Lawmakers are considering new ways to approach the World Health Organization, as President Donald Trump’s intentions behind his threat to terminate the relationship remain unclear.

The WHO retains bipartisan support from Congress, even in the face of evidence that top officials praised China as the country delayed sharing critical information about the coronavirus outbreak. But many Republicans are seeking more transparency and accountability, with some even calling on WHO Director-General Tedros Adhanom Ghebreyesus to resign.

The next steps remain uncertain almost two weeks after Trump announced in a May 29 news conference that he plans to redirect money from the WHO as part of a broader crackdown on China. The United States pays $57.9 million in annual mandatory dues to the WHO and an additional $450 million in voluntary contributions, dwarfing those of other nations.

Lawmakers so far have received no details about what Trump’s threat of “terminating” the relationship means, or where U.S. funding would go instead. But most oppose a formal withdrawal, including key Republican senators involved in health and foreign affairs.

“Leaving the WHO makes particularly China an even greater force in the WHO,” said Sen. Roy Blunt, R-Mo. “And I think a World Health Organization without us in it is not nearly as effective as a World Health Organization with us in it. They say they’re going to find other replacement vehicles for our world health involvement, and I’ll be interested to hear what those are.”

Chinese President Xi Jinping has already pledged a whopping $2 billion to help the WHO fight the coronavirus pandemic over the next two years.

“I think I understand [Trump’s] concern, and maybe we can reform the WHO down the road,” said Sen. Lindsey Graham, R-S.C. “But the main thing is to keep investing in the world health community.”

Graham said a couple of international health efforts created nearly two decades ago — the President’s Emergency Plan for AIDS Relief, or PEPFAR; and the Global Fund to Fight AIDS, Tuberculosis and Malaria — “have been two good examples where American dollars have shown a dividend. But WHO right now is not in very good standing.”

A number of bills introduced by both Democrats and Republicans would urge more transparency in the WHO and boost funding or other commitments to global health. A couple of measures would take a sharper approach, including one bill that would ban voluntary contributions until China is booted and Taiwan is afforded full rights. Another resolution would urge the administration to withhold funds until Tedros resigns.

Multilateral relationships

Stanford University professor Lanhee Chen told CQ Roll Call he is encouraging lawmakers, mostly senators on the Foreign Relations Committee, to develop ideas for new multilateral partnerships that could operate parallel to the WHO in addition to using U.S. contributions as leverage for more changes within the organization. 

“There is some interest in pursuing, in some cases bilateral, in some cases multilateral, arrangements,” Chen said, noting that Australia is one country often discussed. “But there is a universal recognition that the WHO framework has been there for 80 years. It’s not going to be easy to replace it overnight, nor necessarily desirable.”

Redirecting funds is also easier said than done, since government money automatically comes with political pressure. That’s one reason that some nonprofits like Doctors Without Borders don’t accept federal funding. Any agreement would have to come with strong transparency and accountability rules, Chen said.

“There’s no easy answer,” he said. “It’s a challenge.”

But not one lawmaker has expressed interest in fully withdrawing, Chen said. Instead, discussions are focusing on issues like changing how the WHO is governed to streamline its authority and reduce undue political influence.

The State Department indicated that the U.S. is likely to remain a member, although the U.S. could apply additional pressure to the WHO to make changes or redirect global health funds toward other partnerships. A State Department spokesperson pointed to the WHO’s slow response to the Ebola outbreak in 2014 and the HIV/AIDS epidemic, which PEPFAR targets, as additional justification for halting funding.

“The fact is, the very political nature of the WHO — and the constant interference by member states for political reasons — makes it ill-equipped to handle fast-moving pandemics,” the State Department spokesperson said. “To be sure, there are some things WHO does well, like polio vaccinations. And that will certainly continue. But President Trump has asked us to look at new programs that, like PEPFAR, will be far more effective and far more accountable than the WHO can ever be.”

Some of the criticism is unfair, said Ashish Jha, a Harvard University professor of global health, even if the WHO heaped too much public praise on China. The WHO had no authority to force its way into China, which limited its options to cajole Beijing to cooperate.

“The WHO can only do what sovereign countries allow them to do, and that’s been one of the key principles that the United States has been pushing,” he said.

The WHO’s status as a global body of cooperating governments remains unique. 

“The fundamental thing that makes WHO so different is that it’s made of member states,” Jha said. “So anything that requires governments cooperating with each other and truly at a global scale — I can’t think of any organization that has WHO’s reach and legitimacy.” 

Withdrawal logistics

The WHO has largely stayed mum on the controversy after agreeing to an independent review of its COVID-19 response. WHO Health Emergencies Programme executive director Michael Ryan, whose emails were at the center of an investigation by The Associated Press highlighting the discrepancy between the WHO’s public and private comments on China’s response, refused to discuss the issue at a June 3 news conference.

“Our leadership and staff have worked night and day in compliance with the organization’s rules, regulations, to support and share information with our member states equally and engage in frank and forthright conversations with governments at all levels,” Ryan said. “That’s what I would like to say.”

Fully withdrawing from the WHO would be tricky. The U.S. is required to give the WHO one year’s notice, and the administration is also bound to pay membership dues under the fiscal 2020 appropriations law.

“Existing language appropriating funding for assessed contributions to international organizations, a category which includes the World Health Organization, requires the Trump administration to pay the United States’ dues to the WHO,” said Evan Hollander, a Democratic spokesman for the House Appropriations Committee.

Membership fees, or assessed contributions, are typically paid each December, said a GOP House Foreign Relations Committee aide, meaning that 2020 calendar year dues will be paid from fiscal 2021 appropriations. That sets up a potential clash between the White House and Congress if Trump refuses to sign a bill to authorize additional funds.

But that also depends on whether Trump is reelected. The tussle would almost certainly dissipate if the presumed Democratic presidential nominee, former Vice President Joe Biden, is elected this November.

Halting voluntary contributions, which flow from various federal agencies throughout the year, is easier, but Congress could explicitly protect funds to the WHO. Hollander said House Appropriations Chairwoman Nita M. Lowey, D-N.Y., would watch the situation as Congress begins negotiations on next year’s appropriations.

“As Chairwoman Lowey has said, President Trump’s threatened withdrawal [is]shortsighted and harmful to the health of the American people and the entire world,” he said. “The Appropriations Committee is continuing to monitor Trump’s actions as we develop the fiscal year 2021 State and Foreign Operations appropriations bill.”

Any legislation would likely need enough support to overcome a potential presidential veto.

“My impression is that the attack on the WHO is a pretty central part of the president’s reelection campaign,” said Sen. Christopher S. Murphy, D-Conn. “So I think it’s probably going to be difficult to turn back on funding for the WHO, in a bill that this president has to sign because he’s trying to use the WHO as a scapegoat to distract people from his own failure to confront the virus. But there is bipartisan support for the WHO, and I think as soon as President Trump is gone or after this election is over, we’ll be able to find a way back in.”

“Taking our marbles and going home” ultimately won’t be an effective strategy, Jha said, pointing to the strides the WHO made since the Ebola outbreak.

“We stayed in WHO and we helped make a lot of reforms happen,” he said. “They weren’t perfect, but this response is so much better partly because of U.S. leadership.”

Rachel Oswald, Jennifer Shutt and Bridget Bowman contributed to this report.