How Trump's WHO withdrawal could pose problems for the Middle East

US President Donald Trump’s executive order to withdraw his country from the World Health Organisation was one of the most significant decisions made on his first day in office and is likely to reverberate around the Middle East.

The decision was prompted following criticism of the Geneva-based organisation’s handling of global health crises, including the coronavirus pandemic. In a statement, the WHO said it regretted the announcement that signalled the end of a seven decades long relationship that had saved countless lives.

“The United States was a founding member of WHO in 1948 and has participated in shaping and governing WHO’s work ever since,” a WHO representative said. “Together, we ended smallpox, and together we have brought polio to the brink of eradication.

“American institutions have contributed to and benefited from membership in WHO. With the participation of the US and other member states, WHO has over the past seven years implemented the largest set of reforms in its history, to transform our accountability, cost-effectiveness, and impact in countries. This work continues.

“We hope the United States will reconsider and we look forward to engaging in constructive dialogue to maintain the partnership between the USA and WHO, for the benefit of the health and well-being of millions of people around the globe.”

Dubai plays an important role in the way the WHO manages its response to health crises and natural disasters. From the WHO’s vast logistics hub at International Humanitarian City, emergency supplies, shelter and medical aid offers support on an unrivalled scale to wherever it is needed most.

By withdrawing financial support from the organisation’s largest donor, that could be reduced. The Eastern Mediterranean Region has become a disaster area in recent years, making Dubai’s role in providing rapid response ever more significant. Home to about 140 million people, the region continues to face health emergencies created by conflict, climate change and disease.

Disaster relief compromised

That crisis reached a tipping point in the third quarter of 2023, when the Eastern Mediterranean fought rapid escalation of cholera in Sudan, floods in Libya and earthquakes in Morocco, Turkey and Afghanistan. Paired with the escalation of violence in Gaza, the WHO's resources were placed under intense pressure.

Pete Baker, policy fellow and deputy director of Global Health Policy at the Centre for Global Development, said Mr Trump’s decision to withdraw was highly regrettable.

“It undermines global health security and risks progress on critical issues like pandemic preparedness and antimicrobial resistance,” Dr Baker said. “However, it is worth putting the US withdrawal into perspective. The US contributes about 15 per cent of the WHO's budget – roughly $600 million a year.

“The US is also highly restrictive on how the WHO can use its money. If other member states or philanthropists step up and provide more flexible funding – even if it’s less than the US provides – this could help the WHO be more agile and focused in delivering its mandate.”

Historically, the US government has been a significant funder of the WHO, and engaged with technical support on international health issues. Since 2014, annual donations have ranged from $163 million to $816 million. The current WHO budget to tackle health issues around the world in 2024 – 2025 is about $6.8 billion, a 2 per cent increase on the previous annual finance plan.

Split into four segments, $4.9 billion has been set aside for base programmes to achieve the WHO’s strategic objectives, $694 million for polio eradication, $172 million for special programmes and $1 billion for emergencies and disasters. It is the second WHO withdrawal made by Mr Trump, following a similar severance order in May 2020, later reversed by Joe Biden when he took charge in the Oval Office in January 2021. However, the implications of the withdrawal are also likely to be felt closer to home for the Trump administration.

US collaborations at risk

Several US institutions collaborate with the WHO, sharing data and research to manage outbreak of disease and public health concerns, including annual influenza. That work could be harmed from a severance of US relations with the organisation. Polio eradication, cancer prevention and global health security are key priorities for the US Centres for Disease Control and Prevention (CDC) and National Institutes of Health, with each collaborating with the WHO.

Meanwhile, the Secretariat of the 44 WHO Collaborating Centres for Nursing and Midwifery is also based in the US. Collaborations centres are currently operating in Columbia University, Johns Hopkins University, New York, Alabama, Chicago, Miami, Michigan, North Carolina and the University of Pennsylvania.

The centres are US outposts connecting public health leaders, institutions and organisations to universally manage the WHO’s vision of health for all. By withdrawing from the WHO, the US role in global health and the way pandemics are handled, could be compromised.

Three years on from a commitment to form a global taskforce to strengthen pandemic prevention measures, nations have failed to sign up to any agreement. In June, governments, including the US, made firm commitments to complete negotiations at the World Health Assembly within a year. However, America’s involvement in any global pandemic accord now looks unlikely.

“The accompanying withdrawal of US support from the pandemic agreement negotiations is the bigger threat,” said Dr Baker. “The political support of the US for the global health security architecture is irreplaceable. If this continues, it will seriously hamper the world’s efforts to ensure preparedness for future health threats.”