The World Health Organization and the Shifting US and Global Political Orders

Abstract The withdrawal of the United States from the World Health Organization raises crucial questions about its future as the governing International Organization for health. The executive order on withdrawal was one of President Donald Trump's first acts in his second term. As WHO's biggest funder and most powerful state backer, withdrawal could indicate an existential threat. However, almost simultaneously member states passed a new international Pandemic Agreement expanding WHO's authority. How should these conflicting signals be understood? Analyzing WHO's decline in a context of broader US and geopolitical shifts, we find that withdrawal is the outcome of the end to broader political orders of neoliberal internationalism on which WHO depended for legitimacy, rather than idiosyncratic Trump politics. WHO's reliance on certain international norms and power structures leave it compromised. US normative and institutional shifts are far more difficult for WHO to navigate than in past political eras. International relations research suggests avoiding catastrophic impacts therefore depends on reform actions by WHO officials, other member states, and US actors. We find states and others in the US will face harm from WHO decline and suggest they have legal standing to challenge withdrawal. Complacency and inaction may be WHO's biggest risk.