During Donald Trump's presidency, the United States of America's withdrawal from a number of international organizations was among his controversial decisions. One of these significant actions was the withdrawal from the World Health Organization (WHO) in 2020. This action, which had considerable impacts on global health policies and public health worldwide, particularly affected African countries, which are heavily dependent on international aid in the healthcare sector. This article examines the consequences of this decision, namely the United States' withdrawal from the WHO, on African countries, analyzing the challenges and opportunities arising from it.
During his presidency, Donald Trump initiated the process of the United States' withdrawal from the World Health Organization by issuing an executive order. Following the commencement of his second presidential term, on his first working day, he once again emphasized America's withdrawal from this international organization by signing another executive order. Trump's decision in both instances faced widespread concern and criticism both domestically and internationally.
Tarik Jasarevic, a spokesperson for the World Health Organization, called the decision regrettable. This marks the second time Trump has issued an order for the US withdrawal from this organization. At the end of his first presidential term, he also ordered America's withdrawal, accusing the organization of mismanagement, but this was reversed by Joe Biden during his term in response to the COVID-19 pandemic and the potential threat of an influenza virus pandemic.
Trump's decision on January 20th is set to impact the backbone of health equity initiatives for decades, and its consequences extend far beyond geopolitics. The US withdrawal from the World Health Organization is not merely a political decision; it is a direct blow to the security and health of millions of people in low- and middle-income countries on the African continent. This order also suspended the transfer of financial resources, support, and aid from the United States. The US withdrawal from this international organization carries significant weight. Trump had also withdrawn the United States from this organization in 2020.
Reduction of Financial and Support Resources
The withdrawal of the United States, as one of the largest financial contributors to the World Health Organization, will lead to a significant reduction in the organization's budget and financial resources. The US alone provides 22 percent of the WHO's income, equivalent to $261 million annually. Furthermore, the United States, with a contribution of $728 million, accounts for 14 percent of the organization's total voluntary contributions. To better understand the significance of these figures, we examine the WHO's budget structure. The organization's budget is funded from two main sources: assessed contributions and voluntary contributions. Assessed contributions are amounts that member states of the WHO pay annually based on their population and gross domestic product. This type of funding provides a stable and predictable source for covering the organization's core costs. In contrast, voluntary contributions are donated to the organization by member states and other entities such as foundations and private institutions and are typically used to implement projects or achieve specific priorities such as combating specific diseases or public health programs. Overall, the United States, providing approximately 18 percent of the WHO's total budget, is the largest donor to this organization and plays a vital role in its ability to carry out global missions and respond to health crises. Therefore, the reduction or cessation of these financial contributions, especially from the largest donor, can place significant pressure on the organization's financial structure and have widespread negative impacts on its health programs worldwide.
African countries, which are heavily dependent on international financial aid to combat diseases, will face a reduction in resources due to the US withdrawal. This could lead to delays in the provision of vaccines, medicines, and medical equipment, as well as reduce the organization's capacity to implement health programs in Africa, weakening key health programs in Africa and these countries' ability to respond to health crises, potentially leading to increased mortality and the exacerbation of diseases on the continent. In sub-Saharan African countries, where vaccination coverage may fall below fifty percent in some areas and the prevalence of diseases such as cholera, malaria, and dengue may intensify, the Ebola outbreak in West Africa between 2014 and 2016, for example, demonstrated how a health emergency without strong support can endanger many lives.
The Role of the World Health Organization in Africa
The World Health Organization, as an international institution, plays a pivotal role in coordinating public health policies, medical research, and the exchange of health information globally. This organization is of particular importance for developing countries, especially in the African continent, a region where many countries grapple with enormous health challenges such as infectious diseases like AIDS, malaria, and Ebola. In such circumstances, the financial and technical support of the World Health Organization is crucial for providing vaccines, medicines, and medical equipment. Furthermore, the WHO plays an essential role in designing and implementing educational programs and promoting public health in African countries, and many of these countries have been able to combat the spread of infectious diseases through the organization's programs. The reduction of the World Health Organization's budget, especially following the withdrawal of the United States, could lead to decreased access to disease prevention, diagnosis, and treatment programs across the African continent. For example, the Global Polio Eradication Initiative in Afghanistan and Pakistan, which is heavily dependent on US financial aid, will face a serious threat. This will also challenge the United Nations' plan to end diseases like AIDS by 2030.
European countries filled the financial gap in 2020 when Trump last cut US funding. However, it is likely that they will not be able to do so this time, given the economic recession and the geopolitical and financial challenges that European countries themselves face. If the financial gap resulting from the United States' withdrawal cannot be filled from other sources, the responsibility for the funding shortfall for health programs and services will fall on African countries, placing further pressure on governments with limited fiscal space. African countries will face a reduction in financial resources to combat infectious diseases. This could lead to delays in the provision of vaccines, medicines, and medical equipment, as well as reduce the organization's capacity to implement health programs in Africa.
Which Countries Will See the Most Impact?
The countries that will be most affected by this situation are those with a heavy burden of AIDS (Acquired Immunodeficiency Syndrome), tuberculosis, and malaria, as well as countries hosting large populations of refugees and internally displaced persons. Currently, the top ten recipients of assistance from the United States Agency for International Development (USAID) in Africa are: Nigeria, Mali, Niger, Mozambique, Tanzania, Uganda, South Africa, Kenya, Zambia, and the Democratic Republic of Congo. These countries, many of which grapple with the aforementioned health challenges, will undoubtedly witness serious impacts on the health of millions of their citizens if financial resources are not quickly secured to compensate for the gap left by the United States' withdrawal from the World Health Organization. The inability to prevent new infections and the risk of increased drug resistance due to disruptions in treatment programs are among the widespread and concerning consequences of this budget reduction.
In Uganda, where approximately 1.4 million people are living with AIDS, 60 percent of the country's AIDS program costs were funded through the US health assistance program, and about 20 percent was funded by the Global Fund (part of which comes from the US health assistance program).
Evidence suggests that with the reduced US involvement in global health under President Trump's leadership, Europe's role in global health governance may increase. European countries may strengthen their contributions to global health financing and leadership more than before. The reduced role of the US gives Europe an opportunity to become more influential in global health policymaking, strengthen multilateral cooperation, and expand access to health services, especially in areas typically facing resource shortages. Accordingly, poor African countries need multilateral approaches and domestic, regional, and international cooperation for the development of their healthcare systems. The first step in this direction is strengthening health infrastructure and securing sustainable financial resources. African countries can increase their capacity to cope with health crises by improving resource management, strengthening public health systems, and improving the quality of education and training in the health sector. Furthermore, the use of new technologies to improve access to health services in remote and deprived areas, the promotion of preventive policies against diseases, and ultimately, the creation of a favorable environment for attracting investment and strengthening local and global partnerships can help achieve sustainable development of the health system in African countries.
African countries need to adopt a comprehensive and sustainable approach to effectively address the challenges arising from the United States' withdrawal from the World Health Organization. One of the most important steps in this direction is to strengthen the role of regional institutions such as the African Union and the Africa Centres for Disease Control and Prevention. These institutions can effectively mitigate the negative impacts of the US withdrawal by creating joint mechanisms for financing, information exchange, and coordination of health policies. Alongside these efforts, African countries should seek to diversify their funding sources. Utilizing the capacities of international organizations such as the European Union, the World Bank, the Gates Foundation, and other development partners to fund vital projects in the field of public health is essential. Additionally, increasing domestic investment in the public health sector by increasing the share of the national health budget and strengthening cooperation between the government and the private sector can lead to reduced dependence on international aid and lay the groundwork for sustainable development of the health system in these countries.
The Islamic Republic of Iran can play a role in public health and pharmaceuticals in Africa. African countries mainly import their required medicines from the European Union, India, and China, with these three regions supplying over 75 percent of the African continent's pharmaceutical imports. It is worth mentioning that Indian pharmaceutical companies play a significant role in supplying affordable generic drugs to the African market. Furthermore, China has been actively involved in health diplomacy across Africa, providing medical assistance and supporting the development of health infrastructure on the continent since the 1960s. While the United States is one of the largest pharmaceutical exporters globally, its share of African pharmaceutical imports is only 4.4 percent. Within the African continent, South Africa is recognized as a leading exporter in the pharmaceutical industry, with companies like Aspen Pharmacare playing a key role in the production and distribution of branded and generic drugs across the continent. Cuba also exports its health personnel and health specialists to Africa. Iran can also play a more effective role in this area.
The application of new technologies such as digital health systems, telemedicine, and artificial intelligence for disease surveillance and improving the efficiency of the health system is another solution that can mitigate the negative impact of the reduced financial support from the World Health Organization.
Conclusion
In response to the reduction in international support, the African continent may face serious challenges, but at the same time, it will also have opportunities to strengthen its health infrastructure. One of the most significant challenges is the lack of financial resources to provide basic health services. Furthermore, the absence of global coordination in addressing health crises can make African countries more vulnerable to infectious diseases and pandemics.
Overall, by adopting a comprehensive strategy that includes strengthening regional and international collaborations, increasing international cooperation with other countries and non-governmental organizations, attracting diverse financial resources, developing domestic infrastructure, and utilizing new technologies, African countries can enhance their capacity to face the challenges arising from the United States' withdrawal from the World Health Organization and move towards a more independent and resilient healthcare system.
Although Trump's withdrawal from the World Health Organization may lead to a reduction in international support for African countries in the field of healthcare, this decision provides African countries with an opportunity to focus on strengthening health infrastructure and self-reliance in this area. Simultaneously, this action requires greater attention and cooperation from European countries and other international organizations to compensate for the shortage of resources and maintain the ability to respond to global health crises.
Mohammad Movahed Senior Expert at the Center for Political and International Studies
(The opinions expressed are those of the authors and do not purport to reflect the opinions or views of the IPIS)