It's the biggest global health meeting of the year. And the United States won't be taking a seat at the table.
This week, representatives from the 194 countries of the World Health Organization — minus the U.S. — are gathering in Geneva to discuss and vote on policies that will shape global health in the years and decades to come. The topics will range from preparing for the next pandemic to preventing lung cancer by cutting air pollution.
So where's the U.S.? On Inauguration Day, President Donald Trump announced plans to withdraw from the WHO, saying that the U.N. organization had "ripped" off the United States and asserting that it is controlled by China. For the first time since 1948, the U.S. — which provides about one-fifth of WHO's $6.8 billion budget — will be absent from the annual World Health Assembly.
"It's very sad that the U.S. is no longer within the group of countries who want to help make the world a better place," said Barbara Stocking of Britain, the chair of the Panel for a Global Public Health Convention, an independent group focused on pandemic prevention.
That glaring absence of both people and money will affect both WHO's ability to address health crises that don't care about borders -– as well as the ability of the U.S. to collaborate with the rest of the world to solve them, say global health specialists interviewed by NPR.
But the Assembly also comes at a time of opportunity. After years of tough negotiations, member nations are poised to adopt the pandemic treaty, an agreement aimed at ensuring the globe responds to the next pandemic better than COVID-19.
"This coming World Health Assembly will be historic," said Lawrence Gostin, a professor at Georgetown University and Director of the World Health Organization Collaborating Center on National and Global Health Law. "In one way it'll be triumphant," he said, referencing the pandemic treaty. "And in another way, it'll be tragic … because the United States won't be there."
Here's what to watch for at this year's World Health Assembly: How WHO will address its funding crisis; whether WHO adopts the pandemic treaty and what health goals will be set without a U.S. voice
The elephant not in the room
As the biggest financial contributor to WHO, the U.S. has historically played an outsized role in negotiations.
"When the United States wanted something, it could lead and influence like no other country, including our rivals, like China or Russia," said Gostin. "The U.S. won't be there to have that kind of influence now and for the foreseeable future. To me, that's terribly sad."
What emerges in that vacuum of US leadership is still unclear.
"What is lacking now for WHO is not just the budget," said Christoph Benn, director of Global Health Diplomacy at the Joep Lange Institute in Amsterdam. "The U.S. has some of the most sophisticated systems of health expertise in the world. Some of the best experts always come from the U.S., and I can honestly say they will be sorely missed."
But discussion and negotiations will continue. Given the political climate in the U.S., some suspect their absence could galvanize the meeting.
"I think there are a lot of countries who feel like they can exhale in our absence and focus on the work and not have conversations mired in political debates," said a former U.S. health official who has been a delegate at previous assemblies but requested anonymity for fear of retaliation from the Trump administration.
For instance, some pandemic treaty watchers suspect the Trump administration's abrupt withdrawal spurred countries to finalize the agreement ahead of the World Health Assembly. Whether that productive dynamic continues remains to be seen.
"I'll be paying attention to who emerges as not just leaders, but maybe as partners and collaborators," said the official. "There's a constant question of who takes over now. maybe it's not going to be China, maybe it's going to be the Global South working together to solve problems."
NPR reached out to the White House for comment on the upcoming meeting but did not receive a response.
An enormous hole in the budget
WHO faces the most significant budget crisis in its nearly 80-year history.
They're already short $600 million for the 2024-2025 $6.8 billion budget and face even more drastic shortfalls over the next couple years because of the Trump administration's decision to terminate U.S. membership.
The U.S. exit "left a big hole in the budget of WHO that other smaller contributions from other countries from around the world could not compensate for," said Benn.
Already, WHO has cut its proposed budget for 2026-2027 by about 20% to compensate. "To be blunt, we cannot do everything," said WHO Director General Tedros Adhanom Ghebreyesus at a budget committee meeting last week, noting that WHO has started cutting positions, including about half of the leadership team, and will be scaling back programs around the world.
"What the world will notice most dramatically are the cuts in the emergency programs," said Benn, which he says enable countries to respond quickly to outbreaks, like mpox or Ebola, and quickly relay that information to WHO. "If those country programs have to be cut down, it's a big loss."
But WHO is working to diversify its cash flow. The organization is funded through a mix of mandatory contributions — member states contribute based on the size of their economy — and voluntary contributions. Voluntary contributions can come from member countries, and philanthropic donors – led by the Gates Foundation (which is a funder of NPR and this blog).
"The share of the mandatory contributions [in the total budget] has been historically very low, not more than 20 to 25%, meaning the rest of the budget are voluntary contributions," said Benn. WHO is trying to change that. This week, member states will vote on upping mandatory contributions to 30%, said Benn.
Even still, WHO could be short over $1 billion for its next budget, and it's not just because of the U.S. withdrawal.
Many other countries are tightening their belts in the face of global economic uncertainty. As a result, "WHO is also appealing to the private sector and private foundations to increase their contributions," said Benn.
"I've attended probably 25 World Health Assemblies in my lifetime," said Benn. "I do anticipate that the mood this time will be very much downcast. I think it will be palpable that there is a sense of crisis here."
Pandemic treaty to be adopted
After more than three years of negotiations, the 193 member countries of the WHO — but not the U.S. — are expected to adopt the Pandemic Prevention, Preparedness and Response Agreement, which would obligate countries to cooperate to prevent and respond to any future pandemic. But the treaty is not without its controversies, some of which remain to be sorted out.
The agreement is "one of the direct learnings from COVID-19," Maria Van Kerkhove, interim director of the Department of Epidemic and Pandemic Preparedness and Prevention at WHO, told NPR Friday in an interview. "To not only just say that the world wants to do better, but actually take concrete steps to do so."
The 30-page treaty covers a wide range of topics, from paying closer attention to the risk of viruses spilling over from animals to protecting health care workers. But years of tough negotiations have whittled down the initial ambition and scope of the agreement.
"People might look at the accord and say the language is imperfect and of course it's not perfect," said Van Kerhove. "But there's so much to work with in what's actually drafted there."
Even if countries adopt the agreement, there are unresolved details around the most contentious issue — rich countries sharing vaccine and treatment technology in exchange for outbreak data from low- and middle-income countries.
The agreement attempted to formalize this exchange through the Pathogen Access and Benefit-Sharing System. "I call it a kind of grand social global bargain," said Gostin.
"High-income countries would gain access to critical health information and scientific exchange like pathogen samples, genomic sequencing data that we need to develop the lifesaving vaccines and treatments," he said. "In return, we would agree to equitably distribute those medical products throughout the world, through WHO."
That grand bargain proved contentious. Some richer countries balk at the prospect of constraining their pharmaceutical industries, while lower-income countries protest the idea of sharing the data needed to design treatments and vaccines without some guarantee that they'll benefit.
For now, countries have agreed to come to "mutually agreed terms" on this issue over the next year. Whatever ends up being decided, the U.S. won't be part of it.
"It's hard for me to see how the U.S. gets unimpeded, rapid access to the kinds of scientific information we need to rapidly develop our vaccines and treatments," said Gostin. "That could be a problem for every American."
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