Perhaps no institution represents the potential and vulnerability of multilateralism more clearly than the World Health Organization (WHO). Founded in 1948 as a specialized agency of the United Nations, the WHO was created based on an unprecedented assumption after the war – namely, that health goes beyond simply the lack of illness and represents “a state of complete physical, mental and social well-being,” which should be viewed as a basic human right, for which international collaboration is necessary. For more than seventy years now, the WHO has been acting as the key organization responsible for the matters related to public health around the world, defining its standards, coordinating the response to outbreaks, and translating scientific consensus into policies. However, the year of 2026 sees the WHO at the most vulnerable point of its existence due to the withdrawal by the United States, its biggest historical donor.
Core Objectives and Mandate
According to the constitution of the WHO, its main responsibility is to coordinate international efforts towards better health through the United Nations system. This involves a number of goals, which include the fight against communicable and non-communicable diseases, improving health care services especially for developing countries, establishing global norms and standards ranging from essential medicines list to International Health Regulations, coordinating emergency responses in times of epidemics and humanitarian disasters, and ensuring universal health coverage. The WHO usually does not provide any health care service directly but acts as a facilitator, standard setter, and advisor in providing scientific recommendations that the governments can adopt and implement.
Structure and Governance
The WHO uses a decentralized structure in governance to facilitate coordination and flexibility among the different parts of the world. The World Health Assembly (WHA) consists of delegates from all member states, now totalling more than 194 members, and meets every year in Geneva to deliberate on issues related to policies, budgeting, and elections. The Executive Board, consisting of representatives of member states specialized in public health, develops the agenda of the WHA and implements its decisions. The Secretariat, which is led by the Director-General, Dr. Tedros Adhanom Ghebreyesus – who is the first ever African Director-General of the organization – performs the day-to-day functions from Geneva Headquarters. Thereafter comes the decentralized structure of six regional offices and 150 country offices. This is an attempt to combine a global norm-setting body with responsiveness to the needs of specific areas and countries. In terms of funding, the WHO used to depend on a combination of assessed contributions (i.e., mandatory donations depending on the national wealth) and voluntary contributions (i.e., philanthropic funds and private donations).
Major Achievements and Historical Milestones
However, the WHO is proud of many of the most important accomplishments in the field of public health in human history. The organization’s contribution to the global effort of eradicating smallpox, which was officially accomplished in 1980, is an exceptional achievement that is still the only example of intentional worldwide elimination of any human disease. The WHO managed to take the world right to the edge of eradication of polio, having lowered the rate of infection cases by over 99 percent since 1988 when the Global Polio Eradication Initiative started. Moreover, the Alma-Ata Declaration of 1978 presented the idea of “Health for All” through primary health care, which affected the strategies of national health systems in the next decades. Revised International Health Regulations of 2005 laid down the principles of mandatory reporting of disease outbreaks by all member nations; this served as a foundation for today’s pandemic surveillance. This organization has been conducting the fight against HIV/AIDS, tuberculosis, and malaria, as well as the Framework Convention on Tobacco Control signed in 2003, one of the most ratified treaties in the history of UN (alongside with the Global Fund). In case of COVID-19, although there have been sustained international controversy surrounding it, at least the initial declaration of the Public Health Emergency of International Concern and subsequent establishment of COVAX vaccine facility has shown the need for the coordinating body with influence but not much authority.
Current Challenges and Criticisms
The WHO’s most severe modern crisis is unfolding now. The United States exited the organization officially on January 22, 2026, when it implemented an order signed by President Trump a year ago. This marked the end of 78 years of membership, since the U.S. joined the organization from its foundation. Washington had complaints about the mismanagement of the issue of the origin of COVID-19 by the organization, its Chinese bias, and America’s excessive financial contribution. The consequences have been immediate and severe. Having historically supplied roughly a fifth of the WHO’s total budget through assessed and voluntary contributions combined, the American exit forced the organization to slash its 2026–2027 budget to around $4.2 billion and eliminate approximately 2,300 jobs — nearly a quarter of its global workforce — while consolidating its ten departments into four. Even with a 20% increase in assessed contributions from remaining member states and a $500 million pledge from China, the WHO still faces a structural funding deficit estimated near $1.05 billion, compounded by hundreds of millions of dollars in unpaid U.S. arrears from 2024–2025.
It goes beyond the books of the bank in Geneva. The Global Polio Eradication Initiative is now struggling with a $440 million shortfall and a 30% cut to its budget, putting at risk the surveillance efforts in the last endemic regions. Disease early warning systems already deployed in challenging environments like Syria, Somalia, and South Sudan are being compromised at a time when outbreaks of diseases like cholera, measles, and Ebola virus are looming. Public health authorities have cautioned that the U.S. will lose influence over the new WHO Pandemic Agreement and annex, which it played a role in developing for years.
In addition to this immediate financial breakdown, there have been long-term structural problems with the organization as well. The dependence of the WHO on voluntary and earmarked financing – even prior to the withdrawal of the United States – made it possible for donors to control priorities and thus affected its autonomy to deal with neglected but less “fundable” health issues. It had already been criticized in the past because it was too slow and focused on consensus to react effectively to emergency situations – such as the initial response of the WHO during the West Africa Ebola outbreak in 2014. Due to the necessity to rely on member countries for data concerning outbreaks, the WHO can become a hostage of the willingness of national governments to provide it with relevant data. Furthermore, there is a risk that due to increasing dependence on philanthropic mega-donors, there may be a shift toward donor preferences rather than the population’s need. The rivalry of great powers also poses the question of whether the WHO will remain a truly neutral scientific organization or a platform for political struggle.
Balancing Sovereignty and Global Health
The greatest paradox of the World Health Organization, perhaps, is the quality that gives it its legitimacy and yet, at the same time, makes it ineffective. While a government is an entity that can implement and enforce laws, impose sanctions and demand access to confidential data, the WHO lacks any of those capacities. Instead, the authority of the WHO is built upon scientific legitimacy, diplomatic skills, and voluntary cooperation by sovereign states. Although this strategy allows the organization to stay politically impartial and acceptable, at the same time, it renders it helpless when political and geopolitical tensions between the states outweigh collective efforts. Indeed, as evidenced by such events as the coronavirus pandemic and recent funding crisis, governance of the world’s health becomes a political issue as well as a medical one. In other words, the future of the WHO is not merely determined by scientific breakthroughs and organizational reforms but also by the ability of states to understand the borderless nature of infectious diseases.
Future Outlook
The WHO’s future strategy will depend on a number of things coming together at once: whether the organization can successfully navigate its way through a period of transition in terms of leadership and stabilize its financial situation before the tenure of Director-General Tedros comes to an end in 2027 due to term limits; whether member states other than the United States and China commit to providing consistent, unearmarked funds and lessen reliance on donors; and whether reforms – such as increased transparency, efficient decision-making, and fair sharing of burden among the world’s wealthier countries – can be made in response to valid criticisms. While there may yet be cautious optimism among many in the public health community about the possibility of re-engaging the United States, nothing concrete towards this effect has come up as of mid-2026.
Conclusion
The World Health Organization not only serves as a testament to the possibilities when countries work together, as evidenced by the elimination of smallpox, near-eradication of polio, and many decades of achievements in disease control, but also as a lesson on how fragile such institutions created through voluntary cooperation can be in contrast to their enforcement counterparts. The problem of financing the WHO until 2026, brought about by the withdrawal of the United States, has shown how vulnerable the organizational system is, which relies on the generosity of a few major donors. But the very premise of creating the World Health Organization, namely that pathogens do not understand boundaries, and health security is a global public good, has not lost its relevance since 1948.
By: Vishvag Taneja
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