US President Donald Trump signed an executive order initiating the process of withdrawing the United States from the World Health Organization (WHO).

“Oh, this is a big deal,” the newly inaugurated US president said as he approved the document after returning to the White House. It was one of dozens of executive actions he signed on his first day in office.

This is the second time Trump has ordered the United States to withdraw from the World Health Organization.

Trump has criticized the international organization’s handling of Covid-19 and began withdrawing from the Geneva-based agency during the outbreak. President Joe Biden later reversed that decision.

Executing this executive action on day one would make it more likely that the United States would formally withdraw from the global body.

“They want us back very much, so we’ll see what happens,” Trump said in the Oval Office, referring to the World Health Organization and perhaps suggesting the U.S. might eventually come back.

The order said the U.S. withdrew “due to the organization’s mishandling of the Covid-19 pandemic and other global health crises that broke out in Wuhan, China, its failure to adopt urgently needed reforms, and its inability to demonstrate independence from inappropriate behavior.” The political influence of WHO member states”.

The executive order also said the withdrawal was the result of the U.S. paying “unfairly onerous costs” to the World Health Organization, part of the United Nations.

When Trump first took office, he criticized the organization for being too “China-centric” in its response to the Covid-19 pandemic.

Trump has accused the World Health Organization of being biased against China in the way it issued guidance during the outbreak.

Under the Biden administration, the United States continues to be the World Health Organization’s largest funder, contributing nearly a fifth of the agency’s budget in 2023.

The organization has an annual budget of $6.8bn (£5.5bn).

Funding threatens to disappear almost immediately, and it’s unclear whether other countries will step up to fill the gap.

A U.S. withdrawal could impact the WHO’s ability to respond to emergencies such as the Ebola outbreak or MPOX, let alone another Covid-19-type pandemic.

Public health experts say a reversal of progress in fighting infectious diseases such as malaria, tuberculosis, HIV and AIDS could have other consequences for Americans’ health.

Ashish Jha, who served as Covid-19 response coordinator under President Joe Biden, previously warned that leaving would “harm not only the health of people around the world, but also the leadership and scientific strength of the United States.” .

Lawrence Gostin, a global public health expert and professor at Georgetown University, said: “This is a disastrous presidential decision. Withdrawing is a serious harm to world health and a deeper harm to the United States.”

There are also concerns that a U.S. withdrawal could end up opening the door to, rather than reducing, China’s influence in global institutions.

The benefits of the move are few, but some believe it could prompt the WHO to further reform the way it operates, meaning it can better meet the public health needs of people around the world.

If that happens, it might be enough to entice the United States to rejoin. However, the tone in Washington suggests that President Trump’s second attempt to withdraw the United States from international health agencies will not be reconsidered.