What Public Health, Law, and International Relations Leaders Have to Say About Withdrawing from the WHO

by Anthony W. Orlando Today, President Trump officially began the process to withdraw the United States from the World Health Organization. In my capacity as a public health scholar, I have joined 750 experts and leaders throughout the country in signing the following letter to the leadership of the Senate Committee on Foreign Relations and the House Committee on Foreign Affairs:
Dear Senators Risch and Menendez and Representatives Engel and McCaul: The President has declared his intent to withdraw the U.S. from the World Health Organization (WHO). We are scholars and experts with long experience in global public health, U.S. constitutional law and international law and relations. As we outline below, the President lacks the legal authority to withdraw without congressional participation and approval. We therefore write to you with our deep concerns about the immediate hazards to health, safety, and security in the United States and globally from cutting ties with WHO. The WHO requires reforms, but as a founding member and the largest financial contributor, the U.S. is best poised to lead in these reforms if it remains in the WHO. Withdrawing from or cutting funding to the WHO during a global pandemic would be a dangerous action for global health and U.S. national interests. Withdrawal cannot legally take effect for at least a year and requires the U.S. to pay its outstanding contribution. Congress has the power to prevent this decision from going forward, and must not be silent and must note wait. We ask your committees, and other committees with jurisdiction over this matter, to hold hearings promptly to address the question of whether the attempt to unilaterally withdraw from the WHO is legal or in the national interest. We further look to your leadership on additional congressional action, including appropriating the full amount that the United States promised to WHO in FY2021 and passing a resolution expressly prohibiting withdrawal. Exiting from the WHO is antithetical to U.S. health and national security interests. COVID-19 has proven how the zoonotic leap of a single virus anywhere in the world can result in health and economic catastrophe in the U.S. It is not overstatement to say that withdrawal will likely cost lives, American and foreign. Once outside the WHO, the U.S. would lose access to the WHO’s global system for sharing critical outbreak data and vaccines, slowing U.S. ability to return to normalcy from COVID-19, and to prepare and react to future pandemics. The rest of the world would be at heightened risk, too. The U.S. funds the largest portion of the WHO’s Health Emergencies Program, meaning that funding for testing and contact tracing, building health workforces, and vaccine development would be lost. Second or third waves of COVID-19 cases could repeatedly overwhelm health care systems and result in far more lives lost. When international travel resumes, many of these cases would find their way to the U.S., threatening Americans. Beyond COVID-19, the WHO will have less capacity to detect and control future outbreaks without U.S. support, marking a new era of pandemic risk. As COVID-19 has so vividly shown us, an uncoordinated response to health dangers beyond our borders will gravely affect the lives of those living in the U.S. A number of other WHO programs would suffer enormously under U.S. withdrawal, especially as many global health resources are being redirected to fight COVID-19. Historically, the U.S. has served as a global health leader and the largest WHO donor (providing about 15% of its budget, or approximately $450 million annually). The U.S. has helped fund such initiatives as polio eradication, child nutrition, vaccines, HIV/AIDS, malaria, and tuberculosis. Pulling funding could reverse hard-won progress and erode the ability of the U.S. to shape and lead policy. For example, efforts to eradicate polio over the last two decades have reduced global cases by 99.9%, but loss of U.S. funding could potentially allow annual global polio cases to jump from a few hundred to 200,000 within a decade. This work has progressed with global leadership from Rotary Clubs in the U.S. and worldwide, partnering with WHO. Though the U.S. may attempt to remain a global health leader by rerouting funding directly to countries, or through global public-private partnerships, it will have far less ability to shape rules (such as the International Health Regulations), norms (such as the WHO Priority Bacterial Pathogen List), and programs. Even the President’s Emergency Plan for AIDS Relief, the U.S.’s signature achievement in responding to HIV/AIDS, has relied on WHO to deliver health messages, ensure quality medications, and set health workforce standards. As U.S. global health funding and leadership falters, the U.S. will lose capacity to engage in global health diplomacy, with China filling the leadership vacuum created by our departure. Unilateral withdrawal from WHO also raises significant separation of powers concerns, for the President lacks the legal authority to do so without Congress. With the Constitution silent on the process of withdrawing from a treaty, the best understanding of the Constitution is a “mirror principle,” under which the same process the U.S. government uses to enter a treaty is required to withdraw from it. The United States joined WHO through a 1948 joint resolution of Congress. Therefore, a joint resolution would be required to withdraw. Unilateral withdrawal from WHO raises separation of powers concerns for another reason as well. In Youngstown Sheet & Tube Co. v. Sawyer (1952), Justice Jackson famously wrote, “When the President takes measures incompatible with the expressed or implied will of Congress, his power is at its lowest ebb.” By unilaterally withdrawing from WHO, the President would be acting against the implied will of Congress. In the joint resolution to join WHO, Congress set two conditions on withdrawing. First, withdrawal requires a year’s notice. Thus, any effort by the Trump Administration to withdraw could not take effect before July, 2021 at the earliest. Second, the United States must pay WHO dues in full for WHO’s current fiscal year. As Congress holds the power of the purse, this latter condition requires congressional action. Congress therefore clearly intended to retain a role in any decision to withdraw from WHO; it did not cede unilateral authority to the President. To ensure that the President may not claim that Congress’s FY2021 appropriations to WHO is acquiescing in or approving the President’s attempted withdrawal, we recommend that Congress expressly state both its opposition to withdrawal and its unambiguous support for continued U.S. membership. A decision to withdraw the U.S. from or cut U.S. funding to WHO would threaten the health security of Americans as well as all other nations and could dismantle decades of global health progress. The public’s health as well as respect for our separation of powers requires congressional leadership on this question. We call on Congress to hold hearings on a matter vital to U.S. and global health security.
    This piece was originally published by Anthony W. Orlando on his blog. To view the letter and all signatories, see the Georgetown Law site.