US withdrawal from WHO will have significant implications
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US Senator Sheldon Whitehouse answers questions about the RFK hearing
US Senator Sheldon Whitehouse, in RI to attend a groundbreaking for the REGENT' Seaglider factory, answers questions about the RFK hearing
President Trump withdrew the United States from the World Health Organization, a decision criticized by public and global health scholars.
The U.S. provides significant financial support to the WHO, enabling initiatives like disease eradication and maternal health programs.
Critics argue that withdrawing from the WHO will create a vacuum in global health leadership, potentially benefiting China.
The decision raises concerns about the U.S.'s ability to protect its citizens from future pandemics and influence global health policy.
Global health is a matter of national security, especially in an interconnected world facing shared health challenges.
As part of the sweeping reforms in his first few days in office, President Donald Trump announced he is withdrawing the United States from the World Health Organization. The decision, which has been criticized by public and global health scholars, will have far-reaching consequences ‒ not only globally but also for the health and security of the U.S.
In my global health courses, I often remind my students that infectious diseases know no borders. COVID-19 serves as a recent, devastating reminder of how quickly diseases spread across the globe. According to the Population Reference Bureau, 70,000 foreigners arrive daily in the U.S., mostly visitors, and according to the Federal Aviation Administration (2024), 2.9 million passengers fly every day in and out of U.S. airports ‒ international cooperation is essential to safeguard public health.
Given the rising vaccine hesitancy in the U.S. in the context of COVID-19 vaccination rates, this issue will only intensify in the coming years, which would surely take on a new form under Robert F. Kennedy Jr.'s anti-vaccine leadership in Trump's administration. With the recent poliovirus outbreak in New York State in 2022, the U.S. faces an impending public health crisis, which will only be amplified if global efforts to combat disease and outbreak are weakened.
The executive order justifies this withdrawal, citing alleged mismanagement of COVID-19 by the World Health Organization and claims of disproportionate financial demands on the U.S. The organization, founded in 1948, is a specialized agency of the United Nations. The U.S. government has been actively engaged throughout its founding, providing technical and financial support and participating in its governance structure. A report from KFF, formally known as the Kaiser Family Foundation and a leading independent source for health policy research, cites that the U.S. has contributed annually between $163 million and $816 million, making it one of the largest funders, allowing WHO to achieve initiatives such as disease eradication and maternal health programs, among others.
To be sure, scholars advocating for decolonizing global health are critical of the disproportionate decision-making power high-income countries have on what should get funded and how, in sharp contrast to the lesser decision-making power low- or middle-income countries have that are often at the receiving end of the aid. Scholars have noted that these power dynamics echo colonial histories, where global health efforts historically emerged from colonial powers seeking to circumscribe disease in the colonies and protect their populations. Despite these critiques, the solution is reform, not abandonment.
From a strategic perspective, the decision to withdraw has significant geopolitical implications: Ashish Jha, dean of the Brown University School of Public Health, who served as the White House COVID-19 response coordinator from 2022-2023, has called the decision a 'strategic error,' warning that the decision to withdraw from the WHO would create a vacuum in global leadership, likely to be taken up by China. This could risk the U.S. losing its moral authority and its key influence in shaping global health policy.
As such, the decision to abandon the WHO jeopardizes decades of progress in combating diseases like polio and HIV, undermines our ability to protect U.S. citizens from future pandemics, and excludes the country from being included in global discussions on shaping global health policy. In a world as interconnected as ours, global health should not be seen just as an act of altruism; it is a matter of national security.
Given the unimaginable loss the U.S. suffered from COVID-19, one can hope that countries will collaborate to share resources, information and strategies to address some of the highest-priority global health issues.
Sarah Ahmed is an assistant professor of health sciences and women's and gender studies at Providence College.
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(By contrast, several of its neighbors, such as Finland, botched their vaccination efforts.) In other words, Sweden appears to have ended up with a relatively low death rate despite its lack of restrictions, not because of them. It probably could have saved even more lives by adopting NPIs earlier in the pandemic. 'People love to cite Sweden as a success story of the hands-off approach,' Ashish Jha, the dean of the Brown University School of Public Health, told me. 'But if anything, it shows the exact opposite.' The COVID revisionists are on much stronger ground when they claim that the U.S. kept certain pandemic restrictions, above all school closures, in place for too long. Schools are the focus of Zweig's An Abundance of Caution. As he documents at length—and argued persuasively at the time—the risk of severe illness among children was low, and schools themselves do not appear to have been a major source of transmission to the broader community. Yet 74 of the 100 largest school districts in the U.S. began the fall 2020 semester with remote-only instruction, and only 40 percent of schools nationwide offered the option of full-time in-person education. This was a genuine failure. Children who were kept out of school longer experienced much higher rates of learning loss and worse mental-health outcomes. Learning loss was especially severe for poor and minority children. Where the revisionists go too far, however, is in their explanation of why schools remained closed for so long. In Zweig's telling, public-health experts, the media, and teachers' unions constituted a 'laptop class' of liberal elites who indulged in pandemic groupthink. It was clear by summer 2020, he argues, that schools could safely be reopened, because several European countries had already done so. But the overwhelmingly liberal public-health establishment continued to sow fear about in-person learning—in part because Donald Trump was in favor of it—and their credulous allies in the media disseminated the message. 'Acting in concert—as a tribe, if you will—and aided by social media, these powerful factions exerted considerable control over school policy and the public narrative around it,' Zweig writes. This climate of fear led teachers' unions to rebel against the prospect of reopening, at the expense of both children and parents, especially those from underprivileged backgrounds. 'No other group of essential professionals en masse fought—and succeeded—to not have to show up for work,' he writes of teachers. David Zweig: The disaster of school closures should have been foreseen Zweig has a point, but he leaves out some important parts of the story. First, elite opinion on school reopenings was much more divided than he lets on. Throughout 2020, the question was the subject of extensive public debate. The National Academies of Sciences, Engineering, and Medicine came out in favor of reopening in July of that year. Prominent public-health experts argued for reopenings in publications including The Atlantic, The Washington Post, and the Journal of the American Medical Association. Second, perhaps even more important, a crucial reason that teachers' unions were able to resist reopening is that they faced relatively little public backlash. Why? Because much of the opposition to school openings came from parents, who were terrified of COVID and didn't want to put their children, or themselves, in harm's way. When I put that to Zweig, he countered that parents supported remote learning only because they had been misled by the so-called experts. 'Whether or not those people are fearful has to do with—and I know this is a loaded term but I'm using it purposefully—misinformation by the public-health establishment and the media,' he said. No doubt media coverage influenced parental attitudes. But if that were the entire story, opposition to in-person schooling would presumably have been concentrated among wealthy, white, highly educated households—Zweig's laptop class—who on average pay the most attention to the news and expert opinion. In fact, the opposite was true. Support for remote learning was most pronounced among Black, Hispanic, and low-income parents. One nationally representative survey by the University of Southern California found that a majority of low-income families believed schools should remain closed for the 2020–21 school year, compared with only 27 percent of the wealthiest families. Other polls found similar results. What Zweig attributes to media indoctrination is more adequately explained by real-world experience: Poor and minority families were far likelier than wealthy white households to have lost loved ones to the pandemic and to have health conditions putting them at higher risk. They had perfectly good reasons to be afraid, regardless of what The New York Times was saying. Macedo and Lee extend the blame-the-elites style of argument beyond school closures, arguing that other pandemic restrictions remained in place for far too long because the public-health establishment elevated ideology over science. 'One of our central issues is that debate became unwelcome beginning in April 2020,' Macedo told me. He and Lee dedicate a chapter to the debate over the Great Barrington Declaration: a one-page document written by three lockdown-skeptical scientists in October 2020 that called for most people to 'resume life as normal' while governments deployed a strategy of 'focused protection' concentrated on the most vulnerable individuals, namely the elderly. This proposal, Macedo and Lee write, was an 'earnest appeal by serious scholars' that 'deserved a respectful hearing' but instead became the victim of a vicious, coordinated assault by the public-health establishment. They point to a private-email chain in which Dr. Francis Collins, then the director of the National Institutes of Health, called for a 'quick and devastating takedown of its premises,' and a counter-memorandum signed by 7,000 public-health experts that argued that the herd-immunity approach was based on 'a dangerous fallacy unsupported by scientific evidence.' Macedo and Lee write, 'The reaction to the Great Barrington Declaration represented one of the key episodes in the moralization of dissent during the Covid crisis.' Let's start with the merits of the proposal itself. The idea of 'focused protection' sounds great in theory, but would have been almost impossible to implement in practice. In 2020, about 90 million people in America were either older than 65 or had a preexisting condition that made them vulnerable to the coronavirus. The notion that we could have isolated close to a third of the country's residents while allowing the virus to spread unimpeded through the rest of the population was a fantasy. 'In basically every country that tried something like this, we saw infections spill over to the vulnerable,' Adam Kucharski, an epidemiologist at the London School of Hygiene & Tropical Medicine, told me. (When I put that critique to Macedo and Lee, Lee said, 'The idea that focused protection would be more difficult than to protect everyone is hard to wrap my mind around.') On top of that, in October 2020, the world was a few months away from having highly effective vaccines. 'Why needlessly risk the lives of so many people when vaccines were right around the corner?' Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, asked me. Osterholm had been an early lockdown skeptic—Macedo and Lee cite him approvingly at several points—but the imminent possibility of vaccination had made him change his tune. 'This was the moment when it made the least sense to take away NPIs,' he said. Although Collins regrets using the intemperate phrase quick and devastating takedown in that email exchange, he is adamant that public-health officials made the right call in coming out forcefully against the Great Barrington Declaration. 'If this proposal had been implemented, it would have led to the deaths of tens of thousands of people,' Collins told me. 'There was no way we could just sit around silently and let that happen.' They didn't sit around; nor did they silence the Great Barrington Declaration or try to banish its authors to the scientific wilderness, as Macedo and Lee suggest. Yes, the authors of the Great Barrington Declaration came in for some personal abuse, usually by individual epidemiologists on social media. The official response, however, came in the form of a carefully argued article published in an academic journal that responded to the proposal's central claims, offering loads of counterarguments backed by scientific studies. What Macedo and Lee characterize as a subversion of public debate looks more like an example of the marketplace of ideas in action. At times, the revisionist narrative seems to exist in an alternate history in which the United States implemented a heavy-handed, centralized response to the pandemic. In reality, Donald Trump, who was president in 2020 (many COVID revisionists somehow overlook this), spent most of that year downplaying the severity of the pandemic, undermining public-health messaging, and refusing to implement or support the policies that public-health experts, doctors, and much of the country were begging for. The result was a shambolic and porous state-by-state patchwork rather than a unified national strategy to deploy the full resources of the federal government. Macedo and Lee nonetheless look back at that time and conclude that the U.S. did too much, not too little. In their view, there is no evidence that any of the various measures employed to control the virus, other than vaccines, saved any lives. They cite multiple analyses, including their own, that find no difference in pre-vaccination COVID mortality rates between blue states, which had tighter and longer-lasting restrictions, and red states, which had looser restrictions and ended them earlier. Although Macedo and Lee are careful not to explicitly conclude from these analyses that 'nothing worked,' it is hard to come away from their discussion of the evidence with any other view. 'We have to be honest with ourselves,' Lee told me. 'There are a lot of medical interventions that we think will be successful and then they don't work. Sometimes the evidence doesn't bear out what you expect to see.' David Frum: Why the COVID deniers won But the analyses that Macedo and Lee rely on fail to account for differences in the timing of when different states experienced their highest COVID death counts. Several blue states, including New York, New Jersey, and Massachusetts, were hit hard early, and the virus spread before they could implement much of an organized response. By one calculation, the Northeast experienced 56 percent of all U.S. COVID deaths from February through May 2020 despite containing just 17 percent of the country's population; the South, meanwhile, experienced just 17 percent of deaths. In the subsequent months, that dynamic reversed: Northeastern states saw their death rates plummet, while southern states saw their death rates spike. Blue states got hit earlier and harder, but once the pandemic went national, they performed much better. In our conversation, Macedo and Lee countered by pointing to examples of states that experienced the pandemic at similar times and had similar 2020 age-adjusted mortality rates, despite the fact that some (such as California) kept restrictions in place longer than others (such as Florida). But these cases run into a further complication: Although state-level analyses find no pre-vaccine difference in COVID deaths, they do estimate that the most restrictive states experienced about 30 percent fewer infections than the least restrictive ones, which is the precise outcome that NPIs are supposed to achieve. That is why Thomas Bollyky, the lead author of one of the state-level studies that Macedo and Lee cite, told me that he was shocked to hear his work being used to shed doubt on the effectiveness of NPIs. 'I feel like I'm having an Annie Hall–type moment,' Bollyky told me. 'These interventions were designed to reduce infections, and that's exactly what they did.' Why didn't they show an obvious impact on mortality, then? One possibility, Bollyky said, is that a long list of intermediating factors—including age, preexisting conditions, and health-care access—determine whether an infected person will die from COVID. These might be impossible to fully control for in state-by-state comparisons. Another is that the elderly, who were most at risk of dying from infection, were likely to voluntarily adhere to social-distancing policies even when official mandates went away. For example, although Florida was one of the first states to entirely lift restrictions, Bollyky and colleagues found that Florida residents, who are disproportionately elderly, stayed home and wore masks at higher rates than people in most other states. Lockdown policies might have been so effective at changing behavior that people kept following restrictions even after they were lifted, creating the false impression that policy didn't matter in the first place. (There were also plenty of Californians who disobeyed the orders that remained in place in their state, making those policies seem less effective.) Whether restrictions prevented the spread of COVID is a different question from whether they were worth the cost. Macedo, Lee, and Zweig are right that America's pandemic response was marked by a failure to properly weigh trade-offs. As they document at length, public-health officials often framed saving lives from the virus as the only legitimate objective of public policy, without considering the potential damage that would stem from the pursuit of that goal. Most public-health experts now seem to share that assessment. In July 2023, for instance, Collins expressed regret for what he called 'a public-health mindset' in which officials 'attach infinite value to stopping the disease and saving a life' and 'zero value to whether this actually totally disrupts people's lives, ruins the economy, and has many kids kept out of school in a way that they never quite recovered.' The COVID revisionists are right to criticize this tendency, but at times they fall victim to a mirror image of the same mindset: Lockdowns were all costs, no benefits, and thus should have been discarded. 'There is just no evidence that any of these measures actually prevented death,' Lee told me. 'So we have to ask ourselves: Should we really take the kinds of actions where the benefits are uncertain but we know the costs will be severe?' Zweig is even more direct. 'In the end, there was no benefit to keeping schools closed for so-called safety reasons out of 'an abundance of caution,'' he writes. 'And there were no reasonable trade-offs in doing so. There were just harms.' From the March 2025 issue: Why the COVID deniers won If ignoring the costs of lockdowns led in some cases to an overly restrictive response, ignoring the benefits could lead to an overly loose one. In many ways, we were lucky last time. The next virus—and there will be a next one—could be far deadlier. It could disproportionately target children or be much harder to vaccinate against. If all restrictions are off the table, the scale of the disaster could be unprecedented. The revisionist narrative also has the potential to become a self-fulfilling prophecy. If people are convinced that public-health measures don't work in the first place, they will be less likely to follow them, which, in turn, will render them even less effective. This dynamic could even undermine the one measure that the non-right-wing COVID revisionists generally support: vaccines. After all, if people are convinced that the public-health establishment is full of lying ideologues, why make an exception for vaccines? Unchecked COVID revisionism, in trying to correct the errors of the last pandemic, might leave us even less prepared for the next one.
