Letter to Congress on WHO Withdrawal from Public Health, Law and International Relations Leaders

Dear Senators Risch and Menendez and Representatives Engel and McCaul:

The President has declared his intent to withdraw the U.S. from the World Health Organization (WHO). We are scholars and experts with long experience in global public health, U.S. constitutional law and international law and relations. As we outline below, the President lacks the legal authority to withdraw without congressional participation and approval. We therefore write to you with our deep concerns about the immediate hazards to health, safety, and security in the United States and globally from cutting ties with WHO. The WHO requires reforms, but as a founding member and the largest financial contributor, the U.S. is best poised to lead in these reforms if it remains in the WHO.

Withdrawing from or cutting funding to the WHO during a global pandemic would be a dangerous action for global health and U.S. national interests. Withdrawal cannot legally take effect for at least a year and requires the US to pay its outstanding contribution. Congress has the power to prevent this decision from going forward, and must not be silent and must not wait. We ask your committees, and other committees with jurisdiction over this matter, to hold hearings promptly to address the question of whether the attempt to unilaterally withdraw from the WHO is legal or in the national interest. We further look to your leadership on additional congressional action, including appropriating the full amount that the United States promised to WHO in FY2021 and passing a resolution expressly prohibiting withdrawal. Exiting from the WHO is antithetical to U.S. health and national security interests. COVID-19 has proven how the zoonotic leap of a single virus anywhere in the world can result in health and economic catastrophe in the U.S.

It is not overstatement to say that withdrawal will likely cost lives, American and foreign. Once outside the WHO, the U.S. would lose access to the WHO’s global system for sharing critical outbreak data and vaccines, slowing U.S. ability to return to normalcy from COVID-19, and to prepare and react to future pandemics. The rest of the world would be at heightened risk, too. The U.S. funds the largest portion of the WHO’s Health Emergencies Program, meaning that funding for testing and contact tracing, building health workforces, and vaccine development would be lost. Second or third waves of COVID-19 cases could repeatedly overwhelm health care systems and result in far more lives lost. When international travel resumes, many of these cases would find their way to the U.S., threatening Americans. Beyond COVID-19, the WHO will have less capacity to detect and control future outbreaks without U.S. support, marking a new era of pandemic risk. As COVID-19 has so vividly shown us, an uncoordinated response to health dangers beyond our borders will gravely affect the lives of those living in the U.S.

A number of other WHO programs would suffer enormously under U.S. withdrawal, especially as many global health resources are being redirected to fight COVID-19. Historically, the U.S. has served as a global health leader and the largest WHO donor (providing about 15% of its budget, or approximately $450 million annually). The U.S. has helped fund such initiatives as polio eradication, child nutrition, vaccines, HIV/AIDS, malaria, and tuberculosis. Pulling funding could reverse hard-won progress and erode the ability of the U.S. to shape and lead policy. For example, efforts to eradicate polio over the last two decades have reduced global cases by 99.9%, but loss of U.S. funding could potentially allow annual global polio cases to jump from a few hundred to 200,000 within a decade. This work has progressed with global leadership from Rotary Clubs in the U.S. and worldwide, partnering with WHO. Though the U.S. may attempt to remain a global health leader by rerouting funding directly to countries, or through global public-private partnerships, it will have far less ability to shape rules (such as the International Health Regulations), norms (such as the WHO Priority Bacterial Pathogen List), and programs. Even the President’s Emergency Plan for AIDS Relief, the U.S.’s signature achievement in responding to HIV/AIDS, has relied on WHO to deliver health messages, ensure quality medications, and set health workforce standards. As U.S. global health funding and leadership falters, the U.S. will lose capacity to engage in global health diplomacy, with China filling the leadership vacuum created by our departure.

Unilateral withdrawal from WHO also raises significant separation of powers concerns, for the President lacks the legal authority to do so without Congress. With the Constitution silent on the process of withdrawing from a treaty, the best understanding of the Constitution is a “mirror principle,” under which the same process the U.S. government uses to enter a treaty is required to withdraw from it. The United States joined WHO through a 1948 joint resolution of Congress. Therefore, a joint resolution would be required to withdraw.

Unilateral withdrawal from WHO raises separation of powers concerns for another reason as well. In Youngstown Sheet & Tube Co. v. Sawyer (1952), Justice Jackson famously wrote, “When the President takes measures incompatible with the expressed or implied will of Congress, his power is at its lowest ebb.” By unilaterally withdrawing from WHO, the President would be acting against the implied will of Congress.

In the joint resolution to join WHO, Congress set two conditions on withdrawing. First, withdrawal requires a year’s notice. Thus, any effort by the Trump Administration to withdraw could not take effect before July, 2021 at the earliest. Second, the United States must pay WHO dues in full for WHO’s current fiscal year. As Congress holds the power of the purse, this latter condition requires congressional action. Congress therefore clearly intended to retain a role in any decision to withdraw from WHO; it did not cede unilateral authority to the President. To ensure that the President may not claim that Congress’s FY2021 appropriations to WHO is acquiescing in or approving the President’s attempted withdrawal, we recommend that Congress expressly state both its opposition to withdrawal and its unambiguous support for continued U.S. membership.

A decision to withdraw the U.S. from or cut U.S. funding to WHO would threaten the health security of Americans as well as all other nations and could dismantle decades of global health progress. The public’s health as well as respect for our separation of powers requires congressional leadership on this question. We call on Congress to hold hearings on a matter vital to U.S. and global health security.

Sincerely,

*Affiliations listed for identification purposes only and do not reflect institutional endorsement

Lawrence O. Gostin

Linda D. & Timothy J. O’Neill Professor of Global Health Law, Georgetown Law

Harold Hongju Koh

Sterling Professor of International Law, Yale Law School

Matthew M. Kavanagh

Assistant Professor of Global Health, Georgetown University

Georges C. Benjamin

Executive Director, American Public Health Association

Elizabeth H. Bradley

President, Vassar College

Michelle A. Williams

Dean, Harvard T.H. Chan School of Public Health

Victor J. Dzau

President, National Academy of Medicine

Sten H. Vermund

Dean, Yale School of Public Health

James Curran

Dean, Emory University Rollins School of Public Health

Kevin Outterson

Professor of Law, Boston University School of Law

William Foege

Former Director, Centers for Disease Control and Prevention; Professor Emeritus, Emory University

Patricia Davidson

Dean, Johns Hopkins School of Nursing

Margaret Hamburg

Former Director, Food and Drug Administration; Foreign Secretary, National Academy of Medicine

Ambassador Mark Dybul

Georgetown University

Perry N. Halkitis

Dean, Rutgers School of Public Health

Anne-Marie Slaughter

CEO, New America

Jeffrey P. Koplan

Former Director, Centers for Disease Control and Prevention; VP for Global Health, Emory University

Ashish K. Jha

Faculty Director, Harvard Global Health Institute

Ambassador Eric Goosby

Professor of Medicine, University of California, San Francisco

Julie L. Gerberding

Former Director, Centers for Disease Control and Prevention; Co-Chair, CSIS Commission on Health Security

Ambassador Jimmy Kolker

Georgetown University

Wendy Parmet

Matthews Distinguished University Professor of Law, Northeastern University School of Law

Peter Hotez

Dean, National School of Tropical Medicine, Baylor Medical College

Joshua M. Sharfstein,

Vice Dean, Johns Hopkins Bloomberg School of Public Health

Sarah Gehlert

President, American Academy of Social Work and Social Welfare

Dean, University of Southern California School of Social Work

Lindsay Wiley

Professor of Law, American University Washington College of Law

Scott Burris

Professor of Law, Temple Law School

Joanne Epps

Provost, Temple University

Keith Martin

Executive Director, Consortium of Universities for Global Health

Stephen Morrison

Senior Vice President, Center of Strategic and International Studies

Claudio Grossman

Dean Emeritus, American University Washington College of Law

Jorge Delva

Dean, Boston University School of Social Work

Laurence B. Gardner

Executive Dean, University of Miami Miller School of Medicine

Al Sommer

Dean Emeritus, Johns Hopkins Bloomberg School of Public Health

Ezekiel J. Emanuel

Vice Provost, University of Pennsylvania

Janet K. Levit

President, University of Tulsa

Patricia D. White

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Center for Global Development

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Harvard Medical School

Matthew W. Courser

Pacific Institute for Research and Evaluation

Krishna White

Children’s Hospital of Philadelphia

Jessica MacCormac

Society for adolescent health and medicine

Laura M. Pinkston Koenigs

University of Massachusetts Medical School-Baystate

Katherine Atkinson

University of Massachusetts Medical School

Jamie Schwarz

Baystate Medical Center

Harry Hoar III

Baystate Health

Bethany Spielman

Southern Illinois University School of Medicine

Joseph E. Yunis

Pioneer Valley Pediatrics

1. D. Roberts

Baystate Health

Kimberley Serpico

Harvard T.H. Chan School of Public Health

Cherrie Chua

Westfield Pediatrics

Abigail N. Harrison

International Association of Adolescent Health

Taryn Gal

Michigan Organization on Adolescent Sexual Health (MOASH)

Karen Rosewater

Adolescent-Young Adult Medicine

Jennifer Heitel

Jennifer Heitel Consulting

Peg Tamiso

Boston University

Aisha Coursen

Demographic and Health Surveys

Caitlin Davie

Temple University Beasley School of Law

Ellen M. Wells

Purdue University

Dominique R. Williams

Nationwide Children’s Hospital

Kata Chillag

Davidson College

Noah Nesin

Penobscot Community Health Care

Judith E. Tapper

Pioneer Valley Pediatrics

Jonas Goldenberg

Boston University School of Social Work

Jonathan K. Larsen

Temple University Beasley School of Law

Evan Samuel Garber

Temple University Beasley School of Law

Nadja G. Peter

Drexel University College of Medicine

Alexandra Hess

Temple University

Beth Carter

Baystate Children’s Hospital

Rebecca L. Hagedorn

West Virginia University

Jack Rusley

Brown University/Rhode Island Hospital

Supriya Dinesh Mehta

University of Illinois at Chicago School of Public Health

Molly R Sanders

Texas Institute for Excellence in Mental Health

Debbie Jan

University of California, Berkeley

Renee Spencer

Boston University School of Social Work

Chris Ringwalt

Pacific Institute for Research and Evaluation

Esra Caylan

Baystate Medical Center

Paula Condon

Holyoke Pediatric Associates

Heather Elizabeth Martinez

Council of State and Territorial Epidemiologists

Renee Robilliard

Baystate Health

Rebecca Lynne Wells

University of Georgia

Chad Surber

Baystate Health

Pamela J. Burke

Boston Children’s Hospital

Marena Sullivan

Boston University

Michael S. Lyons

University of Cincinnati College of Medicine

Rylin Rodgers

Association of University Centers on Disabilities

Carolyn McCarthy

Advocate Aurora Health Care

Steven Ratner

University of Michigan Law School

Kathryn O’Brien

Baystate Medical Center

Irene C. Hjelmervik

RUHS- Public Health

Eric J. Sigel

University of Colorado School of Medicine

Geoffrey W. Wilkinson

Boston University School of Social Work

Susan Brostrup-Jensen

Boston University School of Social Work

Hani Serag

University of Texas Medical Branch

Vicky Fagan

Public Health Institute – Alcohol Research Group

Colette L. Auerswald

University of California, Berkeley School of Public Health

Robert K Eckert

CareOne

Cydney Marie Murray

Temple University Beasley Law School

Katherine Zuk

Temple University

Rohini Harvey

Baystate Children’s Hospital

Patricia King

Georgetown Law

Jorge L. Contreras

University of Utah S.J. Quinney College of Law

Martha E. Gaines

University of Wisconsin Law School

Kerri McGowan Lowrey

University of Maryland Francis King Carey School of Law

Lars Noah

University of Florida

Vernellia Randall

The University of Dayton School of Law

John Macky Marshall

University of California, Berkeley School of Public Health

Sari Bentianov

Rutgers New Jersey Medical School

Ann Marie Marciarille

University of Missouri – Kansas City School of Law

John E Swartzberg

University of California, Berkeley School of Public Health

Gourab Kar

University of California, Berkeley

Cliona McHale

University of California, Berkeley

Joel W. Grube

Pacific Institute for Research and Evaluation

Carolyn Goldstein

Baystate Medical Center

Sandra McCoy

University of California, Berkeley

Sharona Hoffman

Case Western Reserve University School of Law

Jordan Paradise

Loyola University Chicago Law School

Asa Bradman

University of California, Berkeley

Nneka Holder

MedStar Georgetown University Hospital

Laura Hermer

Mitchell Hamline School of Law

Katrina Abuabara

University of California, San Francisco

Nathan Cortez

Southern Methodist University Dedman School of Law

Sarah Raifman

University of California, San Francisco

Amy L. Weiss

University of South Florida Health

Margae Knox

University of California, Berkeley

Jay Graham

University of California, Berkeley

Christopher E. Czerwonka

Hofstra University School of Law

Erin C. Fuse Brown

Georgia State University College of Law

Michael Reiff

University of Massachusetts

Y.S. (Steve) Lee

Georgia State University School of Law

Leonard Syme

University of California, Berkeley

David Malcolm Potts

University of California, Berkeley School of Public Health

Sarah Anne Reynolds

University of California, Berkeley School of Public Health

Raquel E Aldana

University of California at Davis School of Law

Christopher Davis

Medical College of Wisconsin

Joshua D. Sarnoff

DePaul University

Jose Szapocznik

University of Miami

Andrea Elena Bonny

The Ohio State University

Scott Swartz

University of California, San Francisco

Lisa C. Ikemoto

University of California, Davis

Sarah Dahlberg

University of California, Berkeley

Norma Firestone

University of California, Berkeley

Mary W. Miller

Mary W. Miller, LCSW

Courtney Anderson

Georgia State University College of Law

Michelle Azurin

University of California, Berkeley

Ellen Breckenridge

University of Texas Health School of Public Health

Charlotte Smith

University of California, Berkeley

Anna Mastroianni

University of Washington School of Law

Karen Sokal-Gutierrez

University of California, Berkeley School of Public Health

Paul A. Diller

Willamette University College of Law

Joanna K. Sax

California Western School of Law

Nora V. Demleitner

Washington and Lee University School of Law

Estefani Barba

University of California, Berkeley

Carol S. Wolman

Harvard Medical School

Valarie Blake

West Virginia University College of Law

Ellen Wright Clayton

Vanderbilt University Medical Center

Medha D. Makhlouf

Penn State University – Dickinson Law

Carly Hyland

University of California, Berkeley School of Public Health

Monica Schwarz Josten

Stanford University

Rhonda Barcus

National Rural Health Resource Center

Danielle Pelfrey Duryea

Boston University School of Law

Lawrence S. Phillips

Emory University School of Medicine

Shawn R. Mathis

Loyola Law School Chicago

Joanna Luty

Baystate Medical Center

Barry R. Furrow

Drexel University Kline School of Law

Mary Noel Chavez

UIC School of Public Health

Lauren Wagener

Baystate Medical Center

Jessica L. Roberts

University of Houston Law Center

Steve Klitzman

Peripheral Neuropathy Support Group of Metro DC

Allyn Taylor

University of Washington School of Law

Kimberly Levitt

Bradbury-Sullivan LGBT Community Center

Marie A. Brault

Yale School of Public Health

Hadii M. Mamudu.

East Tennessee State University

Eric C. Jones

University of Texas Health Science Center at Houston

David Ragland

University of California, Berkeley

Dabney P. Evans

Emory University

Aaron B. Katz

University of Washington School of Public Health

Debra A. Schumann

Temple University

Maria Elizabeth Sundaram

Emory Rollins School of Public Health

Patricia Siplon

Saint Michael’s College

Walter A. Orenstein

Emory University School of Medicine

Eileen O’Keefe

Boston University

Avonlea Rickerson

Detroit Health Department

Elizabeth Chalfin

Boston University

Kimberly Marohn

Baystate Medical Center

Matthew S. Frey

PATH

Gregorio Dias

University of California, Berkeley

Kate Beatty

East Tennessee State University

Donald Zeigler

University of Illinois at Chicago

Donald Weinbaum

New Jersey Public Health Association

Susan Chasson

Chasson Van Huele Family Foundation

Rachel Waford

Emory University

Stefanie Iverson Cabral

University of Washington, Bothell

Therese McGinn

Columbia University Mailman School of Public Health

Margaret M. Flint

Pace University Elisabeth Haub School of Law

Jaspal S. Sandhu

University of California, Berkeley

Jennifer Raymond

California State University Channel Islands

Ann Behrmann

American Academy of Pediatrics

Paul F. Walker

Green Cross International

Lynette Menezes

University of South Florida

Heather B. Edelblute

West Chester University

Elsa Pearson

Boston University School of Public Health

Robert Gunier

University of California, Berkeley

Ghada Farhat

Emory University

Hoisum Nguyen

Boston University

Miriam F. Weismann

Florida International University

Jesse Casanova

USF Health International

Stefani N. Baca-Atlas

University of North Carolina School of Social Work

Brian W. Jack

Boston University School of Medicine

David Daniel Potenziani

University of North Carolina

Rafael E. Perez Figueroa

University of Kentucky

Heidi West

Global Environmental Health LAB

Paul Freeman

Department of Global Health University of Washington Seattle

Judy Lewis

University of Connecticut School of Medicine

Heidi S. West

UCLA Fielding School of Public Health

Ruby Barnard-Mayers

Boston University

Mohamed A Mohamed

The George Washington University

Benjamin Waterman

University of Maine

Grace Turkis

University of California Berkeley

Kyana Young

Wake Forest University

Arti Patel Varanasi

Advancing Synergy

Robert A. Bednarczyk

Emory University Rollins School of Public Health

Dr. Russell E. Morgan

National Peace Corps Association

Justin Bullock

Lexington-Fayette Co. Health Department

Lisa Brockman

Wyoming Medicaid

Emily Maistrellis

Columbia University Mailman School of Public Health

Theresa Castillo

Teachers College, Columbia University

Annekathryn Goodman

Massachusetts General Hospital Harvard

Emma Langley

CUNY Graduate School of Public Health & Health Policy

Bethany Caruso

Rollins School of Public Health, Emory University

Lisa Staimez

Rollins School of Public Health, Emory University

Barbara W. Stechenberg

Tufts University School of Medicine

Maryann Amodeo

Boston University School of Social Work

Andrea Lara

Oregon Health & Sciences University

Natalia Rodriguez

Purdue University

Debora Bear

The University of New Mexico Hospital

Christine Plumb

Justice Resource Institute

Melissa Chretien

Chamberlain University

Michael F. Greene

Massachusetts General Hospital

Thuytien Ly

Massachusetts General Hospital

Carrie Coleman

MGH Obstetrics and Gynecology

Holly Ruth Khachadoorian-Elia

Massachusetts General Hospital

Rebecca M. Miller

Harvard University

Kristi Ho

Brandeis University

Hannah Thompson

University of California, Berkeley

Vanessa Mayanja

Peter MacCallum Cancer Centre

Claire Davis

Johns Hopkins University

Jocelyn Antonio

Boston University

Chelsea Lennox

University of Minnesota

Lynne Bartholomew Goltra

Massachusetts General Hospital

Richard G MacKenzie

University of Southern California

Edgar Lopez

Stanford Health Library

Stephanie Marie Cascio

Department of Health and Human Services

Patricia Rodney

Partner in Health, Education and Development (PHEAD)

Hemali Patel

University of Colorado

Laura Korin

Albert Einstein College of Medicine

Trevin Lau

Massachusetts General Hospital

Mary Crossley

University of Pittsburgh School of Law

Shruthi Mahalingaiah

Harvard T. H. Chan School of Public Health

Jennifer L. Schott

Sugarloaf Pediatrics

Rushika Conroy

Baystate Children’s Hospital

Claudia Borzutzky

USC Keck School of Medicine

Erica Sciara

Shoreline Community College

Ruth McDermott-Levy

Villanova University Fitzpatrick College of Nursing

Wayra J. Salem

Liberty University

Charles L. Bormann

Massachusetts General Hospital

Jessica Kahn

Cincinnati Children’s Hospital Medical Center

Cheryl Anderson

Boston Medical Center

Immaculate Apchemengich

University of Wisconsin Milwaukee

Maximillian V. Rasbold-Gabbard

Massachusetts Department of Public Health

Anne M. Althausen Plante

Massachusetts General Hospital

Megan Marx Delaney

Harvard T. H. Chan School of Public Health

Lawrence C. Levine

University of the Pacific, McGeorge School of Law

Cathey E. Falvo

Physicians for Social Responsibility

Cynthia R. Howard

University of Minnesota

Jessica D. Gipson

UCLA Fielding School of Public Health

Anne Marie Armstrong

Massachusetts General Hospital

Ashwini Arumugam

University of Minnesota

Timothy D. Lytton

Georgia State University College of Law

Michael Willers

The Children’s Heart Center of Western Massachusetts

Maayan Leroy-Melamed

Indiana University School of Medicine

Nakita Natala

University of Minnesota

Daniel Lee

University of Michigan School of Public Health

Krista M. Perreira

University of North Carolina at Chapel Hill

Mary Morris

Massachusetts General Hospital

Steffi Masilamani

University of Minnesota

Solveig A. Cunningham

Emory University

Beth K. Thielen

University of Minnesota

Sally T. Lowell

University of Colorado

Peter Suber

Harvard University

Stuart Rennie

University of North Carolina-Chapel Hill

Raul Necochea

University of North Carolina School of Medicine

Rebecca Rae Anderson

College of Public Health, University of Nebraska Medical Center

Nasreen Quadri

University of Minnesota

John Snyder

Amherst Pediatrics

Minda J. Dwyer

Optum Health

Leslie Davis

Walkers Point Community Clinic

Kristen Eckler

Massachusetts General Hospital

Erin Schroeder

Mass General Brigham

Emily Heckel

Harvard T.H. Chan School of Public Health

Phillip Plager

University of Minnesota

Marisa Elena Domino

University of North Carolina-Chapel Hill

John Hoornbeek

Kent State University

Christina Duzyj Buniak

Massachusetts General Hospital

Erin Tracy Bradley

Massachusetts General Hospital

Amanda N. Kallen

Yale University

Paige Noelle Andrews

CDC Foundation

Kimani Paul-Emile

Fordham University School of Law

Nancy Chapman

Advocates for Better Children’s Diets

Deborah Bartz

Harvard Medical School

Stephanie Perez Kerkvliet

University of Minnesota

Sara Brenner

Baystate Medical Center

Audrey Merriam

Yale University

Glenn Markenson

Boston Medical Center

Kyle MacDonald

NYC Department of Health and Mental Hygiene

Gail E. Henderson

University of North Carolina at Chapel Hill, School of Medicine

Katherine Smith

Children’s Hospital of Philadelphia

Beth Cronin

Providence Community Health Center

Shanna M. Pellegrin

Virginia Tec

Stacey M. Gomes

University of Cincinnati

Sonya Panjwani

Texas A&M University

Jennifer Lachance

University of California, Berkeley School of Public Health

Patricia Stauber

University of New Mexico

Audrey Buckland

Johns Hopkins University

Sarah Wetter

Georgetown Law

Ashley Chory

Icahn School of Medicine at Mount Sinai

Lisa M. Jordan

Drew University

Rachel T. Forrest

Westminster College

Holly Jarman

University of Michigan

Scott Greer

University of Michigan

Sowmya Adibhatla

Wisconsin Department of Health Services

Luu Doan Ireland

UMass Memorial Medical Center

Charity Scott

Georgia State University College of Law

Marjorie Shultz

University of California Berkeley

Vivian Valdmanis

Western Michigan University

Jennifer Neczypor

Massachusetts General Hospital

Lena A Hatchett

Loyola University Chicago

Leslie Cofie

East Carolina University

Judith N Wasserheit

University of Washington

Wu Zeng

Georgetown University School of Nursing & Health Studies

Laura Hermanns

University of Wisconsin-Milwaukee

Adnan Hyder

George Washington University Milken Institute School of Public Health

Sara Slabisak

Lewis & Clark Law School

Gregg Gonsalves

Yale University

Tom McDonnell
Elisabeth Haub School of Law at Pace University

Meredith Rosenthal

Harvard T.H. Chan School of Public Health

David Stein

Johns Hopkins Bloomberg School of Public Health

Theresa Glennon

Temple University Beasley School of Law

Myron Falchuk

Harvard Medical School