Weak Regulation and Legal Enforcement of WHO: A Vulnerability to U.S. Withdrawal
Author: Sofea Suhaizad
The World Health Organization (WHO) operates as a specialized agency of the United Nations, yet its regulatory and legal enforcement mechanisms remain weak, leaving it susceptible to political pressures and unilateral withdrawals. The inability of WHO to prevent or penalize a powerful nation like the U.S. for withdrawing highlights the limitations of its legal and governance framework. Powerful nations hold significant leverage over WHO, not only through policy influence but also through financial contributions, which further complicates the organization’s ability to operate independently. The U.S. withdrawal showcased how WHO, despite being a central figure in global health, remains structurally weak in compelling compliance from major global players.
WHO’s Regulatory Structure
The World Health Organization (WHO) serves as the leading international body for global health governance, providing technical guidance, setting health standards, and coordinating responses to public health crises. Its regulatory framework is primarily advisory, relying on scientific research and expert consensus to develop guidelines on issues such as disease control, vaccination policies, and antimicrobial resistance. While WHO establishes legally binding frameworks like the International Health Regulations (IHR) to promote oversight, cooperation and standardization, its recommendations are mostly soft law instruments whose effectiveness depends on member states’ voluntary adoption and implementation. In addition, unlike international regulatory agencies’ use of cooperation agreement or duty to collaborate, legally binding agreements that outline the details on the cross national collaboration, WHO’s authority lacks legally binding commitments that obligate member states to comply with its regulations. Overall, WHO lacks direct enforcement power, making its influence contingent on international collaboration and political will.
Limitations Due to State Sovereignty
Despite its role in shaping global health policy, WHO’s authority is significantly constrained by the principle of state sovereignty. As an organization composed of sovereign nations, WHO cannot impose legally binding health policies or enforce compliance with its recommendations. Member states retain full control over their domestic health policies, leading to inconsistencies in how WHO guidelines are implemented worldwide. This limitation weakens WHO’s ability to ensure uniform adherence to global health regulations, particularly during health crises where coordinated action is crucial. Without enforcement mechanisms, WHO must rely on diplomacy, persuasion, and voluntary cooperation, which can hinder its effectiveness in addressing urgent global health threats. For example, during the COVID-19 pandemic, WHO faced significant challenges in ensuring compliance with international health regulations, as different countries pursued their own pandemic responses without adhering to WHO guidelines. This situation represented the principle of state sovereignty clearly. The absence of enforcement measures makes WHO largely dependent on the goodwill of its members, leaving it vulnerable to political shifts and national interests overriding global health priorities.
WHO's reliance on voluntary donations from member states, especially powerful and affluent countries, is another major flaw in the organization. Since the majority of WHO's revenue comes from voluntary donations rather than assessed payments that all members are required to pay, the organization's financial viability is always in jeopardy. Because member nations oversee financial contributions and regulatory compliance, health programs do not actually fall under the purview of international government organizations, which concentrate on public international law that governs relations between global players. As one of the biggest donors, the United States has historically given WHO a sizable amount of money, giving it the ability to have an impact on policy decisions.
The politicization of WHO is another key factor contributing to its vulnerability. Because WHO relies on international cooperation, it is often caught in geopolitical conflicts between powerful nations. Member states with significant financial contributions may exert undue influence over WHO’s decision-making, leading to concerns about bias in its policies and recommendations. Additionally, geopolitical tensions affect WHO’s ability to coordinate responses to global health crises, as countries may resist working together if they perceive WHO as favoring certain political interests.
Accusations of bias, mismanagement, and favoritism have repeatedly undermined WHO’s legitimacy. For instance, the U.S. withdrawal from WHO in 2020 was largely driven by claims that the organization had mishandled the COVID-19 pandemic and was too lenient toward China. Whether or not these allegations were valid, the perception of WHO as being influenced by political pressures weakens trust in its leadership and decisions. Disputes over data transparency, vaccine distribution, and travel restrictions further complicate WHO’s efforts to manage global health threats effectively. The organization may also face pressure to downplay or emphasize specific health crises based on political considerations, which can undermine public trust in its credibility. As a result, WHO’s role as a neutral and impartial body dedicated to global health security is frequently challenged, limiting its ability to enforce coordinated, science-based health measures worldwide.
Future Concerns: Challenges Facing WHO and Similar Organizations
The vulnerabilities exposed by the U.S. withdrawal from WHO highlight broader concerns about the effectiveness of international organizations in addressing global challenges. One major concern is the increasing inefficiency of WHO, which could lead to a decline in its relevance as a global health authority. If powerful nations continue to disregard WHO’s guidance or threaten withdrawal, the organization may struggle to maintain credibility and cooperation among member states. This could lead to a fragmented global health system, where countries prioritize bilateral or regional agreements over multilateral cooperation, making coordinated responses to pandemics and other health crises more difficult. The risk is that without a unified global health body, responses to future health emergencies may become slower and less effective, resulting in greater loss of life and economic disruption.
If a major donor withdraws its funding—as the U.S. did in 2020—WHO faces serious budgetary constraints that affect its ability to implement programs and respond to global health crises. This financial model creates a power imbalance, where wealthy nations exert disproportionate influence over WHO’s policies and priorities, while low-income countries, which rely on WHO’s support the most, have little say in decision-making. As a result, WHO’s agenda is often shaped by the interests of a few powerful nations rather than being driven solely by global health needs.
A similar issue is faced by the Paris Agreement on climate change, which, like WHO, operates on voluntary commitments rather than legally binding obligations. The U.S. withdrawal from the Paris Agreement in 2017 under the Trump administration demonstrated how international agreements can be easily abandoned when there are no enforceable penalties. This parallels WHO’s vulnerabilities, as both organizations rely on the continued political will of powerful nations to function effectively. The challenge for international governance structures moving forward is to find ways to make agreements more enforceable while maintaining national sovereignty and political cooperation.
Additionally, the rise of alternative health alliances could reduce WHO’s influence over global health governance. In response to frustrations with WHO, some countries have started exploring independent pandemic response mechanisms, such as the G7-led initiative on pandemic preparedness and regional health frameworks like the African Centres for Disease Control and Prevention (Africa CDC). While these organizations can complement WHO’s efforts, they also pose a risk of fragmentation, where global health efforts become divided across multiple competing institutions rather than coordinated under a single authoritative body. If this trend continues, WHO may lose its status as the central hub for global health governance, reducing its ability to coordinate effective responses to international health threats.
Ways to Improve the Situation
To strengthen WHO’s authority and prevent politically motivated withdrawals, significant structural and legal reforms must be implemented. One key improvement is the introduction of legally binding commitments for member states. A restructured WHO could function under an enforceable treaty system. This would mean that once a country becomes a member, it must adhere to WHO’s regulations and funding commitments, making withdrawals more complex and costly. A model similar to the World Trade Organization (WTO), where non-compliance results in measurable consequences, could help ensure that WHO retains authority over global health governance. Additionally, revising the WHO Constitution to establish clearer legal obligations for member states would make it more difficult for countries to unilaterally disengage from global health efforts.
Another critical reform is to establish a more stable financial model that reduces WHO’s dependence on voluntary contributions from powerful nations. A mandatory funding mechanism—similar to the UN’s assessed contributions system—would ensure that all member states contribute based on their economic capacity, preventing financial instability caused by sudden donor withdrawals. This would also reduce the disproportionate influence of major contributors like the United States and China, allowing WHO to operate more independently and prioritize global health concerns rather than political considerations. Additionally, diversifying WHO’s funding sources through global health levies, partnerships with non-governmental organizations, or innovative financing mechanisms could provide greater financial security and reduce the risk of politically motivated defunding.
Another improvement is the creation of stronger enforcement mechanisms to ensure compliance with international health regulations. WHO currently lacks the authority to impose penalties on countries that fail to cooperate or withhold critical health information. Establishing a global health accountability framework, where countries face diplomatic, reputational, or economic consequences for non-compliance, could enhance WHO’s ability to enforce its regulations. This could be implemented through collaboration with other international institutions, such as the United Nations Security Council or the World Bank, which could impose sanctions or restrictions on non-compliant states.
In conclusion, WHO’s vulnerabilities stem from weak legal enforcement, financial instability, political influence, and bureaucratic inefficiencies. To address these challenges, significant reforms are needed, including legally binding commitments, a stable funding model, stronger enforcement mechanisms, and improved crisis response capabilities. However, even with these improvements, future concerns remain, as similar challenges affect other international organizations like the Paris Agreement, and geopolitical divisions continue to threaten global cooperation. Without structural changes, WHO risks becoming an increasingly ineffective institution, leading to a more fragmented and less coordinated global health system. Addressing these issues will be crucial in ensuring that WHO—and global health governance as a whole—remains resilient in the face of future crises.
Reference
AGREEMENT ESTABLISHING THE WORLD TRADE ORGANIZATION. (n.d.). https://www.wto.org/english/docs_e/legal_e/04-wto.pdf
Buse, K., Gostin, L., Kamarulzaman, A. and McKee, M. (2025). The US withdrawal from the WHO: a global health crisis in the making. BMJ, [online] p.r116. doi:https://doi.org/10.1136/bmj.r116.
Faguy, A. (2025). Trump orders the US to leave the World Health Organization. BBC News. [online] 21 Jan. Available at: https://www.bbc.co.uk/news/articles/c391j738rm3o.
O’Neill, R. (2025). WHO freezes hiring, restricts travel after US withdrawal. [online] POLITICO. Available at: https://www.politico.eu/article/who-freezes-hiring-restricts-travel-after-u-s-withdrawal
Jazeera, A. (2025). What a US exit from the WHO means for global healthcare. [online] Al Jazeera. Available at: https://www.aljazeera.com/news/2025/1/28/what-a-us-exit-from-the-who-means-for-global-healthcare.
Public Health on Call. “The Consequences of the U.S.’S Withdrawal from the WHO | Johns Hopkins Bloomberg School of Public Health.” Johns Hopkins Bloomberg School of Public Health, 30 Jan. 2025, publichealth.jhu.edu/2025/the-consequences-of-the-us-withdrawal-from-the-who.
Trump May Face Lawsuit Over US Withdrawal From WHO - Health Policy Watch. [online] Health Policy Watch. Available at: https://healthpolicy-watch.news/trump-may-face-lawsuit-over-his-withdrawal-of-us-from-who/.
