The political fault lines of public health: The U.S. exit from WHO and the Soviet legacy
Today, as discussions continue over whether and when the US will rejoin the WHO, the comparison with the Soviet withdrawal in 1949 is striking.
Today, as discussions continue over whether and when the US will rejoin the WHO, the comparison with the Soviet withdrawal in 1949 is striking. The question is whether the US return to the WHO will be a historical event similar to the Soviet return in 1956, which left its mark on public health.
Following the United States withdrawal from the World Health Organization in January 2026, the American flag was taken down from WHO headquarters in Geneva, an administrative step that symbolized the end of a turbulent relationship. The removal came a year after President Donald Trump signed Executive Order 14155 on his first day in office, instructing the U.S. to leave the organization. In a joint statement, Secretary of State Marco Rubio and Secretary of Health and Human Services Robert F. Kennedy Jr. accused WHO of “tarnishing” U.S. contributions and refusing to return the flag, claiming the agency insisted the U.S. had not met its obligations:
“Even on our way out of the organization, the WHO tarnished and trashed everything that America has done for it. The WHO refuses to hand over the American flag that hung in front of it, arguing it has not approved our withdrawal and, in fact, claims that we owe it compensation. From our days as its primary founder, primary financial backer, and primary champion until now, our final day, the insults to America continue.”
NO PROVISION FOR WITHDRAWAL
In fact, the WHO Constitution contains no provision for withdrawal. The only legal framework for a U.S. exit comes from a 1948 Joint Resolution of the U.S. Congress, which permits withdrawal with one year’s notice only if all assessed financial contributions have been fully paid. By early 2026, the U.S. still owed USD 206.6 million for 2024 and 2025. Although the Biden administration had reversed Trump’s first withdrawal attempt in 2020, it too failed to clear the accumulated arrears, leaving the U.S. in violation of its own legal conditions for departure.
Since the U.S. exit, speculation has grown about when and how the country might rejoin WHO. If history is any guide, a future administration could quickly restore membership, as Biden did on his first day in 2021. The main motivation would likely be to reverse the diplomatic and public-health damage caused by the withdrawal and to reassert U.S. leadership in global health - something WHO officials say remains essential.
COVID-19 ALLEGATIONS AND THE TRUTH
There were ongoing calls for WHO to improve accountability and undertake meaningful governance reforms, yet Washington anchored its justification for withdrawal in one argument: that the organization had failed during the COVID-19 pandemic. WHO Director-General Tedros Adhanom Ghebreyesus rejected COVID-19 claims, calling them inaccurate. The timeline supports his view. When unexplained pneumonia cases appeared in Wuhan, WHO alerted countries on 31 December 2019. It confirmed the novel coronavirus on 9 January, issued global infection-control guidance the next day, and on 30 January declared a Public Health Emergency of International Concern - its highest alert level - urging all countries to prepare testing, tracing, and isolation capacity.
The U.S. response diverged sharply from these warnings. Throughout January and February 2020, federal officials publicly minimized the threat, despite failing CDC test kits and the absence of a national containment strategy. February - later described by WHO as the critical window for stopping global spread - passed with little federal intervention. In early March, WHO called on all countries to “test, test, test,” but U.S. messaging remained fragmented, with political leaders contradicting scientific guidance. When WHO declared a pandemic on 11 March, the administration escalated political criticism instead of strengthening cooperation. Three weeks later, it cut funding to WHO during the most severe global health crisis in a century.
Independent assessments from The Lancet Commission, the Commonwealth Fund, the U.S. Government Accountability Office, and Johns Hopkins all concluded that the American response suffered from lack of coordination, inconsistent communication, politicization of science, and delays in testing and surveillance. Many noted that the U.S. performed worse than almost any other high-income country in deaths per capita.
A HISTORICAL MIRROR: THE SOVIET UNION'S WITHDRAWAL FROM AND RETURN TO THE WHO
The question now is whether a future U.S. return to WHO might echo the historical precedent of the Soviet Union, which withdrew in 1949 and rejoined in 1956. The contexts differ, but the comparison is instructive. The Soviet Union departed WHO claiming Western political dominance, insufficient emphasis on preventive medicine, and disagreements with postwar reconstruction priorities. It argued that WHO favored clinical, curative approaches over population-based prevention - central to the Soviet model.
Another criticism voiced by the Soviet Union concerned the dominance of the United States in WHO’s financing and governance, which they argued gave Western countries disproportionate influence. They accused the organization of “financial inefficiency” and “political dependency” on major donors. In an ironic reversal, the U.S. today criticizes WHO for precisely the opposite reason - being the largest donor yet claiming it does not wield sufficient influence. The USSR also objected to WHO’s postwar programmes in Europe, arguing that the organization focused on supporting capitalist reconstruction while largely neglecting the Soviet bloc - the very force that had borne the greatest burden in defeating Nazi Germany.
Yet the USSR’s return was transformative. In 1958, Viktor Zhdanov delivered a landmark address at the World Health Assembly, urging a global campaign to eradicate smallpox. His proposal led to Resolution WHA11.54 and laid the foundation for one of the greatest achievements in public-health history. Zhdanov’s intervention demonstrated that constructive scientific leadership could reshape WHO’s agenda, even amid Cold War tensions.
Following its return, the USSR became a powerful voice in malaria eradication, drawing on its near-complete elimination of the disease at home. Distinguished Soviet scientists - including parasitologist Yevgeny Pavlovsky, malariologist Alexandra Polovodova, and senior health officials Pyotr Burgasov and Nikolai Anokhin - advocated a centralized eradication approach emphasizing compulsory treatment, vector control, and meticulous surveillance. Their influence helped shape one of WHO’s most ambitious early global health programmes.
In following years, The Soviet Union played a central and indispensable role in shaping the World Health Organization’s vision of Primary Health Care (PHC), culminating in the historic Alma-Ata Declaration of 1978. Long before WHO adopted PHC as a global strategy, the USSR had already developed a health system built on many of the principles later celebrated at Alma-Ata: universal access, strong primary care, a preventive orientation, community-level services, and a network of polyclinics and feldshers embedded in rural areas. This model - state-funded, comprehensive, and prevention-driven - was repeatedly promoted by Soviet health officials as the international benchmark for equitable health systems.
The USSR seized the opportunity to shape global policy when WHO and UNICEF agreed to host the 1978 International Conference on Primary Health Care in Alma-Ata (today Almaty, Kazakhstan), then part of the Soviet Union. The Soviet government offered full political and logistical backing, framed the conference as a showcase of socialist public-health achievements, and worked closely with WHO Assistant Director-General Halfdan Mahler, the architect of the PHC movement. Soviet delegates strongly advocated a people-centered, prevention-first health model, pushing back against Western emphasis on selective, disease-specific interventions.
The Alma-Ata meeting became a stage for the Soviet Union to project its health ideology: that health was a universal right, not a commodity, and that governments bore the duty to provide essential services for all, free of charge. The final declaration reflected many Soviet priorities - especially its insistence on universal coverage, community participation, intersectoral action, and the reduction of health inequalities as both a moral and political imperative.
Although the Cold War overshadowed global health cooperation in many arenas, Alma-Ata marked one of the rare moments when socialist and international public-health visions aligned. The Soviet Union’s strategic diplomacy, ideational leadership, and willingness to host the conference were decisive in transforming Primary Health Care into WHO’s global doctrine - and in shaping one of the most influential health declarations of the 20th century.
Unlike the recent U.S. withdrawal, the Soviet departure in 1949 was not a strategy to deflect domestic failures, and its return marked a renewed engagement that contributed directly to two of the most significant disease-control efforts of the 20th century: malaria elimination and smallpox eradication, and the primary health care programme.
Recalling the Soviet Union’s criticism that WHO once prioritized Western Europe while neglecting the Soviet bloc, Trump’s remark in Davos - “Without us, you’d be speaking German” - reflects a similar distortion of history. In reality, the decisive force that defeated Nazi Germany was the Soviet Union. Around 80–90% of German military casualties occurred on the Eastern Front, where Germany deployed the bulk of its troops, tanks, and aircraft.
The scale of Soviet sacrifice was unmatched: more than 20 million deaths compared to 420,000 U.S. military losses. The war’s turning points - Stalingrad, Kursk, and Operation Bagration - took place in the East and collectively broke the German war machine. Without the USSR absorbing and reversing the invasion, victory in Europe would not have been possible.
Today, as debates continue over whether and when the United States might rejoin WHO, the comparison with the Soviet experience is striking. The U.S. exit reflects deep political divisions over global health governance and the legacy of the pandemic. The Soviet return, by contrast, illustrated how re-engagement can reshape global health efforts and strengthen multilateral cooperation. Whether the U.S. will follow that path remains a question for the next administration and for the future of global health diplomacy.
