January 2026
The US withdrawal from the World Health Organization, formally completed on January 22, 2026, represents one of the most significant institutional interventions in the global public health system in the last few decades. Washington’s decision was explained by statements that the World Health Organization (WHO) did not adequately respond to previous pandemic challenges, primarily to the coronavirus pandemic, and that its work was compromised by the political influence of individual member states. However, looking at this process through the eyes of political science, we can only understand it as a kind of diplomatic or ideological act, as a message that Washington sends not only to the health system, but to the whole world. It is an intervention on the central regulatory body of the global health system, the consequences of which have the character of a systemic effect, similar to the removal of a key active ingredient from a complex therapeutic protocol.
The United States has been the largest funder and one of the most influential actors within the WHO for decades. The contributions of the US, in this context, were not only quantitative but also qualitative, as they shaped priorities, standards, and operational procedures in the field of infectious disease surveillance, vaccine development, and coordination of responses to health crises. By removing that actor from the system, the global health architecture is left without a key stabilizer. In other words, the organism of international public health remains with a significantly weakened immunity at the moment when it is exposed to constant external pathogens in the form of new zoonoses, climate change, and increasing population mobility.
The US decision also has a strong symbolic dimension. It sends a signal that multilateral institutions are no longer viewed as irreplaceable mechanisms of collective security, but as structures whose legitimacy can be questioned in accordance with internal political needs. In this sense, the US withdrawal acts as an injection of the virus of instability into an already weakened system of global governance. That virus does not work immediately, but it is slowly replicating through other spheres of international cooperation, encouraging skepticism about common rules and coordination.
The reaction of the WHO was expectedly restrained and institutionally correct. The organization expressed regret for the decision and stressed that global health security depends on the cooperation of all countries, regardless of political differences. However, a real operational problem is hidden behind that diplomatic formulation. The budget loss caused by the US exit cannot be easily compensated, neither financially nor in terms of technical expertise. That raises a number of questions about WHO’s ability to maintain the same level of preparedness, especially in areas that require costly and time-consuming interventions, such as global surveillance of antimicrobial resistance or the rapid development of vaccine platforms.
The behavior of certain American federal states, such as California, which decided to continue cooperation with international health networks outside the federal framework, is particularly indicative, whereby it is expected that California, for now the only one that has officially joined the WHO since the US withdrawal, will “open the door” for other interested states to do the same. That move points to fragmentation within the US itself, but also to a broader tendency to decentralize health management and the potential creation of alternative methods of association in the field of health. From a pharmaceutical point of view, it resembles a situation in which the therapeutic regimen is broken down into a series of partial protocols, without central control of interactions and side effects. In the short term, such an approach may ensure the continuity of certain functions, but in the long term, it increases the risk of inconsistency and reduced efficiency.
The pressure to reform the WHO will almost certainly increase. For years, many member states have pointed to the need for greater transparency, depoliticization of the decision-making process, and strengthening of the organization’s executive capacity. The withdrawal of the US acts as a catalyst for those demands, but at the same time, it reduces the chances of implementing reforms quickly and systematically. In other words, therapy was recognized as necessary, but one of the main providers of therapy “left the office”. This raises a number of questions about who will take the role of leader of the reform process and with what resources.
In the medium term, the scenario of fragmentation of global health initiatives is realistic. Parallel alliances, bilateral agreements, and regional networks can partially replace the role of the WHO, but will hardly achieve the same degree of coordination. A global response to pandemics requires speed, data sharing, and trust, and these elements cannot be easily synthesized in a disjointed system. From the perspective of medical sciences, this represents a loss of synergistic effect, whereby the sum of individual efforts remains less than the potential of coordinated action.
From a political point of view, the withdrawal of the US from the WHO fits into a broader pattern of redefining the US attitude towards multilateralism. However, in the field of public health, the consequences of such an approach are particularly sensitive. Infectious diseases know no borders, and a virus of instability spreading through institutional cracks can have long-term effects on global security. Social immunity, built over decades through shared protocols and standards, is now showing signs of weakening.
In the end, this is not just a matter of US-WHO relations, but a test of the resilience of the entire global health system. The political DNA of that system was created in the post-war period, based on the assumption that health and safety are inseparable. The withdrawal of a key actor calls that assumption into question and calls for its re-examination. It raises a number of questions about the future of international health cooperation, the role of major powers, and the world’s ability to respond to the next major health crisis with the same degree of coordination as before. In other words, global health is entering a phase of chronic stress, in which each subsequent crisis will test the limits of existing institutional immunity.
Author: Miloš Grozdanović