Has the United States actually withdrawn from the World Health Organization (WHO)? This question will be on the agenda of the WHO’s Executive Board meeting next week, and the World Health Assembly, the WHO’s governing body, will take it up in May.
President Donald Trump announced the withdrawal shortly after taking office a year ago, part of his administration’s broader agenda of disengagement from multilateral institutions.
But formal exit is not so easy. The U.S. effort to withdraw presents unique issues of international law—and offers a rare opportunity for an international organization to push back on U.S. exit from multilateral institutions. For reasons discussed here, we conclude that the United States has not legally withdrawn from the WHO.
Background
The WHO Constitution, adopted in 1946, has no clause authorizing unilateral withdrawal. This was a source of concern to the U.S. Congress when it voted to authorize U.S. membership in the WHO. As a result, Congress attached a condition to its authorization:
[T]he United States reserves its right to withdraw from the Organization on a one-year notice: provided, however, that the financial obligations of the United States to the Organization shall be met in full for the Organization’s current fiscal year.
When President Harry Truman submitted the U.S. instrument of acceptance in 1948, he did so “subject to” this provision. The World Health Assembly unanimously approved the acceptance, thus giving the United States a special right to withdraw that exists for no other WHO member state.
Fast-forward to the present era. Immediately after taking office for his second term, Trump announced his intention to withdraw the United States from the WHO. (Trump has criticized the organization since the COVID pandemic and filed a notice of withdrawal in 2020, although the Biden administration later rescinded the notice before the one-year mark had passed.)
On Jan. 22, 2025, the United States gave its formal notification of withdrawal to the U.N. Secretary General, who serves as the treaty depository for the WHO Constitution. At the same time, the Trump administration stopped paying U.S. dues to the WHO – and also stopped making voluntary contributions, which have historically made up the majority of U.S. financial support for the organization.
More than a year has passed since the U.S. notice of withdrawal. Currently, the United States owes back dues of at least $133 million, including over $3 million from 2023 and $65 million for each of 2024 and 2025. (The unpaid dues from 2024 are consistent with a U.S. practice of being late with its dues to the U.N. and its specialized agencies.) U.S. dues for 2026 have been assessed at over $77 million.
The WHO’s Response to the Attempted U.S. Withdrawal
The WHO has made clear that it hopes the United States will re-engage. In the meantime, however, the organization must decide whether to treat the U.S. withdrawal as valid even though the United States has not paid its dues, as required by the 1948 Congressional authorization. For now, the treaty depository still lists the United States as a party.
A report issued last week by the WHO Director-General discusses the legal issues relating to withdrawal. The report first concludes that there is no general right to withdraw from the organization, drawing on (a) the drafting history of the WHO Constitution; (b) the refusal to accept the purported withdrawals of seven Soviet bloc nations in 1949 and 1950; and (c) a thoughtful analysis of Article 56(1) of the Vienna Convention of the Law of Treaties. The country most immediately affected by this conclusion is Argentina, which also sought to leave the WHO in March 2025.
Turning to the United States, the report acknowledges its “unique position” because of its special right of withdrawal. It then poses the following questions:
- What year is the “current fiscal year”: the year in which the notice is received, the year in which the withdrawal is set to take effect, or some other formulation; and
- Whether the language “PROVIDED, HOWEVER, that the financial obligations of the United States of America to the Organization shall be met in full for the Organization’s current fiscal year” constitute a condition precedent to a “right to withdraw from the organization on a one-year notice” by the United States.
The report thus tees up these issues for consideration by the WHO Executive Board and later by the World Health Assembly.
Assessing the International Legality of the Attempted U.S. Withdrawal
The WHO’s deliberative response to the United States’ purported exit makes good sense. Unlike the 193 other member states, the United States demanded—and the World Health Assembly accepted—a right to withdraw unilaterally when it joined the organization nearly 80 years ago. But that right to exit came with the caveat: that U.S. financial obligations to WHO “shall be met in full for the Organization’s current fiscal year.”
This proviso is properly understood as a legally binding condition precedent to withdrawal. The very fact of its inclusion, its plain language, and its object and purpose support this conclusion. As the Chair of the Senate Committee on Foreign Relations explained at a July 1, 1947, hearing on U.S. ratification of the WHO Constitution, “the act of withdrawal, includes an obligation to pay our assessments for whatever current year in which we withdraw, so that we do not abruptly upset their financial arrangements.” The WHO Director-General has warned that the Trump administration’s precipitous decision to cut off all funding when announcing the U.S. withdrawal has caused precisely such havoc.
Since there is no indication that the Trump administration will pay any dues, there is no present need to figure out just what payments would satisfy the U.S. financial obligations “in full” for the “current fiscal year.” (Does this mean all financial obligations owed up to and including the current fiscal year, or only dues incurred in that particular fiscal year? And does it refer to the year of notice of withdrawal or the year of withdrawal itself?)
We are unaware of any discussion of how to calculate the dues owed in the 1947-48 Congress or in the WHO when it approved the U.S. ratification. The first draft of the reservation, prepared in the Senate, had a 90-day withdrawal clause. The shortness of this window perhaps helps explain both why there was no further clarity on “current fiscal year” and why these Senators wanted to cover portions of the year that came even after withdrawal. It seems logical to us that, at a minimum, the United States must cover all financial obligations through the year in which it gave its notice (i.e., 2025), but it will be for the World Health Assembly to decide whether and how to address this issue.
What Happens Now?
Practically speaking, the United States is unlikely to be involved in future WHO activities—a point recently emphasized in a bombastic joint statement by the U.S. Secretaries of State and Health and Human Service. Disengagement by a member state that even these officials recognize as the WHO’s “primary founder, primary financial backer, and primary champion” is major setback for multilateral efforts to improve the health of the world’s populations.
Yet it is also important to consider the international law implications of these events. The United States is not the first WHO member to fall behind on its financial contributions. Over several decades, the organization has developed a consistent practice to pressure these countries to pay up. If a member’s arrears equal or exceed the amount due for the preceding two full years, the World Health Assembly or the Executive Board can suspend that state’s voting privileges. Suspended countries are encouraged to negotiate a “special arrangement” with the WHO Director-General—essentially, a repayment plan—to provide at least a portion of the dues owed and to have their voting rights restored. Suspensions in recent years have included Afghanistan, Iran, Somalia, Sudan, Venezuela, and Yemen.
The purported withdrawal of seven Soviet-bloc nations in the late 1940s and early 1950s (and later several other states) is also relevant. Most of these states declared that they no longer considered themselves as WHO members; a few claimed a legal right to withdraw. However, because the WHO Constitution lacks a general withdrawal clause, the organization treated these states as “inactive members.” When the countries sought to resume active participation a few years later, the World Health Assembly allowed them to submit a fraction of their unpaid dues without the need for a formal re-accession process.
These two lines of practice may be discussed as the WHO Executive Board and World Health Assembly decide the membership status of the United States. In particular, we expect these bodies to reach two conclusions. First, that as a matter of international law the United States remains a state party to the WHO Constitution so long as its financial obligations for the current fiscal year (likely 2025) are unpaid. Second, that the United States is an inactive member given its nonpayment. This second determination, which might be made at a later date, would mean that the United States will be unable to vote on any WHO initiatives and will lack meaningful voice within the organization.
Since the United States remains a party to the WHO Constitution, we do not consider the legality of the purported withdrawal as a matter of U.S. domestic law—although we note that it is questionable. Nor do we explore what steps under international or domestic law would be necessary for the United States to rejoin if the WHO later recognizes the country as having formally exited.
Conclusion
Although financially hobbled by the end of U.S. funding, the WHO is continuing its important work. Last year, the World Health Assembly adopted the WHO Pandemic Agreement, a legally binding instrument to improve the global response to future pandemics. Member states are now negotiating an annex to the agreement to promote the rapid detection of pandemic-related pathogens and access to vaccines, therapeutics and diagnostic tools. By disengaging, the United States is hobbling its influence in the WHO on the implementation of the Pandemic Agreement and the negotiation of the annex.
Overall, the purported withdrawal of the United States from the WHO shows both the power and the limits of presidential unilateralism. Trump has as a practical matter removed the United States from the WHO—at considerable cost to global health efforts. Yet he cannot stop the WHO from continuing its work. Nor can he formally take the United States out of the WHO without fulfilling the conditions for withdrawal that were established in 1948. We hope that U.S. disengagement, while grave, is only temporary, and that the United States will return to active membership in a future administration.
– Jean Galbraith and Laurence Helfer, Published courtesy of Lawfare.
