'By cutting funding, US will be importing diseases': Public health expert Dr S.S. Lal on Donald Trump withdrawing US from WHO

US President Donald Trump issued an executive order to withdraw the United States from the World Health Organization, citing the "organization’s mishandling of the COVID-19 pandemic", its "failure to adopt urgently needed reforms", and its "inability to demonstrate independence from the inappropriate political influence of WHO member states". The executive order also claims that the WHO "demands unfairly onerous payments from the United States, far out of proportion with other countries’ assessed payments", as another reason for the withdrawal.

In an exclusive interview with THE WEEK, Dr S.S. Lal, an internationally acclaimed public health expert, discusses the far-reaching impact of Trump’s decision on global health. Dr Lal is currently the Asia-Pacific Director of ReAct, a WHO partner organisation and one of the first international independent networks to address the complex nature of antibiotic resistance and its drivers. He is also a former National Professional Officer (NPO) for WHO in India and served as an International Officer in East Timor.

Lal has held senior positions with the UNEP, Global Fund, Wadhwani Foundation, FHI360, and PATH, implementing large-scale public health programmes across 25 low- and middle-income countries in Asia, Africa, and Europe. Edited excerpts:

Q/ Donald Trump has withdrawn the US from WHO, which means the organisation will lose a significant source of funding, as the US is its largest contributor. Given your experience working in low- and middle-income countries and your understanding of the ground realities, what do you think will be the consequences for global public health programmes? What changes or challenges can we expect to see over the next four years with the US out of WHO?

A/ People like Donald Trump lack the ability to grasp that infectious diseases affect everyone. These diseases cannot be confined; most cannot be restricted by geographical borders. For example, only 8,000 people contract tuberculosis (TB) annually in the US—just 8,000. In contrast, India records 27 million cases. However, 80 per cent of TB cases in the US are linked to migrants, and the country cannot eliminate migrants.

Consider the workforce in the US: doctors, nurses, IT professionals—many of these individuals come from other countries, including Asia and Africa. These regions have higher disease burdens, and their migrants inevitably bring some of these diseases with them. Infectious diseases know no borders; they are a shared global challenge.

The problem is that many countries lack the resources to manage their health crises effectively. Until recently, India was in a similar position, relying heavily on loans and funding. Even now, India receives substantial support from organisations like the Global Fund, the world’s largest health fund. India remains one of its biggest beneficiaries due to having the highest TB burden and being among the top for HIV cases.

If countries like the US withdraw support from organisations like WHO, India might manage to survive using its domestic resources. However, many nations without such resources would face severe disruptions to their health programmes. Even today, India receives grants from the World Bank and other international organisations, including the US, to run its health initiatives. Developed nations fund health programmes in other countries not purely out [of philanthropy] but also because these global efforts benefit everyone.

For example, imagine living in a well-maintained colony, but the neighbouring area is impoverished, and people there lack basic facilities like toilets. To protect your own colony and city, you might build toilets for them—not necessarily to help them, but to safeguard your own environment. This same principle applies globally. Americans won't avoid tuberculosis if TB exists outside the US—it’s as simple as that.

Trump might argue that people shouldn’t come to the US, but people will inevitably travel. Ministers from other countries may visit, some of whom might carry TB. Trade and tourism also bring people across borders. As long as international travel continues, infectious diseases cannot be entirely stopped.

Another critical point is that funding health initiatives brings political influence. For example, the US gains significant political power by contributing to global health programmes. In Africa, you will often see vehicles donated by the US, specifically for public health implementation. Through organisations like USAID, WHO, and the Global Fund, the US plays a substantial role in supporting health programmes worldwide.

A large portion of WHO and Global Fund money comes from the US, and a withdrawal will severely impact poor and developing countries, particularly in Asia and Africa. Africa faces challenges due to limited capacity and resources, while Asia struggles due to its massive populations. India, despite being just one country, demonstrates the scale of the issue. Systems in African nations are even less equipped, which will lead to significant suffering if such funding is reduced or withdrawn.

This is going to completely tilt the balance of control. WHO and similar organisations anticipated that such a situation might arise, so they have been preparing for it.

Q/ What is meant by preparation?

A/ Many positions at WHO rely on annual contract renewals. However, over the past two years, this process stalled because of uncertainty, with people fearing Trump might return. As a result, many lost their jobs.

This job loss doesn't just impact individuals; it also means the system is losing valuable experts. These are significant challenges, and they will affect the entire world, not just America. In fact, America is also going to suffer.

Q/ You mentioned that the US has been funding organisations whose money supports programmes in places like Africa. Do you think this situation presents an opportunity for a country like China to step in and directly fund these projects? Considering their existing efforts to create a Sino-centric world, could this be part of their strategy? They are already heavily investing in infrastructure and other initiatives in Africa—do you think they might use this as a chance to expand their influence further?

A/ To some extent yes. However, China is not as prepared as the US in this regard. For the US, this has been a long-standing practice. They have the resources, dedicated funding, and established budgets for such initiatives, making it an ongoing process. Additionally, the US enjoys greater acceptance compared to China.

When China approaches countries like India or Bangladesh with financial aid, these nations often decline, despite China's financial capability. Acceptance is a significant challenge for China. Moreover, China lacks the mechanisms the US has in place. The US government operates through embassies and organisations like USAID. For example, in India, the USAID office within the Delhi embassy has a substantial number of staff dedicated solely to health programmes. Many large-scale projects in India are supported by US funding through USAID.

For an average American, the idea might seem simple: "We’ll save our money and use it here." But the truth is, by cutting funding, the US will essentially be importing diseases. These effects won’t be immediately visible—perhaps not in a year or so—but over time, they will disrupt the balance that has been carefully established over the last several decades.

It’s important to recognise that America’s wealth wasn’t built in isolation. Consider prominent figures like Sundar Pichai and others in leading tech companies like Google. America's prosperity isn’t solely due to its native-born population. After all, almost all Americans, including Trump, are descendants of immigrants.

In recent years, many top positions in the US have been occupied by people from other countries—not as a gesture of representation, but because they are exceptionally talented.

Disrupting this balance will not only impact health but also have serious political ramifications.

Q/ When Trump made this declaration, he pointed out that a country like China contributes significantly less to WHO. He framed this as an unfair burden on the US. Do you think this narrative holds weight? Should other countries, particularly rising economic powers like China, contribute more to organisations like WHO?

A/ There’s no doubt about that. But it depends on the situation. For example, when you need money—whether for political parties or festivals—you go to people who have a history of giving. The wealthiest individuals may not always contribute because you don’t approach them. It’s as simple as that. The US had a culture of contributing, which inspired others to follow suit.

In terms of global influence, the US has always played a significant role—whether you call it global police or something else. Their soft power was immense. The US would say, "We contribute this much, and India should contribute too." This kind of influence was key. China doesn’t have that level of influence.

India, on the other hand, is contributing to 40 or 50 countries, but the scale is smaller. This shift was inevitable, as America can’t continue to carry the burden forever, and changing political dynamics would have brought this situation eventually. However, the abruptness of it is going to be a big blow. WHO and other organisations were anticipating this for the last two years and were preparing, but still, it will be a significant setback for global health. There’s no doubt about that.