By Daniel Nuccio
The United States’ formal withdrawal from the World Health Organization (WHO) took full effect in January, “ending its membership, governance participation, and funding contributions.”
The withdrawal’s finalization came one year after President Donald Trump announced plans for the withdrawal, citing 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 WHO member states.”
Shortly after the announcement, defenders of the WHO, such as the authors of an opinion piece published by The BMJ, criticized the withdrawal, stating, “This severing of ties between the world’s largest economy and its foremost public health body represents a major setback for health diplomacy, scientific collaboration, and funding.”
“The repercussions will ripple across borders, leaving WHO weaker and the US isolated when global health challenges demand unity,” the authors wrote.
In an interview published by the Johns Hopkins Bloomberg School of Public Health, Judd L. Walson, M.D., a professor of International Health at Johns Hopkins University, acknowledged the potential validity of concerns about “the way that WHO operates when handling large crises,” the organization’s “failure to reform,” and its “lackof independence from political pressures,” but also noted, “rarely does walking away from a problem fix the problem.”
Others though, such as former WHO medical officer David Bell and former United Nations Assistant Secretary-General Ramesh Thakur, have suggested the U.S. exit, coupled with the upcoming July 2027 election of a new WHO Director-General, present opportunities for reform.
Drift from Basic Principles
Together, Bell and Thakur serve as co-chairs of the International Health Reform Project (IHRP), an effort that is sponsored by but operationally independent from the Brownstone Institute.
The IHRP, Bell and Thakur wrote in a March article published by The Daily Sceptic, aims “to offer constructive reform rather than reactive protest” and “ensure that future health crises are addressed effectively and with proportionality, transparency and respect for human dignity.”
“For decades, the post-war health architecture led by the WHO rested on principles such as proportionality, transparency, subsidiarity and the primacy of human welfare,” Bell and Thakur wrote. “Covid exposed strains in that architecture. Emergency powers expanded, dissent narrowed and policy debate became increasingly constrained. Measures once shunned for their inevitable harms and ethical concerns—lockdowns, prolonged school closures, border restrictions, universal mask and vaccine mandates—became normalised across very different societies with little regard for age-specific risk or local context.”
Bell and Thakur report there is a larger problem of global health governance drifting away from basic principles and useful functions (e.g., cross-border disease surveillance, data sharing, and technical assistance) in ways that reduce both efficiency and trust.
Mission creep, centralization, dependence on earmarked funds, rigid treaties, “[w]eak accountability,” and a “[p]reference for technological interventions over foundational determinants of health,” are among the trends Bell and Thakur identify as contributing to the larger problems they described.
Calls for Reforms
While acknowledging good work by the WHO over the years in helping eradicate smallpox and improving sanitation, nutrition, and health care in developing nations, Bell, Thakur, and the other members of the IHRP argue the organization requires reform. They call for “a new international health framework grounded in human rights and dignity, national sovereignty, and medical ethics.”
“The WHO needs very deep reform, … from the way the organization is funded to the way evidence influences policy to the way staffing is managed,” Bell told Health Care News, later adding, “If reform doesn’t happen, things will absolutely get worse.”
Proposed WHO Alternative
To help facilitate reform, the IHRP has produced two reports, described as a policy report and a companion technical report. Both are available from the Brownstone Institute.
“The two reports identify the failures and shortcomings, the principles and structural features that are still needed, and conclude with the recommendation either to implement deep reforms or else to negotiate a new international health organization (IHO),” Thakur told Health Care News.
“This has to be an inter-state process and the outcome will be the result of intergovernmental negotiations…” said Thakur. “Our hope is therefore threefold: (a) influential swing countries will be convinced by the evidence and logic of our analysis; (b) they will be persuaded of our twin core arguments that the WHO is no longer fit for purpose but institutionalized international health cooperation remains critical; and (c) they will find our reports helpful in identifying the choices that must be made in redesigning the architecture.”
Much-Needed ‘“‘Off Ramp‘
Brownstone Institute founder and president Jeffrey Tucker, who recently sat down for an interview [1] with Health Care News, said of the IHRP, “The Covid response began with the World Health Organization, which definitely needs reforming. But the question is how is it going to be reformed and what do nations do in a world without the World Health Organization, which does provide a lot of essential services and information.”
The IHRP and the documents its members produced give nations a much needed “off ramp,” says Tucker.
Uphill Battle
As for the likelihood their proposed reforms will be implemented, Bell admits he and his colleagues face a variety of challenges.
“Reform would be very difficult with current leadership and current staff because of the vested interests involved and the vested interests of organizations around the WHO, such as some of the public-private partnerships that feed off of it,” said Bell.
In addition, “there are incentives at the moment to centralize and go towards the securitization of health because it is profitable for the people who are providing a lot of the funding for [the WHO’s] operation,” said Bell.
Thakur says reforming the WHO or replacing it with an alternative will be a difficult task but is necessary.
“We do not hold exaggerated expectations, but we recognize that a start has to be made somewhere, no matter how modest,” said Thakur.
“Going forward, peoples’ health around the world will be better with a substantially reformed WHO or a new IHO than either an unreformed WHO or no international health organization,” Thakur said.
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