To the Editor: “Global Neurosurgery: An Overview” highlights how World Health Organization (WHO)–coordinated frameworks— World Health Assembly resolutions, surgical systems strengthening, and capacity-building partnerships—form the backbone of global neurosurgical development.1 We commend the authors on their work highlighting these collaborations and seek to underscore the imperative to update and expand the landscape of Global Neurosurgery given the current climate. On January 20, 2025, the United States announced its renewed intention to withdraw from the WHO. Executive Order 14 155 stated: “Sec. 2. Actions. (a) The United States intends to withdraw from the WHO. The Presidential Letter to the Secretary-General of the United Nations signed on January 20, 2021, that retracted the United States' July 6, 2020, notification of withdrawal is revoked.” This decision directly threatens the sustainability, equity, and global partnership models emphasized by Garcia et al, which rely heavily on WHO coordination to advance neurosurgical access in low- and middle-income countries (LMICs).2 The fallout is more immediate and devastating in neurosurgery, particularly due to the nature of the conditions and treatments offered which are often lifesaving and because basic neurosurgical care remains an unmet and growing crisis in several LMICs.3 The WHO has been essential in elevating surgical care as a global health priority—including emergency and essential neurosurgery. Initiatives such as the Global Initiative for Emergency and Essential Surgical Care and National Surgical, Obstetric, and Anesthesia Plans, have created national roadmaps showing which countries can build scalable neurosurgical systems. While not exclusively neurosurgical, these frameworks directly prioritize conditions like traumatic brain injury, pediatric hydrocephalus, stroke, and spinal trauma all of which demand timely neurosurgical intervention. For many LMICs, these WHO-supported mechanisms represent the only realistic avenue for long-term surgical capacity-building. These efforts also helped catalyze the Global Neurosurgery movement by leveraging WHO partnerships and academic consortia.4 These WHO-supported platforms operationalize many of the targets outlined in the Overview—particularly neurotrauma, pediatric hydrocephalus, epilepsy, and systems-level strengthening. WHO's influence on global health has helped eradicate smallpox, combat infectious disease through vaccination, and reduce surgical mortality through the implementation of the Surgical Safety Checklist, a proven intervention that improves outcomes, especially in LMICs.3,5 For neurosurgery, the WHO has fostered meaningful collaborations through its eHealth initiatives and global partnerships with the World Federation of Neurosurgical Societies (WFNS), the WFNS Foundation, and the International College of Surgeons. These collaborations support policy development, safety standards, research, and training programs.6 The WHO's collaboration with the WFNS has advanced neurotrauma care across LMICs through national policy guidance, trauma registries, and public safety initiatives such as helmet and seatbelt advocacy.6 As Garcia et al note, these partnerships represent core mechanisms through which neurosurgical advocacy, sustainability, and equitable access are translated into practice. Taking action is essential to sustain global neurosurgical progress. Strengthening bilateral and regional partnerships—for instance, collaborating directly with Uganda's Ministry of Health, where fewer than 20 neurosurgeons serve a population of over 48 million can help expand pediatric neurosurgery training programs, build workforce capacity, and restore critical infrastructure to maintain essential initiatives.7 Similarly, collaboration with Nepal, which faces high rates of traumatic brain and spinal injuries but lacks adequate trauma care infrastructure, could support national trauma and emergency neurosurgical systems.1,3,8 Regional partnerships with organizations such as the African Union, the Pan American Health Organization, and Association of Southeast Asian Nations strengthen trauma registries, promote safety campaigns, and support regional training networks. United States agencies, including the National Institutes of Health, Centers for Disease Control, and United States Agency for International Development, should develop targeted funding streams and training initiatives to sustain neurosurgical services in low- and middle-income countries.1,3,7,8 Academic institutions and professional societies such as the American Association of Neurological Surgeons and Congress of Neurological Surgeons can extend their global impact through remote mentorship networks, virtual case support, and specialized fellowship programs, ensuring knowledge transfer even without WHO coordination.9 These bilateral and regional models echo the long-term, system-strengthening approaches highlighted by Garcia et al as essential to advancing global neurosurgical equity. Beyond governmental influence, public-private collaborations offer a proven model for filling critical gaps. A leading example is the partnership between Medtronic and the WFNS Foundation, which has supplied operating microscopes, navigation systems, and essential tools to hospitals in sub-Saharan Africa, Latin America, and South Asia often enabling neurosurgical services.1,10 This partnership also funds on-site training and technical workshops to build local capacity, showing how industry involvement can create lasting impact. Building open-access data platforms to track surgical burden and outcomes would support evidence-based policy, coalition-based efforts with groups such as WFNS can sustain coordinated advocacy. These strategies must be developed to preserve US support, protect vulnerable patients, and sustain global neurosurgical progress even in the absence of WHO engagement. Such collaborations mirror the multisector, capacity-building strategies underscored in the Overview as critical to sustainable global neurosurgical growth. As Garcia et al emphasize, advancing global neurosurgery requires the sustained, coordinated international engagement now at risk. As the United States distances itself from the WHO, it also turns away from the patients, health systems, and communities that have long depended on this partnership. This absence will be felt in hospitals and operating rooms, across regions without neurosurgeons, and most tragically, in the silence left where coordinated progress once thrived.
Chapman et al. (Fri,) studied this question.