President Trump on Friday announced that he plans to terminate the United States' relationship with and funding to the World Health Organization (WHO), and experts predict that the move could have an impact on both existing and future health initiatives as soon as next year.

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Trump says he plans to terminate US funding to WHO

The United States is a member of WHO and the organization's biggest donor, contributing about 15% of WHO's total budget. Last year, the United States contributed about $450 million to WHO, according to Nature. So far this year, the United States has contributed about $34 million in membership dues to WHO.

But Trump in April announced that his administration had paused U.S. funding to WHO and said he would consider terminating the funding completely pending the results of a formal investigation into the global health agency's response to the Covid-19 pandemic. At the time, Trump accused WHO of "severely mismanaging and covering up the spread of the [new] coronavirus."

According to Nature, WHO in January began warning countries about the potential spread of the new coronavirus and, in February, recommended countries prepare for the virus' widescale spread. However, Trump has alleged that WHO in December 2019 ignored reports that the novel coronavirus was spreading in Wuhan, China, and he threatened to permanently freeze U.S. funding to the organization unless it could "actually demonstrate independence from China."

WHO Director-General Tedros Adhanom Ghebreyesusin in response to the allegations has said WHO is committed to an independent review of its response to the new coronavirus pandemic, and an assessment of WHO's operations in early 2020 has been made public.

But Trump on Friday announced that he plans to move forward with completely suspending U.S. funding to WHO—and he plans to terminate the country's relationship with the organization. Trump again said WHO did not adequately respond to the Covid-19 pandemic and alleged that China has "total control" over the organization. He added that the United States will "redirect[t]" the funding it had planned to give to WHO to "other worldwide and deserving urgent global public health needs," though he did not provide specific examples, the Associated Press reports.

What Trump's decision could mean for public health

Given that the United States is WHO's biggest donor, losing that funding likely will threaten both existing and future health initiatives, experts say—and the move could "significantly weaken" WHO altogether, the AP reports.

David Heymann, an epidemiologist at the London School of Hygiene and Tropical Medicine, has said ending U.S. funding to WHO could particularly harm efforts to curb new cases of certain diseases, such as malaria, and jeopardize progress made under certain vaccination initiatives for diseases such as polio.

According to Nature, the United States contributes 27% of WHO's budget for polio eradication programs; 19% of the organization's budget for programs to intended to curb tuberculosis, HIV, malaria, and vaccine-preventable diseases; and 23% of the group's budget for emergency health operations.

And although Trump said the United States will redirect its funding for WHO to other global health programs, experts have raised concerns that pulling the funding from WHO could lead to a lack of international collaboration around global health. "[W]e'd see a lot more incoherence in global health," Amanda Glassman, a senior fellow at the Center for Global Development, has said.

Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University, has warned that lack of coordination could be particularly harmful as the world tries to coordinate a response to Covid-19.

"In this pandemic, people have said we're building the plane while flying," Katz said. "This proposal is like removing the windows while the plane is mid-air."

Particularly, some health researchers have expressed concerns that the move could disrupt the exchange of knowledge and information between the United States and other countries regarding diseases like Covid-19.

For instance, Glassman has said U.S. epidemiologists often rely on information from WHO researchers around the world—which is especially important to maintain as U.S. researchers continue to assess the state of the Covid-19 pandemic in neighboring countries. "We need something like the WHO to manage relationships and keep information flowing, whether that's genomic sequences or standards of care," Glassman said.

The move also could weaken the United States' existing diplomatic ties with some countries, as well as programs in countries where the United States provides the majority of international aid, Nature reports.

"There are certain areas where we are the provider of last resort, and U.S. funding supports these operations," WHO spokesperson Marcia Poole recently said.

Similarly, the United States sometimes relies on WHO to work in countries where "diplomatic ties are almost non-existent," such as China, according to Suerie Moon, a global-health researcher at the Graduate Institute of International and Development Studies in Geneva.

Further, Kelley Lee, a global health-policy researcher at Simon Fraser University in Burnaby, Canada, said the move eventually could lead to the United States losing some of its influence in shaping health initiatives throughout the world. "If the U.S. pulls out and leaves a vacuum, it will be filled by other countries, like China," Lee said.

Does Trump have the authority to terminate US-WHO relationship?

Some experts also have questioned whether Trump has the authority to terminate the United States' relationship with WHO. For instance, several experts said Trump may need congressional approval to terminate the relationship.

Kelley Lee, a professor of public health at Simon Fraser University, said, "The only situation where he can do this is if Congress had agreed beforehand to give these powers to the president."

Larry Gostin, director of the O'Neill Institute for National and Global Health Law at Georgetown University, said, "It is an overreach of his constitutional powers." According to NPR's "Goats and Soda," Gostin said Congress could challenge the decision in federal court if he decides to move forward  (Maxmen, Nature, 5/27; Associated Press/Los Angeles Times, 5/29; Huang, "Goats and Soda," NPR, 5/29).