“President Trump is trying to downsize WHO, and the question is whether other high-income countries in Europe, Australia, Japan and elsewhere will pick up some of the slack,” Vermund says. “Will the Gates Foundation, which has been a very generous donor, pick up anything? It's conceivable that other people will take over things until we have a new administration that is more friendly toward WHO, but I doubt they can pick up the entire share of WHO's budget. Payment is made by the US.
And it is not just money that the US provides to WHO, but also staff and expertise. “The Centers for Disease Control and Prevention has sent many staff to WHO, and I would predict that the Trump administration, with a new CDC director, will call those people home,” Vermund says. “That would make a huge difference, because WHO money doesn't pay for those individuals. “So I think you will have to see an almost immediate reduction in the workforce and the removal of key professionals within the WHO organization.”
According to Gostin, most of the funding the US provides to WHO is basic mandatory funding that all members are required to provide, but some funds are specifically earmarked for purposes in which the US has a vested interest, such as polio. Eradication, HIV/AIDS, and the process of identifying and controlling disease before it spreads and reaches American shores. Gostin says that without US funding these programs will not disappear completely, but they will be significantly weakened.
“Polio could be on the rise again,” says Gostin. “Remember we had polio in the sewage of New York just a few years ago, and our children are not being vaccinated. And we've faced not just COVID-19 but other real health concerns in the United States, which has killed more than a million people. We have Zika, and the next health emergency may be just one or two mutations away. Perhaps it is already here in the form of avian influenza, and we will need WHO to help us with this.
Both Gostin and Vermund fear that withdrawing from WHO would leave the U.S. behind in obtaining critical information, such as pathogen samples and genomic sequencing data, that pharmaceutical companies need to create effective vaccines. Gostin explains how the US relies on WHO data each year to effectively update the seasonal influenza vaccine, while Vermund points out that economically speaking, it would be difficult for the US to require WHO to “eliminate” diseases at their source. It is far more efficient to provide funds to help do that. Try to deal with them when they come to the country.
“We spent over $2 billion preparing for Ebola to reach U.S. shores in 2014 and 2015, and since we only had five or six cases, it was very cost-ineffective,” Vermund says. “So this is a typical example of how when the United States moves alone, it will be very inefficient compared to contributing to a multinational response to control a disease in the country of origin.”