In a striking first, the United States has not participated in the World Health Organization’s (WHO) annual World Health Assembly — the organization’s most significant global health meeting — held this week in Geneva. It’s the first absence by the U.S. since joining WHO in 1948, following President Donald Trump’s decision to withdraw from the organization, citing claims of bias and mismanagement.
As delegates from 194 member countries gather to shape global health policy — including efforts to prevent future pandemics and reduce health risks like air pollution — the absence of the U.S. leaves a noticeable void in both presence and funding.
A Void in Leadership and Expertise
“The U.S. has long been a global health leader. Its absence is deeply regrettable,” said Barbara Stocking, chair of the Panel for a Global Public Health Convention. “This sends a message that one of the world’s most powerful nations is stepping back from global collaboration.”
Historically, the U.S. has influenced major health initiatives and negotiations at WHO, contributing nearly 20% of its $6.8 billion budget. Without U.S. representatives, experts say WHO loses a crucial voice in crafting responses to global crises, from disease outbreaks to vaccine development.
“The U.S. often shaped the agenda and pushed for action. Now, that leadership is gone,” said Lawrence Gostin, professor at Georgetown University and Director of the WHO Collaborating Center on National and Global Health Law.
Still, the absence may spur other nations to step up. “Some delegates feel freer to focus on solutions without being mired in U.S.-centered political disputes,” said a former U.S. health official who spoke anonymously due to concerns about backlash from the Trump administration.
WHO Faces a Deepening Budget Crisis
The U.S. withdrawal comes at a time when WHO is grappling with its most severe budget shortfall in decades. Already $600 million short for the 2024–2025 cycle, the organization expects an even larger gap in future years, driven largely by the loss of U.S. funding.
“This shortfall can’t be easily replaced by smaller contributions from other countries,” said Christoph Benn of the Joep Lange Institute in Amsterdam. “And the U.S. brings more than money — it brings top-tier expertise that’s now missing.”
WHO has already slashed its proposed 2026–2027 budget by 20% and begun scaling back programs, including cutting about half of its leadership staff. Emergency response operations — vital for rapid action against outbreaks like Ebola or mpox — are particularly vulnerable.
In a bid to stabilize finances, WHO is urging member states to increase their mandatory contributions and is appealing to philanthropic donors and the private sector, including the Gates Foundation. This week, member countries will vote on raising mandatory contributions from 20–25% of the budget to 30%.
Yet even if approved, a budget gap exceeding $1 billion remains likely.
Pandemic Treaty on the Brink of Adoption
Despite the financial strain, the Assembly is poised for a landmark achievement: the adoption of the long-anticipated Pandemic Prevention, Preparedness and Response Agreement. This global treaty — the product of over three years of negotiation — is designed to ensure stronger international cooperation in the face of future pandemics.
“This is one of the most concrete outcomes from lessons learned during COVID-19,” said Maria Van Kerkhove, interim director of WHO’s epidemic preparedness department. “It shows we’re moving from talk to action.”
The treaty outlines global obligations, including surveillance of animal-to-human disease transmission and better protections for healthcare workers. However, it has faced heated debate, particularly over how rich countries will share vaccine and treatment technologies in exchange for outbreak data from low- and middle-income nations.
Central to this is the Pathogen Access and Benefit-Sharing System, which proposes a trade: countries provide samples and data to speed up vaccine development, and in return, they receive equitable access to medical interventions. Yet this “global bargain” remains unresolved.
“We’ve agreed to keep negotiating over the next year,” said Van Kerkhove. “There’s still work to do.”
The U.S. will have no role in shaping these ongoing talks — and that could carry significant consequences.
“It’s hard to imagine how the U.S. can ensure quick access to vital scientific data like genomic sequences, which are key to developing vaccines,” said Gostin. “That puts American health security at risk.”
A Shift in Global Health Power?
With the U.S. stepping back, a key question lingers: who will lead global health efforts now?
Some see potential in a rising coalition of countries from the Global South — nations that could drive cooperation on health issues without being overshadowed by geopolitical tensions.
“I’ll be watching to see which countries emerge not just as leaders, but as true collaborators,” said the former U.S. health official.
Whether that shift proves productive or problematic will unfold in the months and years to come. But for now, the world is moving forward on pandemic preparedness — without the United States at the table.