As delegates meet in Geneva without the WHO’s largest donor for the first time in 78 years, the US$4.2 billion budget on the table is no longer merely a financial document. It is a referendum on global health cooperation.
Inside the corridors of the Seventy-ninth World Health Assembly (WHA79), which opened on 18 May 2026, the language remained diplomatic as always. Terms such as “operational efficiencies”, “programme prioritisation” and “sustainable financing” echoed through meeting rooms. Yet beneath the procedural calm sits an uncomfortable truth: the world’s premier health body is gathering without its most powerful member for the first time in its history.
On 22 January 2026, the United States formally completed its withdrawal from the World Health Organization, ending a 78-year relationship dating back to the WHO’s founding in 1948. That partnership shaped everything from disease surveillance to emergency response financing. A year after President Donald Trump signed the executive order initiating withdrawal, what appeared in 2025 as political brinkmanship is now institutional reality.
The consequences are immediate and profound. The WHO is entering its 2026–2027 cycle with a sharply reduced budget, unpaid US dues estimated at more than US$260 million, and growing anxiety over how to sustain core programmes. For many delegates at WHA79, this is no longer merely a financial crisis. It is a referendum on the future of multilateral health cooperation itself.
Will this rupture force the WHO into long-delayed reform and a more balanced funding structure? Or will it accelerate a fragmented global order where health security becomes increasingly transactional, geopolitical and unequal?
A system built on fragile financing
For years, global health experts warned that the WHO’s funding model was unsustainable. The organisation depended heavily on voluntary contributions from a small group of wealthy countries and philanthropic actors, many of them tightly earmarked for donor priorities rather than global needs.
The US was central to that architecture. Historically the WHO’s largest single donor, the US contributed roughly 12% to 18% of the agency’s overall financing in recent biennia, including a 22% share of assessed dues, the maximum any member state can be charged. Washington’s support extended far beyond money. US agencies, especially the Centers for Disease Control and Prevention, provided technical expertise, laboratory partnerships, outbreak intelligence and surveillance systems deeply embedded within international health networks.
Now, that ecosystem is under strain.
The WHO’s approved base programme budget for 2026–2027 has been cut from the Director-General’s proposed US$5.3 billion to US$4.2 billion, a 21% reduction approved by the Seventy-eighth World Health Assembly in May 2025. Even after spending cuts and emergency adjustments, major funding gaps remain. Member states have approved a second 20% increase in assessed contributions in an attempt to reduce dependence on voluntary funding and gradually raise predictable financing to half the core budget by the 2030–31 biennium. It is a significant policy shift, but one that may still fall short of stabilising the institution.
The immediate challenge is straightforward: the WHO must now attempt to do more with less in a world facing more outbreaks, more climate-linked emergencies and more geopolitical fragmentation than at any point in recent memory.
The real cost will be felt far from Geneva
Budget discussions in international institutions often sound abstract until they reach clinics, laboratories and frontline workers.
For countries across the Global South, the fear is not simply institutional decline. It is whether critical public health systems can continue functioning.
The threat to polio eradication illustrates the stakes. India’s success in eliminating wild poliovirus, with the last case recorded on 13 January 2011 and certification as polio-free on 27 March 2014, was built on years of coordinated global action through the Global Polio Eradication Initiative. Surveillance systems, laboratory networks and technical support from international partners played a critical role. Today, as the world enters the difficult and expensive “last mile” of eradication, funding instability risks slowing progress precisely when vigilance matters most.
Antimicrobial resistance presents another looming danger. Often described as the “silent pandemic”, bacterial AMR was directly responsible for an estimated 1.27 million deaths globally in 2019 and associated with another 4.95 million deaths, according to the Global Burden of AMR study published in The Lancet in 2022. The burden falls disproportionately on low- and middle-income countries where surveillance and stewardship systems remain weak. US-backed investments in laboratory strengthening and AMR monitoring helped sustain fragile capacities across many regions. Scaling back these efforts could have consequences that unfold quietly, but catastrophically, over the next decade.
Then there is pandemic preparedness.
The COVID-19 crisis exposed the consequences of delayed coordination and fragmented responses. Since then, the WHO has attempted to strengthen global surveillance and emergency systems against future threats ranging from avian influenza to mpox. Yet these capabilities depend heavily on flexible financing and rapid deployment mechanisms, both of which are now under pressure.
For densely populated countries, where urbanisation, climate vulnerability and infectious disease risks intersect, a weakened WHO is not a distant diplomatic concern. It is a direct public health risk.
The rise of health nationalism
The US withdrawal signals something larger than institutional disagreement. It reflects a broader political shift in which multilateralism is increasingly viewed with suspicion.
Washington has defended its exit by citing concerns around transparency, political influence and the WHO’s handling of COVID-19. Critics argue that reform has been overdue for years and that bureaucratic inefficiencies have undermined trust.
Some of these concerns are legitimate. The WHO has long faced criticism over governance, accountability and prioritisation failures, many of which predate the US withdrawal. Concerns around fragmented financing, excessive donor influence, weak reform implementation and institutional inefficiency are well documented. However, these weaknesses do not necessarily justify withdrawal. If anything, disengagement reduces the ability of major member states to push reforms from within. Abandoning multilateral institutions altogether creates risks far greater than imperfect governance.
Pathogens do not recognise sovereignty. Climate-linked health threats do not stop at borders. Yet the political mood across many countries is shifting towards bilateral deals, national self-interest and transactional diplomacy.
Health is increasingly becoming another arena for geopolitical competition.
At the same time, private philanthropies are assuming a larger role in global health financing. Organisations such as the Gates Foundation have become indispensable funders for vaccines, disease eradication and health innovation. Their contributions are substantial and often lifesaving. But growing dependence on philanthropy also raises difficult questions.
Who ultimately shapes global health priorities when public institutions weaken? Can an intergovernmental body remain fully independent when large portions of its funding come from earmarked private sources?
These are no longer theoretical debates. They are becoming central governance questions for the future of international health.
A moment for the Global South
For emerging economies, the post-US landscape presents both risk and opportunity.
Countries such as China, members of the European Union and several Gulf states have already signalled increased financial commitments. Meanwhile, middle powers including India, Brazil and Indonesia are expanding investments in domestic health security, pharmaceutical production and digital health infrastructure.
India occupies a particularly important position in this transition.
Over the past decade, the country has evolved from being primarily an aid recipient to becoming a major development and health partner. Its vaccine manufacturing capacity, digital public health infrastructure and pharmaceutical exports have given it growing influence in global health governance. During the pandemic, India’s vaccine diplomacy demonstrated how health cooperation can become an instrument of both solidarity and strategic leadership.
There is cautious optimism among policymakers in Geneva and across the Global South that this crisis could eventually produce a more multipolar and representative system.
South-South cooperation is expanding. Regional institutions such as the Africa Centres for Disease Control and Prevention are becoming more assertive. Discussions around innovative financing, health bonds and regional preparedness mechanisms are gaining traction.
But optimism alone will not solve structural weaknesses.
Low- and middle-income countries are themselves navigating economic pressures, debt burdens and competing domestic priorities. Asking them to contribute more financially to multilateral institutions is politically difficult, even if strategically necessary.
Reform or retreat
Inside WHA79, much of the debate revolves around technical language: efficiencies, restructuring, accountability frameworks and financing models. Yet beneath these negotiations lies a more existential question about what kind of world governments want to build after the shocks of COVID-19.
A weaker WHO would almost certainly mean slower outbreak responses, more fragile surveillance systems and widening inequality in access to medicines, vaccines and emergency support. The countries hit hardest would not be wealthy nations with strong domestic systems, but vulnerable populations already living on the edge of health insecurity.
Yet this crisis may also offer the WHO its clearest opportunity in decades to reinvent itself.
Tedros Adhanom Ghebreyesus has repeatedly emphasised the need for a leaner, more focused and more country-oriented organisation. Many member states now acknowledge that predictable financing, stronger accountability and depoliticised scientific cooperation are no longer optional reforms. They are conditions for survival.
Whether the organisation can truly transform itself remains uncertain.
But one reality is undeniable: the world cannot afford the collapse of global health cooperation at a moment when climate change, antimicrobial resistance and emerging pathogens are intensifying simultaneously.
The US exit is a shock to the system. The response to that shock will shape the future of global public health for decades.
As delegates leave Geneva this week, the question hanging over WHA79 is not whether the old order is ending. It already has. The real question is whether the world can build something more resilient before the next crisis arrives.
