U.S. says it has completed WHO withdrawal, but legal fight looms over unpaid dues

WASHINGTON — The United States on Jan. 22 declared it had completed its withdrawal from the World Health Organization, ending nearly eight decades as the U.N. health agency’s most powerful member and largest funder.

“Today, the United States has formally concluded its withdrawal from the World Health Organization,” the Department of Health and Human Services said in a statement co-signed by Secretary of Health and Human Services Robert F. Kennedy Jr. and Secretary of State Marco Rubio. The announcement said U.S. membership, financial contributions and official participation in WHO governing bodies and technical committees had all been terminated.

The move caps a yearlong process launched on Jan. 20, 2025, when President Donald Trump, on his first day of a second term, signed Executive Order 14155 directing U.S. agencies to leave WHO, freeze funding and prepare alternative arrangements. It also revives a clash that began in 2020 over the agency’s handling of the COVID-19 pandemic and Trump’s accusations that WHO was too deferential to China.

But even as the administration insists the United States is now out, WHO officials and many international law experts say the situation is more complicated. They argue that under the terms Congress set when it joined WHO in 1948, the United States cannot legally withdraw until it pays what the agency says are hundreds of millions of dollars in outstanding dues.

That dispute leaves the world’s largest economy in an unusual gray zone: politically and financially disengaged from WHO, yet possibly still bound to its constitution on paper.

A unique escape clause, and a fight over the bill

When Congress authorized U.S. membership in WHO in 1948, it did so with a condition unusual in international law. In the joint resolution approving entry, lawmakers reserved the right for the United States to leave on one year’s written notice, “provided that the financial obligations of the United States to the Organization shall be met in full for the Organization’s current fiscal year.”

The World Health Assembly, WHO’s top decision-making body, accepted that condition at the time, giving the United States a special exit clause no other member has.

The Trump administration invoked that clause on Jan. 22, 2025, when it notified the U.N. secretary-general that the United States intended to withdraw from WHO one year later. HHS and the State Department say that notice period has now run its course.

International lawyers and WHO budget documents, however, indicate the United States has not fully paid its assessed contributions for several recent years. A report prepared for WHO’s Executive Board notes that U.S. dues for 2024 and 2025 remain outstanding, and that 2026 assessments were not paid before the claimed withdrawal date.

WHO officials, speaking publicly and in internal memos, have said the United States owes at least more than $100 million in back dues. Figures provided by WHO representatives to news organizations place the total closer to $280 million when various obligations are included.

The administration disputes that it must settle those bills to leave.

“HHS has determined that the United States has no legal obligation to pay additional funds to WHO as a condition of withdrawal,” the department’s fact sheet on the move states.

Lawrence Gostin, a professor of global health law at Georgetown University who has served as an adviser to WHO, said in an interview that the 1948 condition functions as a prerequisite for a lawful exit.

“Congress made payment of current financial obligations a condition of withdrawal,” he said. “If those obligations are not met, the United States remains a party to the WHO Constitution in international law, regardless of what the administration declares.”

WHO’s Executive Board is expected to take up the question when it meets in Geneva in February, with further debate anticipated at the World Health Assembly in May. Outcomes could range from treating the United States as a member in arrears to recognizing it as having withdrawn, or adopting some form of “inactive member” status with no voting rights.

WHO loses its biggest backer

For WHO, the U.S. departure has immediate financial and operational consequences.

In recent years, the United States contributed about $111 million annually in assessed dues and an estimated $500 million to $600 million in voluntary funding for specific programs, according to U.S. government figures and WHO budget data. Those voluntary funds supported polio eradication, emergency response, HIV and tuberculosis programs, and maternal and child health initiatives, among others.

HHS said all U.S. government funding to WHO has now ended. U.S. personnel and contractors embedded at WHO offices in Geneva and in country programs around the world have been recalled or reassigned. U.S. agencies have also stopped participating in WHO’s executive board, policy committees and many technical working groups.

WHO Director-General Tedros Adhanom Ghebreyesus called the U.S. notification “deeply regrettable,” saying the country has been “a founding member and a vital partner” in responses to smallpox, polio, HIV, Ebola, influenza and other threats.

“Withdrawal from the WHO is a loss for the United States, and also a loss for the rest of the world,” he said in a statement.

The agency has already begun tightening its belt, instituting hiring freezes and cutting back on travel and in-person technical missions, according to internal communications described by staff.

Tedros has said WHO has secured roughly three-quarters of its required budget for the current cycle but must close the remaining gap amid heightened demands for pandemic preparedness and surveillance.

Surveillance and vaccines in a quieter Geneva

Public health specialists say the most significant impacts may not be immediate program cuts but more subtle losses in information sharing and coordination.

One of WHO’s most valuable functions is its role as a hub for global disease surveillance. It gathers and synthesizes data from member states, laboratories and networks, then issues alerts and technical guidance on emerging threats.

By stepping away from WHO committees and governance, the United States risks losing early insight into how that raw data is collected, interpreted and turned into recommendations, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

“This is one of the most penny-wise and billion-dollar-foolish moves I’ve seen,” he said. “You save a relatively small amount of money and give up a critical role in detecting and responding to infections that can shut down your economy.”

One concrete concern is seasonal influenza. Twice a year, WHO convenes experts to review circulating flu strains and recommend the composition of the next season’s vaccines. U.S. scientists and regulators have long played a central role in those meetings.

With the United States no longer a WHO member, federal officials have stepped back from that formal group, though individual American researchers may still be invited in their personal capacities. Vaccine manufacturers and health officials say any erosion of that coordination could complicate decisions about which strains to target and when to update vaccines.

Disease eradication campaigns also face uncertainty. The Global Polio Eradication Initiative, a partnership that includes WHO and the U.S. Centers for Disease Control and Prevention, has relied heavily on American funding and technical expertise. If U.S. support through WHO diminishes and is not fully replaced by bilateral channels, health workers in conflict-affected and low-income countries could struggle to maintain vaccination coverage and surveillance.

Sovereignty, politics and a shifting balance of power

The administration portrays the withdrawal as part of a broader “America First Global Health Strategy.”

Executive Order 14155 criticized WHO’s response to COVID-19, alleging that the agency failed to hold China accountable and mishandled early guidance on masks and airborne transmission. The HHS statement on Jan. 22 said WHO had “failed to enact urgently needed reforms” and placed “an unfair financial burden on U.S. taxpayers.”

Kennedy, a longtime critic of vaccines and pharmaceutical companies before becoming HHS secretary in 2025, has framed the move as reclaiming U.S. sovereignty over health policy and protecting “bodily autonomy” from international mandates. WHO notes that it issues technical guidance and recommendations, but binding domestic policies on issues like masks and vaccine requirements are set by national governments.

Professional medical and public health organizations in the United States have repeatedly warned against leaving WHO. The Infectious Diseases Society of America called the decision “shortsighted and scientifically reckless,” saying it would “weaken our ability to prevent and respond to infectious disease threats at home and abroad.”

In Congress, Republicans who control at least one chamber have largely backed Trump’s stance, arguing that WHO is overly bureaucratic and politically influenced. Some lawmakers have introduced legislation to codify the withdrawal in statute, though no such bill has passed both chambers.

Democrats and some Republicans on foreign relations and appropriations committees contend that the move undercuts U.S. leadership and strengthens rivals.

Analysts say the vacuum left by the United States could give countries such as China, India, Russia and Saudi Arabia more room to steer WHO’s agenda, including on sensitive issues such as pathogen-sharing rules, access to outbreak sites, intellectual property for vaccines and the human-rights framing of health measures.

An exit tested by the next outbreak

WHO headquarters in Geneva continues to fly the U.S. flag amid its row of member state banners, a symbolic gesture officials say reflects hope that Washington might one day return to full engagement.

For now, the United States has stopped paying, stopped voting and largely stopped showing up, even as lawyers on both sides debate whether it has truly left.

The practical test of the decision is unlikely to come in a courtroom or at a budget meeting, but in the appearance of the next pandemic threat — when speed, trust and coordination across borders will again determine how much damage a new pathogen can do before it reaches American shores.