NEW YORK (AP) — The U.S. has finalized its withdrawal from the World Health Organization, one year after President Donald Trump announced America was ending its 78-year-old commitment, federal officials said Thursday.
But it's hardly a clean break.
The U.S. owes about $280 million to the global health agency, according to WHO. And Trump administration officials acknowledge that they haven't finished working out some issues, such as lost access to data from other countries that could give America an early warning of a new pandemic.
The withdrawal will hurt the global response to new outbreaks and will hobble the ability of U.S. scientists and pharmaceutical companies to develop vaccines and medicines against new threats, said Lawrence Gostin, a public health law expert at Georgetown University.
“In my opinion, it’s the most ruinous presidential decision in my lifetime,” he said.
The WHO is the United Nations’ specialized health agency and is mandated to coordinate the response to global health threats, such as outbreaks of mpox, Ebola and polio. It also provides technical assistance to poorer countries; helps distribute scarce vaccines, supplies and treatments; and sets guidelines for hundreds of health conditions, including mental health and cancer.
Nearly every country in the world is a member.
U.S. officials helped lead the WHO's creation, and America has long been among the organization's biggest donors, providing hundreds of millions of dollars and hundreds of staffers with specialized public health expertise.
On average, the U.S. pays $111 million a year in member dues to the WHO and roughly $570 million more in annual voluntary contributions, according to the U.S. Department of Health and Human Services.
In an executive order issued right after taking office, Trump said the U.S. was withdrawing from WHO due to the organization’s mishandling of the COVID-19 pandemic and other global health crises. He also cited the agency’s “failure to adopt urgently needed reforms” and its “inability to demonstrate independence from the inappropriate political influence of WHO member states.”
WHO, like other public health organizations, made costly mistakes during the pandemic, including at one point advising people against wearing masks. It also asserted that COVID-19 wasn’t airborne, a stance it didn’t officially reverse until 2024.
Another Trump administration complaint: None of WHO's chief executives — there have been nine since the organization was created in 1948 — have been Americans. Administration officials view that as unfair given how much the WHO relies on U.S. financial contributions and on U.S. Centers for Disease Control and Prevention personnel.
Experts say the U.S. exit could cripple numerous global health initiatives, including the effort to eradicate polio, maternal and child health programs, and research to identify new viral threats.
Dr. Ronald Nahass, president of the Infectious Diseases Society of America, called the U.S. withdrawal “shortsighted and misguided” and “scientifically reckless.”
The U.S. has ceased official participation in WHO-sponsored committees, leadership bodies, governance structures and technical working groups. That would seem to include the WHO group that assesses what flu strains are circulating and makes critical decisions about updating flu shots.
It also signals the U.S. is no longer participating in global flu information-sharing that guides vaccine decisions.
Such disease intelligence has helped Americans be “at the front of the line” when new outbreaks occur and new vaccines and medicines are quickly needed to counteract them and save lives, Gostin said.
Trump administration officials say they already have public health relationships with many countries and are working to ensure direct sharing of that kind of information, rather than having WHO serve as a middleman. But U.S. officials did not give specifics about how many such arrangements are in place.
Gostin, an expert on international public health treaties and collaborations, said it's unlikely the U.S. will reach agreements with more than a couple dozen countries.
Many emerging viruses are first spotted in China, but “is China going to sign a contract with the United States?” Gostin said. “Are countries in Africa going to do it? Are the countries Trump has slapped with a huge tariff going to send us their data? The claim is almost laughable.”
Gostin also believes Trump overstepped his authority in pulling out of WHO. The U.S. joined the organization through an act of Congress and it is supposed to take an act of Congress to withdraw, he argued.
The U.S. is legally required to give notice one year in advance of withdrawal — which it did — but also to pay any outstanding financial obligations.
The U.S. has not paid any of its dues for 2024 and 2025, leaving a balance of about $280 million at current exchange rates, according to WHO.
An administration official denied that requirement Thursday, saying the U.S. had no obligation to pay prior to withdrawing as a member.
This story was first published on Jan. 22, 2026. It was updated on Jan. 23, 2026 to correct the amount of money owed to WHO. It is about $280 million, not more than $130 million.
Shastri reported from Milwaukee.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
FILE - Director General of the World Health Organization (WHO) Tedros Adhanom Ghebreyesus, left, delivers his statement, during the opening of the 78th World Health Assembly at the European headquarters of the United Nations in Geneva, Switzerland, May 19, 2025. (Magali Girardin/Keystone via AP, File)
President Donald Trump applauses during a signing ceremony on his Board of Peace initiative at the Annual Meeting of the World Economic Forum in Davos, Switzerland, Thursday, Jan. 22, 2026. (AP Photo/Markus Schreiber)
CAIRO (AP) — The Iranian security agents came at 2 a.m., pulling up in a half-dozen cars outside the home of the Nakhii family. They woke up the sleeping sisters, Nyusha and Mona, and forced them to give the passwords for their phones. Then they took the two away.
The women were accused of participating in the nationwide protests that shook Iran a week earlier, a friend of the pair told The Associated Press, speaking on condition of anonymity for her security as she described the Jan. 16 arrests.
Such arrests have been happening for weeks following the government crackdown last month that crushed the protests calling for the end of the country’s theocratic rule. Reports of raids on homes and workplaces have come from major cities and rural towns alike, revealing a dragnet that has touched large swaths of Iranian society. University students, doctors, lawyers, teachers, actors, business owners, athletes and filmmakers have been swept up, as well as reformist figures close to President Masoud Pezeshkian.
They are often held incommunicado for days or weeks and prevented from contacting family members or lawyers, according to activists monitoring the arrests. That has left desperate relatives searching for their loved ones.
The U.S.-based Human Rights Activists News Agency has put the number of arrests at more than 50,000. The AP has been unable to verify the figure. Tracking the detainees has been difficult since Iranian authorities imposed an internet blackout, and reports leak out only with difficulty.
Other activist groups outside Iran have also been working to document the sweeps.
“Authorities continue to identify people and detain them,” said Shiva Nazarahari, an organizer with one of those groups, the Committee for Monitoring the Status of Detained Protesters.
So far, the committee has verified the names of more than 2,200 people who were arrested, using direct reports from families and a network of contacts on the ground. The arrestees include 107 university students, 82 children as young as 13, as well as 19 lawyers and 106 doctors.
Nazarahari said authorities have been reviewing municipal street cameras, store surveillance cameras and drone footage to track people who participated in the protests to their homes or places of work, where they are arrested.
The protests began in late December, triggered by anger over spiraling prices, and quickly spread across the country. They peaked on Jan. 8 and 9, when hundreds of thousands of people in more than 190 cities and towns across the country took to the streets.
Security forces responded by unleashing unprecedented violence. The Human Rights Activists News Agency has so far counted more than 7,000 dead and says the true number is far higher. Iran’s government offered its only death toll on Jan. 21, saying 3,117 people were killed. The theocracy has undercounted or not reported fatalities from past unrest.
Gholamhossein Mohseni Ejehi, a hard-line cleric who heads Iran’s judiciary, became the face of the crackdown, labeling protesters “terrorists” and calling for fast-tracked punishments.
Since then, “detentions have been very widespread because it’s like a whole suffocation of society,” said one protester, reached by the AP in Gohardasht, a middle-class area outside the Iranian capital. He said two of his relatives and three of his brother’s friends were killed in the first days of the crackdown, as well as several neighbors. The protester spoke on condition of anonymity for fear of being targeted by authorities.
The Nakhii sisters, 37-year-old Nyusha and 25-year-old Mona, were first taken to Tehran’s notorious Evin prison, where they were allowed to contact their parents, their friend said. Later, she said, they were moved to Qarchak, a women’s prison on the outskirts of Tehran where rights groups reported conditions that included overcrowding and lack of hygiene even before the crackdown.
Other people whose arrests were documented by the detainees committee have disappeared into the prisons. The family of Abolfazl Jazbi has not heard from him since his Jan. 15 arrest at a factory in the southern city of Isfahan. Jazbi suffers from a severe blood disorder that requires medication, according to the committee.
Atila Sultanpour, 45, has not been heard from since he was taken from his home in Tehran on Jan. 29 by security agents who beat him severely, according to Dadban, a group of Iranian lawyers based abroad who are also documenting detentions.
Authorities have also moved to suspend bank accounts, block SIM cards and confiscate the property of protesters' relatives or people who publicly express support for them, said Musa Barzin, an attorney with Dadban, citing reports from families.
In past crackdowns on protests, authorities sometimes adhered to a veneer of due process and rule of law, but not this time, Barzin said. Authorities are increasingly denying detainees access to legal counsel and often holding them for days or weeks before allowing any phone calls to family. Lawyers representing arrested protesters also have faced court summons and detention, according to Dadban.
“The following of the law is in the worst situation it has ever been,” Barzin said.
Despite the crackdown, many civic groups continue to issue defiant statements.
The Writers’ Association of Iran, an independent group with a long tradition of dissent, issued a statement describing the protests as an uprising against “47 years of systemic corruption and discrimination.”
It also announced that two of its members had been detained, including a member of its secretariat.
A national council representing schoolteachers urged families to speak out about detained children and students. “Do not fear the threats of security forces. Refer to independent counsel. Make your children’s names public,” it said in a statement.
A spokesman for the council said Sunday that it has documented the deaths of at least 200 minors who were killed in the crackdown. That figure is up several dozen from the count just days before.
“Every day we tell ourselves this is the last list,” Mohammad Habibi wrote on X. “But the next morning, new names arrive again.”
Bar associations and medical groups have also spoken out, including Iran’s state-sanctioned doctors council, which called on authorities to stop harassing medical staff.
Anger over the bloodshed now adds to the bitterness over the economy, which has been hollowed out by decades of sanctions, corruption and mismanagement. The value of the currency has plunged, and inflation has climbed to record levels.
The Iranian government has announced gestures such as launching a new coupon program for essential goods. Labor and trade groups, including a national retirees syndicate, have issued statements condemning the economic and political crisis.
Meanwhile, U.S. President Donald Trump has moved an aircraft carrier and other military assets to the Persian Gulf and suggested the U.S. could attack Iran over the killing of peaceful demonstrators or if Tehran launches mass executions over the protests. A second American aircraft carrier is on its way to the Mideast.
Iran’s theocracy has faced down protests and U.S. threats in the past, and the crackdown showed the iron grip it holds over the country. This week, authorities organized pro-government rallies with hundreds of thousands of people to mark the anniversary of the 1979 Islamic Revolution.
Still, Barzin said, he sees the ferocity of the crackdown as a sign that Iran’s leadership “for the first time is afraid of being overthrown.”
Associated Press Writer Kareem Chehayeb in Beirut contributed to this report.
FILE - In this image from video obtained by the AP outside Iran, a masked demonstrator holds a picture of Iran's Crown Prince Reza Pahlavi during a protest in Tehran, Iran, on Jan. 9, 2026. (UGC via AP, File)
FILE - In this image from video circulating on social media, protesters dance and cheer around a bonfire as they take to the streets of Tehran, Iran, on Jan. 9, 2026. (UGC via AP, File)
FILE - In this image from video made by an individual not employed by The Associated Press and obtained by the AP outside Iran, people block an intersection during a protest in Tehran, Iran, on Jan. 8, 2026. (UGC via AP, File)
