THE U.S.’S EXIT FROM WHO, A CHANCE TO RESHAPE GLOBAL HEALTH

THE CONTEXT: On January 22, 2025, President Trump signed an executive order initiating the U.S. withdrawal from the World Health Organization, which will take effect on January 22, 2026. Following Trump’s criticism of WHO’s pandemic response and financial structure, this decision will result in losing the organization’s largest donor, who contributed approximately 18% of its $6.8 billion budget for 2024-2025.

GLOBAL HEALTH GOVERNANCE: It ensures collective action to address transnational health challenges such as pandemics, antimicrobial resistance, and health inequities. It relies on inclusive institutions that foster cooperation, equity, and innovation while avoiding the pitfalls of extractive institutions, which concentrate power and resources among a select elite.

FUNDING PATTERN AND REQUIREMENTS OF WHO

INCLUSIVE VS. EXTRACTIVE INSTITUTIONS IN GLOBAL HEALTH:

CURRENT SCENARIO: FUNDING IMPACT AND OPERATIONAL CHALLENGES

FUNDING IMPACT

• • S. Contribution to WHO’s Budget: The United States has historically been the largest financial contributor to WHO, accounting for approximately 18% of its total budget. The 2024–2025 biennium amounts to $261 million in assessed contributions and an additional $698 million in voluntary contributions, making up a significant portion of WHO’s $6.83 billion budget.
    • Assessed contributions (ACs) represent 16.8% of WHO’s total funding, with voluntary contributions (VCs) comprising 83.2%. Over time, reliance on VCs has grown significantly, increasing from 54% in 1990 to 88% by 2025.
  • Impact of U.S. Withdrawal on Funding: The cessation of U.S. funding will create a substantial shortfall, jeopardizing critical global health programs such as polio eradication, HIV/AIDS treatment, tuberculosis control, and pandemic preparedness. The unpredictability of VCs, often earmarked for specific projects, limits WHO’s flexibility in addressing emerging health crises like antimicrobial resistance or neglected tropical diseases.
  • Global Funding Trends: High-income countries dominate voluntary contributions, accounting for 90% of VCs, while upper-middle-income countries contribute the least relative to their gross national income (GNI).

OPERATIONAL CHALLENGES

• • Loss of Expertise: The withdrawal will result in the recall of U.S. personnel seconded to WHO, including experts from agencies such as the Centers for Disease Control and Prevention (CDC). This could disrupt critical technical assistance in disease surveillance, vaccine development, and biosecurity.
  • Disruption of Global Health Initiatives: Programs heavily reliant on U.S. funding—such as maternal health services, immunization campaigns, and pandemic treaty negotiations—may face delays or cancellations. Marginalized communities in low-income countries will bear the brunt of these disruptions, exacerbating existing health inequities.
  • Leadership Vacuum: The U.S.’s withdrawal creates a leadership vacuum in global health governance. While countries like China have pledged increased support for WHO, this shift could alter the balance of power within international health institutions. The absence of U.S. influence may hinder ongoing reform efforts to improve WHO’s transparency, efficiency, and accountability.
  • Erosion of Multilateralism: The decision reflects a broader trend of rising nationalism and retreat from multilateralism among high-income countries. This undermines collective action at a time when global health challenges—such as climate change-induced diseases and zoonotic outbreaks—demand coordinated responses.

GLOBAL PERSPECTIVE: SHIFTING POWER DYNAMICS AND REFORM OPPORTUNITIES

SHIFTING POWER DYNAMICS:

• • Emerging Role of Asia and Africa: The U.S. withdrawal from WHO creates an opportunity for countries in Asia and Africa to assert greater influence in global health governance. These regions, which bear the brunt of global health challenges like infectious diseases and underfunded healthcare systems, can now play a pivotal role in reshaping priorities.
  • Leadership Potential of BRICS: The BRICS bloc (Brazil, Russia, India, China, and South Africa) can redefine global health leadership by advocating for equitable healthcare policies and funding mechanisms. For instance, BRICS has championed the One Health approach, integrating human, animal, and environmental health to address interconnected challenges like zoonotic diseases and climate change-related health risks.
  • Multipolarity in Global Governance: The rise of emerging economies like India, Indonesia, Brazil, and South Africa reflects a shift toward a multipolar world order, where power is more evenly distributed among nations. These countries have advocated for greater representation in international institutions such as the WHO Executive Board, IMF, World Bank, and UN Security Council.

REFORM OPPORTUNITIES

• • Reassessing WHO’s Structure: WHO’s current centralized structure has been criticized for being bureaucratic and slow in responding to crises. Relocating specific divisions (e.g., infectious disease control) to regional offices in Brazzaville (Congo) or New Delhi (India) could align resources with areas most affected by these challenges.
  • Diversifying Expertise Pools: WHO’s reliance on experts from high-income countries has created an imbalance in global health governance. Countries like India can invest in training programs for global health experts specializing in diseases prevalent in Africa or Southeast Asia. India’s National Institute of Epidemiology could collaborate with African universities to build capacity in disease surveillance.
  • Improving Financial Sustainability: WHO’s funding model is overly dependent on voluntary contributions (83% of its budget), which are often earmarked for donor-driven priorities. Increasing assessed contributions from member states can ensure predictable funding.
  • Promoting Regional Leadership: Regional organizations such as ASEAN (Association of Southeast Asian Nations) and AU (African Union) can play a larger role in coordinating responses to health emergencies. ASEAN’s response to the 2003 SARS outbreak demonstrated the effectiveness of regional collaboration.
  • Technology Transfer and Innovation: BRICS nations can lead efforts to develop and transfer affordable healthcare technologies to LMICs. India’s generic pharmaceutical industry has already played a key role in reducing the cost of HIV/AIDS treatment globally.

THE OPPORTUNITY FOR INDIA:

• • India as a Global Health Leader: India has emerged as a pivotal player in global health governance, leveraging its pharmaceutical industry, vaccine production capabilities, and health diplomacy. Known as the “Pharmacy of the World,” India supplies 60% of global vaccines and 20% of generic medicines, contributing significantly to affordable healthcare worldwide.
  • Capacity Building: India produces over 78,000 doctors annually, many of whom contribute to global healthcare systems in countries like the U.S. (80,000 members of Indian origin in AAPI) and the UK (second-largest nationality in NHS). India can establish premier institutions focusing on global health education and research, modeled on entities like the London School of Hygiene & Tropical Medicine.
  • South-South Cooperation: India has provided technical assistance to over 100 countries through bilateral and multilateral platforms. The India-Africa Health Summit focuses on capacity building in healthcare infrastructure. Through platforms like BRICS and SCO, India advocates for equitable healthcare policies and funding mechanisms tailored to LMICs’ needs.

THE CONCLUSION:

The shifting power dynamics in global governance allow emerging economies in Asia and Africa to lead reforms within WHO and other international institutions. By advocating for decentralization, equitable resource allocation, and capacity building within LMICs, these nations can create a more inclusive global health system that addresses the unique challenges faced by underserved populations.

UPSC PAST YEAR QUESTION:

Q. The COVID-19 pandemic exposed vulnerabilities in global health governance. Critically examine the role of WHO and suggest reforms to strengthen its functioning. 2022

MAINS PRACTICE QUESTION:

Q. The withdrawal of the United States from the World Health Organization (WHO) presents both challenges and opportunities for global health governance. Analyze

SOURCE:

https://www.thehindu.com/opinion/lead/the-uss-exit-from-who-a-chance-to-reshape-global-health/article69180589.ece#:~:text=On%20January%2020%2C%202025%2C%20the,the%20functionality%20of%20the%20organisation.