Portal de Periódicos da CAPES

US withdrawal from WHO is unlawful and threatens global and US health and security

2020; Elsevier BV; Volume: 396; Issue: 10247 Linguagem: Inglês

10.1016/s0140-6736(20)31527-0

1474-547X

Lawrence O. Gostin, Harold Hongju Koh, Michelle A. Williams, Margaret Hamburg, Georges C. Benjamin, William H. Foege, Patricia M. Davidson, Elizabeth H. Bradley, Michèle Barry, Jeffrey P. Koplan, Mirta Flia Roses Periago, Wafaa El‐Sadr, Ann Kurth, Sten H. Vermund, Matthew M. Kavanagh,

Health and Conflict Studies

On May 29, 2020, President Donald Trump announced the USA would sever its relationship with WHO and redirect funds to US global health priorities.1McNeil Jr, DG Trump says US is leaving WHO, but experts aren't so sure.The New York Times. May 30, 2020; https://www.nytimes.com/2020/05/29/health/virus-who.htmlDate accessed: July 7, 2020Google Scholar On July 6, 2020, the US administration officially notified UN Secretary-General António Guterres of its intention to withdraw from WHO membership.2Rauhala E Demirjian K Olorunnipa T Trump administration sends letter withdrawing US from World Health Organization over coronavirus response.The Washington Post. July 7, 2020; https://www.washingtonpost.com/world/trump-united-states-withdrawal-world-health-organization-coronavirus/2020/07/07/ae0a25e4-b550-11ea-9a1d-d3db1cbe07ce_story.htmlDate accessed: July 7, 2020Google Scholar This notification coincides with record daily increases in COVID-19 cases worldwide and rising infections in more than three-quarters of the US states.3The New York TimesCoronavirus in the US: latest map and case count.The New York Times. July 7, 2020; https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.htmlDate accessed: July 7, 2020Google Scholar, 4WHOCoronavirus disease 2019 (COVID-19) situation reports.https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/Date: 2020Date accessed: July 7, 2020Google Scholar In response, 750 leaders from academia, science, and law have urged the US Congress to block the president's action.5Gostin LO Koh HH Kavanagh MM et al.Letter to Congress on WHO withdrawal public health, law and international relations leaders.https://oneill.law.georgetown.edu/letter-to-congress-on-who-withdrawal-from-public-health-law-and-international-relations-leaders/Date: June 30, 2020Date accessed: July 7, 2020Google Scholar The US Congress, the courts, and the public all have the power to block this reckless decision. The USA entered WHO membership through a 1948 joint resolution passed by both houses of Congress and this resolution has been supported by successive administrations. Former President Harry Truman explicitly referenced that resolution as his legal basis for joining WHO.6Koh HH Trump's empty "withdrawal" from the World Health Organization.Just Security. May 30, 2020; https://www.justsecurity.org/70493/trumps-empty-withdrawal-from-the-world-health-organization/Date accessed: July 7, 2020Google Scholar The current US administration's unilateral action notifying the UN that the USA is withdrawing violates US law because it does not have express approval of Congress to leave WHO. A Supreme Court precedent has made clear that "When the President takes measures incompatible with the expressed or implied will of Congress, his power is at its lowest ebb."7Youngstown Sheet and Tube Company v. Sawyer, 343 U.S. 579 (1952).Google Scholar The US administration's decision to sever ties and terminate WHO funding violates a binding condition in Congress's 1948 resolution, which must be met before the USA may withdraw. The law mandates the USA must pay its financial obligations for the current fiscal year. Because withdrawal could not occur until next July, the USA must pay its mandatory WHO contributions through the end of 2021. And because any withdrawal could not take effect until July, 2021, a new US presidential administration could simply revoke the withdrawal upon taking office. Withdrawal from WHO would have dire consequences for US security, diplomacy, and influence. WHO has unmatched global reach and legitimacy. The US administration would be hard pressed to disentangle the country from WHO governance and programmes. The Pan American Health Organization (PAHO) is among six WHO regional offices and is headquartered in Washington, DC, USA. The USA is also a state party to two WHO treaties: the WHO Constitution, establishing it as the "directing and co-ordinating authority on international health";8WHOConstitution of the World Health Organization.https://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdfDate: 1946Date accessed: July 7, 2020Google Scholar and the International Health Regulations (IHR 2005), the governing framework for epidemic preparedness and response.9WHOInternational Health Regulations.https://www.who.int/health-topics/international-health-regulations#tab=tab_1Date: 2020Date accessed: July 7, 2020Google Scholar Various US institutions collaborate with WHO on vital work that would be harmed if the relationship is severed. There are 21 WHO collaborating centres at the US Centers for Disease Control and Prevention (CDC) and three at the National Institutes of Health, focused on US priorities, including polio eradication, cancer prevention, and global health security.10WHOWHO collaborating centres global database.https://apps.who.int/whocc/ReportDetails.aspx?bkGL7M2F8I0hgDOcgIgPXfIKvz3GAvXGshErTaG7+mI=Date: 2020Date accessed: July 7, 2020Google Scholar The Secretariat of the 44 WHO Collaborating Centers for Nursing and Midwifery is based in the USA. This autumn, seasonal influenza and COVID-19 will pose a double burden on health system capacities.11Gostin LO Salmon DA The dual epidemics of COVID-19 and influenza: vaccine acceptance, coverage, and mandates.JAMA. 2020; (published online June 11.)https://doi.org/10.1001/jama.2020.10802Crossref Scopus (97) Google Scholar The USA could be cut out of the global system to design annual influenza vaccines. The WHO Global Influenza Surveillance and Response System aggregates data from countries around the world to track and study circulating viruses.12WHOInto the history of influenza control: GISRS: backbone of global influenza surveillance.https://www.who.int/influenza/gip-anniversary/en/Date: May 18, 2017Date accessed: July 7, 2020Google Scholar US agencies, pharmaceutical companies, and laboratories also rely on the WHO Pandemic Influenza Preparedness Framework to gain access to new influenza virus samples for research and development. Severing ties with WHO could impede US access to crucial tools for developing biological countermeasures to influenza. A COVID-19 vaccine is urgently needed not only to safeguard public health but also to safely reopen society. WHO is conducting the Solidarity trial for COVID-19 treatments joined by more than 100 countries.13WHO"Solidarity" clinical trial for COVID-19 treatments.https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatmentsDate: 2020Date accessed: July 7, 2020Google Scholar WHO also leads the Access to COVID-19 Tools (ACT) Accelerator for COVID-19 diagnostics, therapeutics, and vaccines.14WHOThe access to COVID-19 tools (ACT) accelerator.https://www.who.int/initiatives/act-acceleratorDate: 2020Date accessed: July 7, 2020Google Scholar If the USA does not participate in these WHO initiatives, Americans could have limited access to scarce vaccine supplies, and are likely to be barred from travel to foreign destinations. Experienced US personnel are often seconded to WHO or embedded in outbreak response teams. US scientists gained access to Wuhan, China, as part of a WHO COVID-19 mission to China.15WHOWHO timeline—COVID-19.https://www.who.int/news-room/detail/27-04-2020-who-timeline-covid-19Date: April 27, 2020Date accessed: July 7, 2020Google Scholar US global health strategies to rapidly respond to international disease outbreaks will be compromised without membership of WHO. Beyond COVID-19, WHO is tracking and responding to dozens of infectious disease outbreaks around the world, including yellow fever in Togo, Middle East respiratory syndrome in Saudi Arabia, and dengue fever in Brazil.16WHODisease outbreak news.https://www.who.int/csr/don/en/Date: 2020Date accessed: July 7, 2020Google Scholar, 17PAHOReported cases of dengue fever in the Americas.https://www.paho.org/data/index.php/en/mnu-topics/indicadores-dengue-en/dengue-nacional-en/252-dengue-pais-ano-en.htmlDate: 2020Date accessed: July 7, 2020Google Scholar On June 25, 2020, the Democratic Republic of the Congo (DRC) Government declared the end of the world's second longest outbreak of Ebola virus disease.18WHODisease outbreak news. Ebola virus disease—Democratic Republic of Congo.https://www.who.int/csr/don/26-June-2020-ebola-drc/en/Date: June 26, 2020Date accessed: July 7, 2020Google Scholar WHO deployed staff to a Congolese warzone, even when the White House banned CDC personnel from involvement in this effort.19Gostin LO Kavanagh MM Cameron E Ebola and war in the Democratic Republic of Congo: avoiding failure and thinking ahead.JAMA. 2019; 321: 243-244Crossref PubMed Scopus (16) Google Scholar The DRC Government reported a new unrelated outbreak of Ebola virus disease in June, 2020, in the country's northwest, and WHO surge teams have been deployed.20Global Outbreak and Response NetworkNew Ebola outbreak detected in northwest Democratic Republic of the Congo; WHO surge team supporting the response.https://extranet.who.int/goarn/content/new-ebola-outbreak-detected-northwest-democratic-republic-congo-who-surge-team-supporting-0Date: 2020Date accessed: July 7, 2020Google Scholar WHO's crucial role in curtailing infectious diseases extends beyond outbreaks to diseases. In 1980, the World Health Assembly declared smallpox eradicated, WHO's historic achievement. Today, WHO's key work in HIV, tuberculosis, malaria, and maternal mortality makes US foreign assistance effective. COVID-19 has revealed shortcomings in WHO's powers and funding, warranting substantial reforms. WHO has limited authority to ensure state compliance with the IHR, including constrained ability to independently verify official state reports. But after leaving WHO, the USA would be on the outside looking in, without global influence to promote crucial reforms. Stand-alone US programmes, moreover, could never substitute for a truly global agency. Absent treaty obligations, in a multipolar world, mean there are no guarantees that countries will cooperate with the USA. Health and security in the USA and globally require robust collaboration with WHO—a cornerstone of US funding and policy since 1948. The USA cannot cut ties with WHO without incurring major disruption and damage, making Americans far less safe. That is the last thing the global community needs as the world faces a historic health emergency. LOG is director of the WHO Collaborating Center on National and Global Health Law. MAH is co-chair of the WHO Expert Advisory Committee on Developing Global Standards for Governance and Oversight of Human Genome Editing and receives no compensation for this work apart from travel-related expenses. The other authors declare no competing interests.