WHO in Africa: three ways the continent stands to lose from Trump’s decision to pull out

President Donald Trump’s decision to withdraw the US from the World Health Organization (WHO) will be keenly felt across the globe, with profound implications for health in Africa.

In the executive order putting the withdrawal process in place, Trump also paused the transfer of US funds, support and resources to the WHO.

Trump’s executive order is his second attempt to pull the US out of the agency. He has also complained that the US financial contribution to the international organisation is “onerous”.

The biggest impacts will come from the loss of US funding. The US is by far the WHO’s largest state donor, contributing approximately 18% of the agency’s total funding.

The WHO’s funding is split into two tranches.

There are assessed contributions: countries’ membership fees, to which all WHO members agree and over which the WHO has full control. The US accounts for 22%, or US$264 million of these, for the current 2024/25 budget. The US is yet to pay the WHO its assessed contributions for 2024 and 2025. Withdrawing from the organisation without paying these fees would violate US law and must be challenged in the US courts.

Then there are voluntary contributions: donations by member countries, foundations and other sources, usually earmarked to that donor’s priorities. The US contributes 16%, or US$442 million, of all voluntary contributions.

In the case of the US, these priorities include HIV/AIDS, polio eradication and health emergencies.

As experts in global health law, we are deeply concerned about the impacts of this order, which will be far reaching.

The US withdrawal from the WHO threatens core health programmes in Africa. It will weaken the ability of African countries to respond to health emergencies, and could lead to increases in death and illness on the continent.

It will also have broader implications for leadership and governance in global health.

Impact on core programmes

Trump’s decision to withdraw comes at a time when the WHO’s health priorities in Africa were already underfunded. Eight of 12 areas were funded less than 50% earlier this year.

Twenty-seven percent of all US funding through the WHO for the African region goes to polio eradication, 20% supports improved access to quality essential health services, and much of the balance goes to pandemic preparedness and response.

The WHO/US partnership has long supported the HIV/AIDS response in Africa, but the redirection and reduction in funds could reduce the availability of prevention, testing and treatment programmes across the continent. This threatens progress to end AIDS by 2030.

The funding gap will also have an impact on programmes designed to increase access to quality essential health services, including the prevention and treatment of tuberculosis and malaria, and child and maternal health services.

If the WHO is forced to cut back on these services due to a lack of financing, it could lead to increases in mortality and morbidity in Africa.

European countries filled the financing gap in 2020 when Trump last withheld US funding from the WHO. But it is unlikely that they will be able to do so again, as countries across Europe are facing their own geopolitical and financial challenges.

The WHO’s budget was already thinly spread, and its mandate keeps growing.

Through its new investment round, the WHO raised US$1.7 billion in pledges, and is expecting another US$2.1 billion through partnerships and other agreements. Yet even before the US president’s executive order, this left a funding gap of approximately US$3.3 billion (or 47%) for the WHO’s 2025-2028 strategy.

If the gap left by the loss of US funding cannot be filled from other sources, it will fall to African nations to fund health programmes and services that are cut, placing a greater strain on governments reckoning with limited fiscal space.

Weakened response to health emergencies

Trump’s decision comes at a pivotal moment for health in Africa, which is experiencing major outbreaks.

The US has been a key actor supporting WHO-led emergency responses to outbreaks.

Last year, the US partnered with the WHO and Rwanda to rapidly bring a Marburg outbreak under control. The Marburg virus continues to threaten the continent. Tanzania has just confirmed an outbreak.

Earlier in August 2024, the WHO and Africa Centres for Disease Control each declared mpox on the continent to be a public health emergency.

The Biden administration delivered 60,000 vaccines, pledged 1 million more, and contributed over US$22 million to support capacity building and vaccination.

But now US health officials have been instructed to immediately stop working with the WHO, preventing US teams in Africa from responding to Marburg virus and mpox.

Even before these outbreaks, the US supported WHO-led emergency responses to COVID-19, Ebola and HIV/AIDS. The US withdrawal could lead to increased transmission, sickness and death in vulnerable regions.

Similarly, strong partnership between the WHO and the US has helped build health system capacities in Africa for public health emergencies.

US experts have supported nearly half of all WHO joint external evaluation missions to assess countries’ pandemic preparedness and response capacities under the International Health Regulations. This is a binding WHO agreement to help countries prepare for, detect and initially respond to health emergencies globally.

The US withdrawal from the WHO risks eroding these efforts, though it may also accelerate a regionalisation of health security already underway in Africa, led by the African Union through the Africa CDC.

Restructuring of governance

The US was instrumental in establishing the WHO and shaping WHO norms and standards, in particular driving amendments to the International Health Regulations adopted in June 2024. This included improved obligations to facilitate the rapid sharing of information between the WHO and countries.

The US has also been a key figure in ongoing negotiations for a new international treaty, a Pandemic Agreement. This would create new rights and obligations to prevent, prepare for and respond to pandemics with elements that go beyond the International Health Regulations. These include obligations on the equitable sharing of vaccines.

Trump’s executive order would prevent these instruments from being implemented or enforced in the US.

This would only entrench inequitable dynamics when the next global health emergency breaks out, given the concentration of global pharmaceutical companies in the US.

The order also pulls the US out of the Pandemic Agreement negotiations. This will inevitably create new diplomatic dynamics. Optimistically, this could provide enhanced opportunities for African nations to strengthen their position on equity.

The US departure from the WHO will create a leadership vacuum, ushering in a restructuring of power and alliances for global health.

This vacuum could cede influence to US adversaries, opening the door to even greater Chinese influence on the African continent.

But it also presents opportunities for greater African leadership in global health, which could strengthen African self-reliance.

Trump has directed the US to find “credible and transparent” partners to assume the activities the WHO would have performed. And yet there is no substitute for the WHO, with its worldwide reach and stature.

For more than 75 years, the WHO has been, and remains, the only global health organisation with the membership, authority, expertise and credibility to protect and promote health for the world’s population.

For this reason, the African Union, among scores of other bodies and leaders, has already urged Trump to reconsider.

It is now time for the global community to stand up for the WHO and ensure its vital health work in Africa and beyond can thrive.

Lawrence O. Gostin is the Director of the World Health Organization Collaborating Center on National and Global Health Law. He is also a member of the WHO Committee on Amendments to the International Health Regulations

Alexandra Finch does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.