The US, the World Health Organization, and the Global Health Infrastructure, JAMA Health Forum, March 14, 2025, by Sandro Galea, M.D., Dr.P.H., Editor in Chief
The US has, in the Centers for Disease Control and Prevention, one of the premier public health agencies in the world. In addition, state and local health departments add a further level of public health action that serves the country well in tackling public health challenges. And yet, it has been amply documented that the US spends less money on public health than it should for a country of its size and complexity, and that ongoing cuts to public health funding pose a threat to population health. This was perhaps most evident during the COVID-19 pandemic, when public health systems were frequently threatened and had a difficult time keeping up with a rapidly changing infectious threat. More than 1 million individuals died of COVID-19 in the US. This death toll plus the estimated $16 trillion cost of the COVID-19 pandemic in the US are a sobering reflection of the underinvestment in public health that exposes the country to risk.
The COVID-19 pandemic is also a recent reminder of how difficult it is to separate the work of public health domestically from the work of public health globally. COVID-19 amply showed that pandemics do not respect national boundaries, and that global coordination is a key element of global disease control. However, in recent years, US engagement in global efforts to control disease has been challenged by its domestic political changes. In 2020, under the first Trump presidency and during the COVID-19 pandemic, the US withdrew from the World Health Organization (WHO), only to return in the first few months of the Biden Administration. The second Trump Administration similarly withdrew from the WHO during its first week in office. This immediately threatened the function of the WHO. The WHO Director-General subsequently issued a hiring freeze, and noted a range of consequences that US withdrawal may have on the capacity of the WHO to carry out its mission.
Academic analysis has also noted a range of harmful consequences that may follow the US withdrawal from the WHO. These include, but are certainly not limited to, having less access to surveillance data needed to anticipate outbreaks and losing influence on what remains the world’s most important health agency. The global consequences may be even more severe given the funding cuts, threatening the organization’s ability to function effectively, particularly during global health crises. Therefore, the US finds itself at a worrisome inflection point in its alignment with global health infrastructure. Time will tell whether the anticipated consequences—for the US and global health—of disengagement from the WHO will emerge, but if they do, they will be an unfortunate and self-inflicted undercutting of US leadership in global health.
Comment:
By Don McCanne, M.D.
The World Health Organization? In the first Trump administration, the underfunding of public health, and especially the termination of our participation in the WHO, contributed significantly to the death of more than one million individuals in the United States, not to mention the other world-wide suffering and deaths in the COVID-19 pandemic. And this is only one of the many crucial functions of the WHO. More than one million US deaths!
Though the Biden administration renewed our participation in the WHO, did the voters in our last presidential election really ask Trump to withdraw us again from the WHO? The media tells us that their minds were on immigration and the price of eggs. But it was also quite clear that people thought that Trump would be more effective in reducing taxes (though primarily for the top 1% of incomes) and would reduce government spending (believing that those reductions would be in waste, fraud and abuse, but not in programs such as Social Security and Medicare). Very little thought and discussion was given to other programs such as WHO (not to mention USAID, education, CDC HIV prevention, diabetes prevention, food security – especially for children, and federal employment opportunities). Although half of the nation still does not recognize the potential impact of these reductions in spending on important government programs, the other half does, and that recognition is increasing. As people begin to feel the impact of reductions in government services, and the impact of price increases because of Trump’s tariffs and other flawed economic policies, it is likely that they will recognize the emptiness of Trump’s promises and be ready for policies that will meet their needs.
But right now, most recognize that we do not want these attacks on our health and well-being, and we do want the health of our country and of the world protected. Those who are informed know that we do want the WHO and USAID protected and supported, and those who don’t realize that need to be educated to find out what these programs do and support them to protect us and our families and friends at home and throughout the world. We don’t have the luxury of waiting to see how much harm terminating these programs will do since the cost in suffering and lives will be too great. We need to let our legislators know now (as we are already doing in their town hall meetings), and they will let the president and his administration know. Preserving the health of all citizens of the world is not selfish and not all that expensive. We certainly cannot stand by and watch the wealthiest man in the world tear these systems apart.
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