The WHO constitution doesn’t have a legal mechanism that allows countries to pull out. But that doesn’t mean they can’t.
US President Donald Trump’s decision to withdraw from the World Health Organization (WHO) last month set off a domino effect across the globe – but no one knows exactly what happens next.
In Argentina, President Javier Milei is initiating a pullout of the United Nations (UN) health agency, while Hungary’s Viktor Orbán has publicly mulled an exit and Italy’s right-wing politicians and health minister have also clashed over whether to leave the organisation.
Yet these world leaders could find that actually pulling out of the WHO might not be so simple due to the legal framework established when the organisation was founded in 1946.
“It’s fair to say, in this sense, that it is not straightforward,” Steven Solomon, the WHO’s principal legal officer, told journalists earlier this month.
Nearly every country on Earth is a member of the WHO.
Upon joining, they signed a constitution that lays out the organisation’s role and responsibilities, for example helping governments improve their health services and trying to eradicate diseases.
That document, which is an international treaty, has no clause allowing for withdrawal. Solomon said that’s because its drafters viewed global health as a critical issue that should be handled in as inclusive a way as possible.
“The idea in the field of public health was for the WHO to be as universal as possible,” Stéphanie Dagron, an international law professor focused on global health at the University of Geneva, told Euronews Health.
When the US joined in 1948, however, it reserved the right to exit the WHO – a stipulation other countries agreed to but did not negotiate for themselves.
That could make leaving more legally complicated for Argentina and other would-be defectors.
However, “the fact that an international treaty does not envisage withdrawal from it does not mean that countries cannot withdraw,” Pedro Villarreal, who researches global health law at the German Institute for International and Security Affairs think tank, told Euronews Health.
Another 20th century agreement – the Vienna Convention of 1969 – gives some clues as to how it might play out. It says that if member states want to pull out of international treaties that lack withdrawal clauses, they must give one year’s notice.
That could slow down the timeline for Argentina and others to disentangle themselves from the WHO.
Pulling out vs ‘inactive’ membership
Countries eyeing a WHO exit may not have to shut the proverbial door all the way behind them.
While the US’s departure has been disruptive, it isn’t totally unprecedented. The Soviet Union, for example, left the WHO in 1949, and then rejoined in 1956.
However, the organisation did not view the Soviet Union as having formally withdrawn, but rather as having “inactive status,” the WHO’s Solomon said.
Today, “the question of whether withdrawal is possible, and if so, how it would be given effect, and under what conditions, is a matter of interpretation,” he added.
It’s not clear what would happen if the WHO were to negotiate an “inactive status” for countries that are now planning to exit, which are in a “sort of limbo,” Villarreal said.
But it could mean that if they later want to rejoin the WHO they could skip some of the formalities, like ratifying the constitution again.
Their obligations to the WHO would be another matter.
All member states are required to pay annual fees – the US being the top contributor – but Villarreal said that if they go inactive and stop paying their dues, they would lose voting rights at the World Health Assembly, an annual meeting where countries make decisions for the WHO.
They also may not benefit from global health projects, which could be the biggest consequences for countries like Argentina and Hungary if they follow through on their threats to withdraw, Villarreal said.
Solomon said any debate about countries leaving the WHO should be handled at the World Health Assembly, which will hold its next meeting in May.
For now, it is not on the agenda.
“At the moment, it’s a political announcement,” Dagron said.
