US withdrawal from the WHO: Implications for Bangladesh

The beginning of Donald Trump's second term saw a quick and anticipated decision to withdraw the United States from the World Health Organization (WHO). This decision echoed his earlier attempt in July 2020 -- an effort eventually reversed by President Biden, given the one-year notice required for formal withdrawal from this organization. 

 

Now, with the withdrawal in motion again, the implications for global health are profound and concerning.  The repercussions are evident and do not require extensive research to identify. For instance, within just a few weeks, almost one-fourth of countries experience interruptions in the distribution of tuberculosis medications. 

 

 

The US withdrawal has a compounded impact due to simultaneous reductions in USAID funding. Additionally, the closure of UNAIDS and the withdrawal of Swiss and other international funding have worsened the crisis.

 

 

In a densely populated country like Bangladesh, which is already facing significant health challenges, this move caused considerable anxiety. The WHO has long been a vital partner, offering technical expertise and financial support that have bolstered Bangladesh's healthcare system. 

As the United States reduces its global health role, Bangladesh now faces the urgent task of adapting to this new reality and finding alternative ways to address the funding gap left by decreased US support.

 

 

The role of WHO

Since its establishment in 1948, the WHO has been the cornerstone of global health cooperation. As the directing and coordinating authority for health within the United Nations system, WHO's mandate extends beyond bureaucratic coordination, encompassing vital functions that safeguard lives worldwide. 

 

 

WHO’s core functions include providing leadership on critical health matters, shaping the research agenda, setting norms and standards, articulating evidence-based policy options, catalyzing change, and building sustainable institutional capacity. At the country level, WHO supports evidence-based guidelines, capacity building, institutional strengthening, and the development of appropriate health policies to improve service delivery.

 

 

The US-WHO relationship

Historically, the US has been one of the largest financial contributors to the WHO, playing a key role in shaping its policies and initiatives. As the WHO's largest financial contributor, the United States accounts for approximately 18% of the organization's budget. This funding sustains critical health programs worldwide, which are now confronting potential disruption.

 

 

The US withdrawal represents a larger retreat from multilateralism during the Trump administration, stemming from criticisms of the WHO’s management of the Covid-19 outbreak and its perceived closeness to China. This departure poses risks of job losses, a reduction in essential health initiatives, and a diminished capacity for global health responses.

 

 

 

Role of WHO in Bangladesh's health sector

The WHO has played a crucial role in supporting Bangladesh’s progress in the health sector. Through close collaboration with the government, the WHO contributed to many health achievements, including reductions in maternal, infant, and child mortality, increased immunization coverage, polio elimination, and declines in malaria, tuberculosis, and diarrheal diseases. This partnership has been instrumental in achieving key health-related Millennium Development Goals (MDGs), such as MDG 4 on child mortality.

 

 

As Bangladesh encounters new challenges, such as the increasing burden of non-communicable diseases, health emergencies, and climate-related risks, the WHO remains an essential partner in enhancing resilience. 

 

 

In the meantime, it has supported the development of the Health Population Nutrition Sector Programme (HPNSP) for 2017–2022, which aims to achieve universal health coverage (UHC) by strengthening governance, health systems, and service quality. WHO's Country Cooperation Strategy (CCS) for 2020–2024 provides a coordinated approach to advancing Bangladesh’s health agenda while ensuring the protection of past achievements.

 

 

Consequences of US withdrawal on global health

The consequences of the US withdrawal extend far beyond the headquarters of WHO, impacting health systems around the globe. WHO-led initiatives aimed at reducing childhood mortality, combating infectious diseases, and improving maternal health are now at risk. Crucial programs, such as polio eradication and tuberculosis control, which heavily depend on US funding, may face significant disruption.

 

 

Disease surveillance, a critical function of WHO, is particularly vulnerable. As the WHO identifies outbreaks, shares real-time data, and coordinates containment efforts, the exclusion of the United States from this information flow increases its susceptibility to future pandemics and biological threats. 

 

 

Additionally, the lack of strong international collaboration leaves the US isolated, as no other organization matches the WHO's capacity to coordinate global responses to health threats. It is hoped that the US will soon recognize that distancing itself from the WHO is not only misguided but could also be disastrous for its own health security. 

 

 

While the US withdrawal presents significant challenges, many countries -- including the European Union and China -- are stepping up to fill the funding gap. The increase in supplemental resources following Covid-19 reflects a growing global confidence in WHO. However, with the US being the largest donor withdrawing support, the resulting funding shortfalls appear difficult to overcome in the short term.

 

 

While the absence of US leadership poses challenges, it highlights the importance of diversified partnerships and resilient health systems for countries like Bangladesh

Impact on Bangladesh’s healthcare system

For Bangladesh, the US withdrawal poses both immediate and long-term challenges. This departure puts WHO-supported initiatives at risk and further strains Bangladesh's already stretched healthcare infrastructure.

 

 

The US has been a significant donor, frequently collaborating with the WHO to address issues such as tuberculosis, HIV/AIDS, malaria, and maternal health. The loss of funding jeopardizes the progress made in these critical areas. The role of WHO in facilitating vaccine distribution has become increasingly critical since the pandemic began. In fact, WHO led the global vaccine distribution effort through the COVAX Facility program during the crisis. 

 

 

The United States, as the largest donor of Covid-19 vaccines to this program, played a significant role in helping Bangladesh overcome this crisis. Without US contributions, Bangladesh would have likely faced substantial delays in securing vaccines for its population. 

Overall, the disruption in global health coordination due to the US withdrawal from this global health body will continue to significantly impact Bangladesh's access to essential health interventions. 

 

 

Bangladesh’s possible response

In response, Bangladesh may adapt its health policies and strategies to build resilience as follows:

Strengthen domestic healthcare financing: Increasing the health sector budget and exploring innovative financing options, such as health bonds, is crucial to compensate for lost international funding. Build healthcare infrastructure: Investing in workforce education, supply chain resilience, and local medicine production will ensure long-term healthcare system stability. Public-private partnerships: Collaborating with private healthcare providers and pharmaceutical companies can expand access to affordable healthcare and reduce reliance on imports.

 

Focus on preventive healthcare: Strengthening public health campaigns on hygiene, nutrition, vaccination, and non-communicable disease prevention will improve population health and reduce disease burdens.
Enhance local health financing: Adopting and expanding health insurance coverage and community-based schemes will protect vulnerable populations from financial hardships in healthcare.

 

Harness technology: Using digital health solutions, such as telemedicine and mobile health applications, will improve healthcare accessibility, particularly in remote areas. Pursue regional and multilateral partnerships: Strengthening ties with neighbouring countries and organizations like the EU and UNICEF can help bridge funding and resource gaps.

 

Conclusion

The US withdrawal from WHO represents a significant shift in global health dynamics that will undoubtedly impact Bangladesh. However, this situation also provides Bangladesh with an opportunity to develop a more self-reliant healthcare system. By strengthening domestic financing, encouraging public-private partnerships, investing in technology, building new alliances, and seeking alternative donors, Bangladesh can effectively adapt to the changing landscape of global health funding. 

 

 

While the absence of US leadership poses challenges, it highlights the importance of diversified partnerships and resilient health systems for countries like Bangladesh. Md Mustafizur Rahman, trained as a medical graduate, served as the Ambassador and Permanent Representative of Bangladesh to the UN Offices, WHO, WTO and other international organizations in Geneva.