President Donald Trump has redoubled his criticism of the World Health Organization, threatening to permanently withdraw funding and cancel US membership even as it deals with a devastating global pandemic.
In a letter to WHO Director-General Tedros Adhanom Ghebreyesus on Monday, Trump bemoaned "repeated missteps by you and your organization" and said he would permanently halt financial contributions if the WHO does not "commit to major substantive improvements in the next 30 days." Trump temporarily suspended funding to the organization last month.
The threat is in line with Trump's track record of extracting the US from various international bodies and treaties.
But it's a remarkable ultimatum for an American President to issue during a global public health crisis which has so far claimed more than 300,000 lives.
The move, made after the first day of the WHO's annual summit, leaves Trump isolated on the global stage. China called on the US to "stop the blame game" on Tuesday, while the EU said "it is not the time for finger pointing". Leaders of several countries, including France and Germany, also stressed the importance of the WHO's work in battling the pandemic during Monday's meeting.
If Trump follows through on the threat, however, it could have significant consequences in the US and around the world.
What does the WHO do?
The WHO is a UN agency founded in 1948, only several years after the UN itself was formed. The agency was created to coordinate international health policy, particularly on infectious disease.
The organization is comprised of and run by 194 member states. Each member chooses a delegation of health experts and leaders to represent the country in the World Health Assembly, the organization's decision and policy-making body
The member states directly control the organization's leadership and direction -- the assembly appoints the WHO director general, sets its agenda and priorities, reviews and approves budgets, and more. The WHO has more than 150 field offices globally, where staff on the ground work with local authorities to provide guidance and health care assistance.
In the 70 years since its founding, the WHO has had its share of successes: it helped eradicate smallpox, reduced polio cases by 99%, and has been on the front lines of the battle against outbreaks like Ebola. More recently, it is helping countries battle the dengue outbreak in South and Southeast Asia, providing local clinics and health ministries with training, equipment, financial aid and community resources.
But the WHO has also faced criticism for being overly bureaucratic, politicized, and dependent on a few major donors.
How is it funded?
The WHO is funded by several sources: international organizations, private donors, member states, and its parent organization, the UN.
Each member state is required to pay dues to be a part of the organization; these are called "assessed contributions," and are calculated relative to each country's wealth and population. These dues only make up about a quarter of the WHO's total funding.
The rest of the three quarters mostly come from "voluntary contributions," meaning donations from member states or partners.
Of all the countries, the US is by far the largest donor; in the two-year funding cycle of 2018 to 2019, it gave $893 million to the WHO. But most of this total was given voluntarily; the US paid $237 million in the required membership dues, and another $656 million in the form of donations.
US donations make up 14.67% of all voluntary contributions given globally. The next biggest donor is the Bill and Melinda Gates Foundation, an American private organization, which gave $531 million in the same period.
The amount that countries decide to contribute on top of their mandatory dues varies significantly by nation. The UK, for example, give $335 million to the body voluntarily -- around eight times its required payment of $43 million. Similarly, about 80% of Germany's contribution is voluntary.
But only around 12% of China's contributions were voluntary between 2018 and 2019, and less than a third of France's payments were voluntary.
Why is Trump criticizing the WHO?
Some of the WHO's critics have long alleged that member states hold different levels of influence in the agency due to their political and financial capabilities.
Major donors like the US are perceived by some as holding outsized influence, which has historically caused friction; during the Cold War, the Soviet Union and its allies left the WHO for a number of years because they felt the US had too much sway in the organization.
More recently, the same skepticism has been aimed toward the WHO's relationship with China; critics have questioned whether the WHO is independent enough, given China's rising wealth and power.
That line of criticism has been seized on by Trump, who initially praised the WHO and China's responses to the coronavirus but changed his tone in recent weeks.
Trump had commended both parties throughout March for their handling of the crisis, but condemned them in mid-April. Then, in his Monday letter, he accused the WHO of "political gamesmanship" for praising China's strict domestic travel restrictions while being "inexplicably against my closing of the United States border."
He went on to highlight the WHO's reaffirmation of "China's now-debunked claim that the coronavirus could not be transmitted between humans."
What happens if the US pulls out?
The WHO would lose a significant chunk of its funding if the US stopped sending payments or withdrew entirely from the organization.
Whether other nations would increase their contributions to plug the gap remains to be seen, but it is clear that other world leaders would be concerned about the prospect -- particularly given the state of the Covid-19 pandemic.
"We need a strong WHO to tackle Covid-19, and the WHO is us, its member states," Emmanuel Macron said in a pre-recorded statement to the World Health Assembly on Monday.
German Chancellor Angela Merkel also urged international cooperation to defeat the pandemic. "We are experiencing a global crisis with hundreds of thousands of people who have been infected, and affected with social and economic consequences that show that virtually no country has been spared by this pandemic," Merkel said. "So no country can solve this problem alone. We must work together."
And on Tuesday, the EU strongly criticized any attempts to pull apart the WHO.
"Global cooperation and solidarity through multilateral efforts are the only effective and viable option to win this battle as we have underlined several times," spokesperson for the European Commission Virginie Battu-Henriksson said Tuesday. "This is the time for solidarity, it is not the time for finger pointing or undermining multilateral cooperation."
It therefore seems unlikely that any decision by the US to leave would encourage other states to follow suit. The move would more likely be met with a chorus of disapproval from most countries and international organizations, similar to the global response after Trump announced his intention to withdraw from the Paris Climate Accord in 2017.
The US would also be left with less access to WHO resources as it fights its coronavirus outbreak, and little say on how the WHO operates, if it stopped being a member state. Given the size of its contributions, it is currently a major player within the organization.