On his first day back in the White House, US President Donald Trump began the process of withdrawing the US from the World Health Organization (WHO).

Trump had initiated the US pullout during his first term, but the decision was reversed by then-President Joe Biden.

Scientists fear the move could roll back decades-long gains made in fighting infectious diseases like AIDS, malaria, and tuberculosis, and have cautioned that withdrawing from the global health organisation could weaken the world’s defences against dangerous new outbreaks capable of triggering pandemics.

Here’s a look at what Trump’s decision means.

What happened?

In the first Oval Office appearance of his second term, Trump signed an executive order detailing how the withdrawal process might begin.

His move calls for pausing the future transfer of US government funds to the organisation, recalling and reassigning federal personnel and contractors working with the WHO, and calls on officials to “identify credible and transparent United States and international partners to assume necessary activities previously undertaken by” the organisation.

This isn’t the first time Trump has tried to sever ties with the WHO, the UN’s specialised health agency.

In July 2020, several months after WHO declared COVID-19 to be a pandemic and as cases surged globally, Trump’s administration officially notified UN Secretary-General Antonio Guterres that the US was planning to pull out of WHO, suspending funding to the agency.

Dr Tom Frieden, president and CEO of the advocacy group Resolve to Save Lives, said Trump’s move “makes Americans – and the world – less safe”.

Can Trump really withdraw the US from WHO?

Yes, as long as he gets the approval of Congress and the US meets its financial obligations to WHO for the current fiscal year.

The US joined WHO via a 1948 joint resolution passed by both chambers of Congress, which has subsequently been supported by all administrations. The resolution requires the US to provide a one-year notice period should it decide to leave WHO.

What does this mean for WHO?

It will put the WHO in a difficult financial position. The US has historically been among WHO’s biggest donors, providing the UN health agency not only with hundreds of millions of dollars, but also hundreds of staffers with specialised public health expertise.

In the last decade, the US has given WHO about $160 million to $815 million (€153 million to €780 million) every year. WHO’s yearly budget is about $2 billion to $3 billion (€1.9 billion to €2.9 billion).

The WHO provides technical assistance to poorer countries, helps distribute scarce vaccines, supplies, and treatments, and sets guidelines for hundreds of health conditions, including mental health and cancer.

Losing US funding could cripple numerous global health initiatives, including the effort to eradicate polio, maternal and child health programs, and research to identify new viral threats.

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American scientists would also lose quick access to critical genetic databases run by WHO, which could stall attempts to produce vaccines and medicines.

Lawrence Gostin, director of the WHO Collaborating Center on Global Health Law at Georgetown University, said losing American resources would devastate WHO’s global surveillance and epidemic response efforts.

“It would make it more likely that we could see novel diseases spinning out of control, crossing borders, and potentially sparking a pandemic,” Gostin said.

How will other countries respond?

When Trump first pulled out of the WHO, Germany boosted its funding to briefly become the agency’s biggest donor. However, it’s not clear that Germany or other European leaders would have the same appetite to fill those funding gaps this time around.

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“If other member states or philanthropists step up and provide more flexible funding – even if it’s less than the US provides – this could help WHO be more agile and focused in delivering its mandate,” Dr Pete Baker, deputy director of the global health policy programme at the US-based think tank Center for Global Development, said in a statement.

Why is Trump withdrawing the US from WHO?

At a September campaign rally, Trump said he would “take on the corruption” at WHO and other public health institutions that he said were “dominated” by corporate power and China.

In 2020, Trump alleged WHO was “colluding” with China to hide the extent of the coronavirus’ spread in the early days of the pandemic.

An AP investigation in June 2020 found that China withheld crucial details about the virus shortly after it emerged, frustrating WHO’s efforts to assess its potential for danger and stop its spread.

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What has WHO said?

After Trump’s announcement, the agency said it “regrets the announcement that the United States of America intends to withdraw” from the WHO and that it hopes the US will reconsider.

The group pointed to decades-long US-WHO cooperation to address global health threats such as smallpox and polio, and noted that it has been reforming its processes in recent years to improve its “accountability, cost-effectiveness, and impact in countries”.