by Matt Lubin
When Dr. Debra Houry, the former Chief Medical Officer of the CDC, was called to testify before the U.S. Senate in September of 2025, she did so in order to address the Senators’ concerns about Robert F. Kennedy Jr and the pressure he was putting on agency heads to make unscientific recommendations or leave their positions. But in the course of her testimony, Dr. Houry raised a separate concern with implications far beyond any personnel dispute. Since the beginning of the year, she told Congress, "global flu sample submissions have dropped by 60% and Covid samples by 70%, leaving us with far less visibility into what's coming." As winter begins and the United States enters peak season for respiratory viruses, the country has less than half the data it normally relies upon to understand what these viruses look like and predict how they might spread. When Senator Hickenlooper asked Dr. Houry why this was the case, she attributed the sharp decline in data directly to the administration's decision to withdraw the United States from the World Health Organization.
The process of removing the United States from the WHO began during the first Trump administration. In July 2020, the United States notified the United Nations of its intent to withdraw from the WHO, citing the organization's "mishandling" of the COVID-19 pandemic and allegations of undue influence by China. This withdrawal was set to take effect in July 2021, but it was immediately retracted by the Biden administration upon the change of power, restoring the U.S. to its status as a member state and financial contributor. Once President Trump returned to office on January 20, 2025, his administration issued a new Executive Order declaring an immediate withdrawal from the WHO, calling for the immediate cessation of “any United States Government funds, support, or resources to the WHO.”[1]
It should be noted that this executive action may stand on shaky legal ground, from both an international and American law perspective. According to WHO regulations, ratified by a joint resolution of Congress in 1948, any member state wishing to withdraw must first provide a one-year notice and pay off all its past dues. Additionally, a 2025 Congressional Research report writes that it is unclear whether or not the president has the authority to unilaterally withdraw from the WHO without congressional approval. In fact, in official documents of the WHO, the organization itself appears to not truly recognize the United States as having already withdrawn, because they claim that the Trump administration has not met the necessary requirements to do so.[2]
Since the Executive Order issued on January 20, 2025, this flow of information about global disease has indeed been disrupted as the CDC has ceased reporting data into the central WHO platforms, FluNet and FluID. Consequently, when the WHO convened its critical vaccine composition meeting in London to decide upon the composition of this winter’s flu shot, the United States was notably absent and its data was missing from the conversation. This data is essential simply because the United States is so populous and geographically vast, American patients make up a crucial chunk of the information needed to generate an accurate global picture of viral evolution. Without it, the predictive models used to design vaccines become less precise.
As in every relationship, the breakdown of communication between the US and the WHO has two sides to it; just as the US is no longer providing information to the WHO, information from global partners to the CDC has likewise been interrupted. Until this year, the process by which the United States prepares for the annual virus season relies heavily on the WHO, specifically through its Global Influenza Surveillance and Response System (GISRS). Established in 1952, this network comprises institutions in over 130 member states that constantly share viral samples and epidemiological data to monitor how influenza is evolving.
For the past seventy years, GISRS has acted as a global early warning system. When a new strain of flu begins to circulate in the Southern Hemisphere or parts of Asia, local National Influenza Centres collect specimens and share them with WHO Collaborating Centres—one of which has historically been the U.S. CDC in Atlanta. This sharing of physical virus samples and genetic sequencing data is what allows scientists to determine which strains are going up or down in frequency and how the specific strains are “moving” across the globe through their human hosts. This information is crucial for deciding the flu strain that should be targeted for the current year’s vaccine, and it is further important for general forecasting of the burden of disease. With this data, the entire healthcare system can be better prepared.
America is thus entering into its peak flu season with much less ‘visibility’ than it should have. To quote Dr. Houry’s written testimony to Congress in September, “we won’t know which flu or COVID strain is emerging globally and when it’s coming or how bad it will be.” Such a situation was entirely predictable; indeed, many papers and comments by public health experts warned that the U.S. withdrawal from the WHO would precipitate this self-inflicted wound. If a novel flu strain or a new variant of COVID-19 emerges abroad, the U.S. now lacks the real-time visibility and access to physical samples required to quickly develop diagnostic tests and countermeasures. By withdrawing from the WHO network, the U.S. has voluntarily blinded itself to the biological reality of the seasonally changing viruses. The drop in flu and COVID-19 sample submissions described by Dr. Houry to the Senate was already predicted by public health experts.
Even more basic than the US contribution to disease surveillance and data communication, however, is providing the money to fund all these activities. Historically, the U.S. has contributed to ~20% of the WHO budget, far more than any other country, while still remaining only a tiny drop (usually less than one hundredth of one percent)[3] in the overall US federal government spending. The sudden pause on these funds forced the WHO to reshuffle its budget overnight, and the chaos that ensued has required months of painful reprioritization as programs are cut. Overall, it is estimated that about one-quarter of the WHO’s operations will have to be shut down.
With these budget shortfalls, the world is losing out on resources far beyond those necessary for monitoring patterns of infectious diseases. Especially in conjunction with cuts to USAID, which have already been estimated to cost a quarter of a million lives, it is almost certain that the diminished WHO capacity will result in an unimaginably high death count in the world’s poorest countries. New WHO guidelines published on Dec 1, 2025 respond to recent survey data from 108 countries indicating that funding cuts have reduced critical services by huge percentages, and those services include maternal care, vaccination, and health emergency preparedness and response. It is difficult to grasp the scale of the impact, but it is also hard to identify who, precisely, will be hurt by this decision. Pandemic preparedness is like fire prevention; citizens do not notice the absence of a fire station until they are faced with a burning building and no one answers their call.
Diminished pandemic preparedness is only one dimension of what the United States has lost. Global health has long been an important tool that the United States has leveraged to pursue its foreign policy through aid, trade, and diplomacy. Investments in international disease surveillance, vaccine research, and public-health capacity building have served not only humanitarian goals but also broader strategic interests such as reinforcing alliances and building American leadership. By withdrawing from the WHO, the United States risks losing its primary platform to shape international rules regarding intellectual property, drug approval, and vaccine distribution, ceding that ground to competitors like China, who have already signaled their eagerness to fill the vacuum. The abrupt withdrawal, together with the canceling or diminishing of so many other international programs, sends a profoundly negative moral signal: when it suits American political interests, the world's most powerful nation is willing to walk away from its commitments, leaving poorer countries to fend for themselves. That perception inevitably results in diminished diplomatic leverage and weakened alliances, with the potential to negatively impact the interests of Americans more broadly.
The Trump Administration and its health officials have framed the withdrawal as a matter of sovereignty, arguing that international health bureaucracies threaten American self-determination. "US public health policy will be shaped by Americans for Americans" featured in an official press statement from the State Department. Yet these sovereignty claims do not stand up to scrutiny. The WHO issues guidelines and recommendations but has no enforcement mechanism; it cannot issue sanctions or even formal censures. The latest Pandemic Agreement explicitly states that nothing in it provides "any authority to direct, order, alter or otherwise prescribe the national and/or domestic law." The WHO has never had the power to compel any nation to do anything, which is evidenced by the very fact that the United States has enacted an immediate withdrawal despite the fact that the WHO believes that doing so violates its agreement. The World Health Organization, at its core, is not a regulatory body but a mechanism for coordination. Walking away does not enhance American sovereignty; it simply removes America from the conversation.
To be sure, the institution from which America has withdrawn is far from perfect. The WHO has faced legitimate criticism for its handling of major health crises over the past half-century, from the slow initial response to HIV/AIDS, to coordination failures during Ebola outbreaks, to its much-debated handling of the COVID-19 pandemic, especially during those early months of 2019 and 2020. The WHO is indeed a bureaucracy with all the inefficiencies that term implies, and it operates in a political environment involving hundreds of parties with different interests and highly unequal power balances. In May 2025, Health Secretary Robert F. Kennedy, Jr. told the World Health Assembly that we desperately need to “create new institutions or revisit existing institutions that are lean, efficient, transparent, and accountable.” Reform is needed, and American leadership could be a key player in achieving it.
Instead, by withdrawing from the WHO, the United States is now at a severe disadvantage when it comes to international coordination of public health efforts. As Johns Hopkins Professor Paul Spiegel put it: “The WHO can be improved; there are inefficiencies, like with all organizations. But by pulling out and removing the huge amount of money that the US gives, you’re not allowing the WHO to make reforms.” As the organization's largest contributor, the United States possessed significant leverage to push for exactly the kind of transparency and accountability that Kennedy has called for. Inside the organization, American officials held positions of influence, American priorities shaped the agenda, and American pressure could have compelled change. Now on the outside looking in, the United States can only watch as others fill the vacuum.
Since the WHO itself continues to consider the United States as a member nation, there remains a possibility, at least in theory, that if the current administration reverses its decision to withdraw, the US would be welcomed back immediately. That prospect is vanishingly remote, although presumably the WHO would also be quick to welcome in the United States if a future president would choose to re-join. The current administration, however, has already moved aggressively to implement the withdrawal regardless of legal ambiguities, and no meaningful political constituency exists to challenge it.
What remains, then, is to ask what an "America First" approach to global health might look like and whether it can accomplish the same goals as the WHO. The administration's answer, articulated in its September 2025 "America First Global Health Strategy," is a push to fund frontline community health workers and establish a network of bilateral agreements with individual countries that would, in Secretary Rubio's words, "directly benefit the American people and directly promote our national interest." In early December, the White House invited officials from Kenya to work out such an agreement, and more are expected to come eventually.
Yet public health experts argue that applying a bilateral framework to pandemic preparedness is a fundamental strategic error. Infectious diseases do not respect treaties or political alliances. A pandemic strain is just as likely to emerge in a nation with whom the United States has strained or nonexistent diplomatic relations as it is in an allied nation. The WHO maintains access to regions where the US government cannot easily operate due to political sensitivities or conflict; if a novel pathogen appears in such a region, the WHO can still deploy surveillance teams and share data globally. By leaving the organization, the United States loses its ability to monitor threats in these diplomatic blind spots, essentially betting that the next pandemic will originate in a friendly country.
History suggests this is an unwise wager. The 1918 influenza pandemic likely originated in Kansas, but HIV/AIDS emerged in Central Africa, SARS in China, MERS in Saudi Arabia, Ebola in Guinea, and COVID-19 again in China. The geographic origin of the next pandemic is unknowable, which is precisely why the WHO operates a global surveillance network.
Moreover, in the high-stakes environment of pathogen detection, every hour matters. The WHO's existing infrastructure allows for rapid, simultaneous data-sharing across all member states through centralized databases. Replacing this with a patchwork of bilateral deals means that information must be individually negotiated and transmitted through diplomatic channels. Ironically, this means that the Trump administration’s attempt to avoid the bureaucracy of the WHO would end up creating a whole new series of bureaucracies requiring multiples of redundant government workers for individual countries. The fragmentation of data into dozens of individual agreements creates delays that can make the difference between whether a novel pathogen is contained to its local region or spreads to become a global pandemic.
In theory, the United States retains enormous capacity to shape global health even outside the WHO framework (as it had done, for example, through PEPFAR, a US initiative to control HIV/AIDS outbreak worldwide). The US could facilitate public-private partnerships with for-profit pharmaceutical companies, US-based philanthropies, and non-profit organizations with more targeted health focuses such as Gavi, the Vaccine Alliance. It could channel resources through the World Bank, an international institution heavily subject to American influence, which could issue development bonds or bridging grants that might cost Americans less than previous annual WHO contributions while still maintaining US engagement. And when it comes to pandemic surveillance and preparedness, the infrastructure to build alternatives to the WHO do exist. The US Army Medical Research Institute of Infectious Diseases, or USAMRIID, possesses world-class capabilities to combat emerging threats to health security, and the State Department's Bureau of Global Health Security and Diplomacy, recently established by the Biden Administration in 2023, is also well positioned to help coordinate these efforts if the new White House chooses to use it.
But building these alternatives takes time measured in years, not months, while the threats they are meant to address can emerge in mere days. The WHO, for all its flaws, represents seven decades of institutional knowledge, established relationships, and proven protocols. Replicating that infrastructure from scratch is not impossible, but it is slow, expensive, and risky. In the meantime, as made clear by Dr. Houry’s testimony to Congress, America began its winter season with less visibility into global disease patterns than it has had in generations, and this blindness is likely to have tragic consequences.
Infectious diseases are by their nature a collective action problem. They emerge unpredictably, spread indiscriminately, and threaten everyone. An approach that truly puts American interests first would recognize this reality and invest in the global infrastructure that keeps Americans safe; “America First” should not mean “America Blind.” When Dr. Houry told Congress that the CDC had 60% fewer sample submissions, she was not describing an inconvenience, she was describing the lack of data needed to respond to potential emerging catastrophes. The next pandemic will not wait for the United States to rebuild its own World Health Organization. The only question is whether Americans will be watching when it arrives.
[1] This withdrawal was not limited to the WHO, but also applied to UNESCO; further retreats from global influence can be seen in the dismantling of USAID and PEPFAR. This article focuses only on the World Health Organization.
[2] While the administration may not have said so explicitly, the language of the Executive Order implies that that U.S. government, for its part, believes that the 2020 announcement made during Trump’s first term in office serves as the WHO’s one-year notice, and that past financial contributions from the U.S. more than make up for its current debt.
[3] In 2021-2022, for example, the United States provided about $700 million over the course of two years, while the total expenditures from 2022 alone was $6.3 trillion.
Matt Lubin is a Ph.D. candidate in The Johns Hopkins University’s Cellular, Molecular, and Developmental Biology and Biophysics (CMDB) program and serves as the Science Policy Coordinator for the Science Policy and Diplomacy Group.
Edited by John Soltis, Brendon Davis, and Naina Misra