth of the WHO’s total funding, even as budget demands rose and programs increasingly reflected niche priorities rather than core communicable-disease functions. Efforts to increase mandatory assessed contributions risk further entrenching these imbalances. It is not unreasonable for Washington to ask why it should continue underwriting an institution with which it has diminishing confidence.
Still, withdrawal has costs. The WHO fills a critical role in outbreak intelligence and emergency coordination. Leaving without a strategy would create avoidable vulnerabilities.
The America First Global Health Strategy offers a path forward. It preserves U.S. commitments to fighting HIV/AIDS, malaria, tuberculosis, and polio, but shifts delivery toward bilateral agreements emphasizing accountability, integration with domestic health systems, data and sample sharing, outbreak detection, and eventual self-reliance. Rather than routing funds through multilayered, inefficient implementing partners, the strategy prioritizes direct engagement with partner governments, co-financing, and measurable performance.
This approach has risks. Weak institutions can mask failure as compliance and surveillance and monitoring falter when poorly designed. But multilateralism has experienced similar challenges. The answer is not nostalgia for the old system, but clearer incentives, independent verification, and consequences for non-performance—features largely absent from WHO governance.
Withdrawal does not require total disengagement. Certain WHO efforts remain valuable such as the Epidemic Intelligence from Open Sources (EIOS) platform, which aggregates early outbreak signals. In addition, WHO prequalification of medical products remains commercially relevant for manufacturers seeking access to procurement markets in low- and middle-income countries. Selective, technical engagement in these areas can preserve access where no efficient unilateral substitute exists.
While characterized as unilateral, the United States is not alone. Several G7 and middle-income democracies similarly are concerned with opaque emergency processes, donor capture, and weak accountability. Argentina has publicly criticized WHO governance and has signaled that it also may withdraw, underscoring that dissatisfaction is not limited to high-income states. Credible alternatives proposed under the America First Global Health Strategy put additional pressure on WHO to demonstrate relevance. If Washington articulates clear conditions for reform and coordinates with like-minded partners, it may exert more influence from the outside than from within a consensus-bound institution.
January 22 is not the end of American leadership in global health. It is the start of a test—of whether influence is better exercised through conditional engagement, parallel institutions, and results-driven partnerships than through deference to an organization that has struggled to learn from failure.
Brett D. Schaefer is a senior fellow at the American Enterprise Institute (AEI), where he focuses on multilateral treaties, peacekeeping, and the United Nations and international organizations.
Roger Bate is a nonresident scholar with the International Center for Law & Economics (ICLE). He researches international and domestic health policy, with a special interest in medicines. He has a PhD in applied economics from Cambridge University.
