When U.S. President Donald Trump announced in January that the United States would withdraw from the World Health Organization, global health officials braced for a seismic shift. As the world’s largest single donor, the U.S. has historically covered roughly 18 percent of the WHO’s biennial budget. In practical terms, that amounts to a shortfall of nearly $600 million in voluntary contributions for the 2024–2025 budget cycle alone, followed by a projected 21 percent reduction in funding over the 2026–2027 period. Faced with the sudden loss of its largest backer, WHO leadership and its member states have spent the first half of 2025 redesigning the agency’s priorities, trimming costs, and seeking new revenue streams to fill the gap.

At WHO headquarters in Geneva, planning began almost immediately after Trump’s announcement. “Our goal is to focus on the highest‑value work,” says Daniel Thornton, WHO’s director of coordinated resource mobilization. In practice, that means protecting core functions—such as outbreak response, evaluation of new vaccines and treatments, and normative guidance on pressing health issues—while scaling back or suspending lower‑priority programs. Offices in wealthier regions, training initiatives with modest impact, and some administrative committees have been placed under review or slated for closure. As part of this austerity drive, WHO managers have cut dozens of positions, merged back‑office functions, and asked staff members across the agency to volunteer for extra assignments without additional pay.

Under the 2022 funding reform agreement, China is poised to assume the largest share of assessed contributions—rising from just over 15 percent to roughly 20 percent of the total state fees. But assessed fees, which are mandatory dues each member state must pay, historically account for only about 20 percent of WHO’s overall revenue. The remaining 80 percent comes from voluntary contributions, many of which were earmarked by donors for specific diseases or regions. With the U.S. departure, the agency must cobble together replacements for those voluntary streams. China’s higher assessed contribution will cover some fixed, core expenses, but it does little to replace the flexible funds once provided by U.S. agencies like USAID and CDC.

Key to generating new revenue has been WHO’s push for more flexible, unearmarked funding from other governments, philanthropic foundations, and the private sector. At the World Health Assembly in May 2025, diplomats and donor representatives gathered in Geneva to debate which programs to protect and which to pare back. Behind closed doors, WHO staff made a case for safeguarding emergency response capacities—including the Global Measles and Rubella Laboratory Network (over 700 laboratories around the world) and the agency’s central emergency relief operations, which coordinate mobilization and logistics during outbreaks. Those areas had already been tapped by the U.S. for targeted funding in past years, so losing that support risked weakening WHO’s ability to detect and contain epidemics from mpox to cholera.

To prevent program collapse, WHO is courting new donors and expanding partnerships with coastal governments, regional development banks, and wealthy philanthropists. The Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance, have stepped forward with multi‑million‑dollar pledges to sustain polio eradication efforts and routine immunization campaigns. Several Gulf states and European governments have increased their voluntary commitments, though none approached U.S. levels. In addition, private sector players—especially major pharmaceutical companies—are negotiating in‑kind donations of medical supplies and vaccines for emergency stockpiles. This strategy helps lessen the burden on the WHO’s cash reserves but still obliges the agency to coordinate complex distribution networks.

Still, filling a $600 million hole is no small feat. In its April 2025 budget update, WHO reported that $259 million in U.S. voluntary contributions—previously earmarked for both its base programs and emergencies—had been terminated overnight. That triggered an immediate reallocation of resources: roughly $125 million cut from base programs, $100 million from emergency operations, and $32 million from polio eradication. WHO’s leadership had to make immediate cuts to nonessential activities by March 31, 2025, to avoid overspending. As a result, regional offices in the Americas and Europe were instructed to freeze hiring, close certain training centers, and delay planned expansions in laboratory capacity.

Even with these austerity measures, WHO staff worry about longer‑term consequences. Training programs on noncommunicable disease (NCD) prevention, tobacco control workshops in middle‑income countries, and technical assistance for health‑system strengthening in Central Asia have all been placed on the chopping block. The argument in Geneva is that, during a crisis of this magnitude, priority must go to epidemic readiness, essential vaccine prequalification, and guidelines on emerging threats such as antimicrobial resistance. If and when new funding emerges—perhaps through the WHO Foundation’s renewed fundraising drive—some of the suspended NCD programs may return. But until additional cash is secured, they remain dormant.

One area where the agency has shown surprising resilience is its real‑time emergency operations hub. In 2024, WHO had already beefed up this unit to respond swiftly to multiple simultaneous crises—Ebola flare‑ups in West Africa, locust plagues in the Horn of Africa, and lingering mpox clusters in Southeast Asia. Although U.S. support had funded many of the dedicated coordinators and rapid‑response teams, WHO has tapped into a revolving roster of on‑call specialists paid through pooled global emergency funds. These funds—gathered from multiple donors including the European Union, the U.K.’s Foreign, Commonwealth & Development Office (FCDO), and larger foundations—now cover a larger share of outbreak response budgets. Staff from partner agencies, such as Médecins Sans Frontières and the Red Cross, have also been asked to embed technical advisors directly into WHO’s regional hubs, reducing payroll costs.

Another key plank of WHO’s survival strategy is accelerating the transition from project‑specific funding to more unearmarked, flexible contributions. Historically, the agency’s voluntary contributions were heavily earmarked—over 70 percent directed at particular diseases or geographic regions. In contrast, assessed contributions are far more flexible but have remained stagnant because the U.S. had consistently underpaid its assessed fees. Now, with U.S. assessed contributions set to vanish, WHO is negotiating with middle‑income countries like Brazil and South Africa to gradually raise their assessed fee levels above their 2022 commitments. Some smaller countries, particularly in sub‑Saharan Africa, have indicated willingness to increase their tier of membership, if only modestly, to signal solidarity and encourage larger donors.

Simultaneously, the WHO Foundation—a stand‑alone entity created in 2020—has intensified its canvas of high‑net‑worth donors and corporate partners. By May 2025, it had raised over $200 million in pledges earmarked for WHO’s emergency fund. While these allocations cannot replace core budgetary streams, they can be deployed quickly when an outbreak flares. According to Anil Soni, CEO of the WHO Foundation, philanthropic engagement is vital to bridging the gap left by the U.S. departure. “We cannot chase small‑scale private donations forever,” Soni cautions. “We need to secure multi‑year partnerships that align with WHO’s strategic priorities, not just one‑off checks.”

Even as WHO scrambles to stabilize finances, its governance structure is under scrutiny. Donors are questioning whether WHO needs more than 20 technical committees, countless advisory groups, and dozens of advisory boards. In Geneva, senior officials have circulated memos asking: “Should we continue producing the same volume of publications, guidelines, and capacity‑building toolkits—often duplicative of partner efforts? Or should we slim down to only issuing high‑impact, evidence‑based reports?” The recommendations under consideration include merging several overlapping committees—such as NCD advisory groups, reproductive health expert panels, and regional emergency technical task forces—into single, cross‑cutting teams. Such consolidation would yield salary savings and operational efficiencies, at the cost of narrower specialization.

As the year unfolds, WHO’s ability to maintain its core mandate—leading global disease surveillance, guiding vaccine prequalification, and coordinating emergency operations—will depend on a delicate balancing act. In late April, several lower‑income countries alerted the agency that they would scale back requests for technical assistance on health system strengthening, since WHO could no longer subsidize the travel and lodging of its consultants. In response, WHO is expanding its remote assistance capacity: launching new online training platforms, remote diagnostics support for laboratories, and virtual policy‑advice sessions via teleconferencing. While these measures reduce costs, they are no substitute for in‑country experts who can mentor local staff face‑to‑face.

The U.S. departure also has ripple effects on WHO’s research and development pipelines. Prior to 2025, U.S. funding enabled WHO to convene high‑level expert panels to assess emerging medical countermeasures—ranging from next‑generation influenza vaccines to rapid diagnostics for neglected tropical diseases. With that budget slice gone, WHO is prioritizing pandemic‑related R\&D and deferring new technical reviews of non‑priority candidates. For example, planned frameworks to prequalify a newly licensed oral cholera vaccine in 2026 have been put on the back burner. Instead, WHO is focusing on ensuring that existing stockpiles of cholera vaccine are efficiently distributed to hotspots in conflict zones. Similarly, its roadmap for expanding antiviral treatment guidelines for Hepatitis C has been delayed by a year.

Complicating all of these adjustments is the United States’ ambiguous posture. While Trump’s withdrawal process runs through January 21, 2026, the U.S. flag still flies outside WHO’s Geneva headquarters, and Washington is technically a full member until that date. In early May, President Trump suggested he might reconsider the exit if WHO “cleaned itself up,” injecting hope among some observers that U.S. funding could resume. Yet most donor governments believe that, even if the U.S. were to rejoin at a later date, the U.S. contribution would likely be reduced in scope and influence. Consequently, WHO’s new financial model must assume prolonged absence of U.S. core funding.

Beyond reshaping its budget, WHO is actively courting alignment with other multilateral bodies. Discussions are underway to merge certain emergency stockpiles with those managed by UNICEF, and to transfer some elements of intellectual property management—such as licensing of digital health tools—to the World Intellectual Property Organization (WIPO). Additionally, WHO has struck preliminary agreements with the Coalition for Epidemic Preparedness Innovations (CEPI) for joint vaccine development funding, ensuring smoother financing pipelines for future high‑priority vaccines.

Inside the agency’s corridors, many staff feel a mixture of frustration and resolve. “We have a duty to protect the world’s most vulnerable,” says one senior epidemiologist, speaking on condition of anonymity. “If anything, this crisis forces us to sharpen our focus, be more agile, and rethink how we deliver global public goods.” Yet others worry that internal capacity could erode beyond repair. The specialized influenza surveillance unit, which historically tracked seasonal and avian flu viruses, recently lost two senior lab scientists. Those positions remain open, as WHO has no budget to replace them. The result: a temporary blind spot in global flu surveillance that experts fear could leave the world exposed to the next pandemic strain.

In its budget status report for March 31, 2025, WHO noted that financing for base programs was at 92 percent of approved levels, despite the U.S. cut. But the agency cautioned that this rate of financing might drop to 88 percent by June unless new contributions arrive. For emergency operations and polio eradication segments—historically over‑funded due to crisis‑driven appeals—the funding pipeline is more volatile. Polio labs in West Africa and South Asia now rely on bilateral pledges from Rotary International and Gavi, rather than WHO’s core budget, making that program vulnerable to shifts in donor priorities.

Looking ahead, the next big test arrives with the annual budget revision for 2026–2027. WHO leaders must convince the World Health Assembly to approve a new funding strategy that integrates higher assessed contributions from China, greater engagement by middle‑income countries, and more ambitious targets for voluntary contributions from nonstate actors. The assembly’s draft resolution calls for member states to increase their assessed fees by at least 1 percent annually through 2028, and for the WHO Foundation to secure $1 billion in multi‑year pledges by the same deadline.

Whether these measures succeed will shape WHO’s ability to lead global health efforts. If funding gaps widen, WHO risks shrinking into a lean emergency‐response agency, lacking capacity to set global health norms, advise on nutrition and NCD prevention, or support faint health systems in fragile states. Conversely, if new donors step up and the agency hallows its core competencies, WHO could emerge more resilient and focused—albeit leaner than in its heyday.

One thing is certain: operating without U.S. funding has forced WHO to confront fundamental questions about its scope, governance, and financing. With China poised to be the single largest state contributor and a more fragmented voluntary funding landscape, WHO is entering uncharted territory. In the words of one senior official, “We are designing a new WHO—one that can survive and thrive without the world’s biggest financier. Our success will depend on the solidarity and foresight of the global health community.”

(Adapted from Reuters.com)