The CDC could lose the ability to select next year’s flu vaccine if the Trump administration follows through with terminating its relationship with the World Health Organization.
“The selection of the influenza vaccine every year is a very detailed process by which stakeholders sit around the table and look at data from around the world. If the U.S. isn’t at that table, Americans lose out and are less safe,” said Charles Holmes, co-director of the Georgetown University Center for Innovation in Global Health, said Friday during a media briefing by the Infectious Diseases Society of America.
Holmes’s comments follow President Donald Trump’s announcement last month that he’ll end ties with the WHO if it doesn’t commit to changes and accusing the global body of deferring too often to China.
There are few details on what withdrawal actually means except withholding some U.S. funds, which would lessen the U.S.'s influence in negotiations. Trump’s May 18 letter to the WHO director-general said the U.S. would make permanent its “freeze” of funding if the global body didn’t commit to “major substantive improvements” within 30 days. That 30-day interim is about to expire. Because the U.S. is a major contributor to WHO, any reduction in funding could also harm the global body’s effectiveness.
The U.S. could lose voting privileges if it doesn’t pay member dues, said Clint Hermes, a medical research attorney with Bass, Berry & Sims PLC who has extensive experience setting up clinical trials abroad.
“If withdrawal simply means that the U.S. stops paying its dues, the WHO enforces its assessed financial obligations through its Constitution, which provides that the World Health Assembly can suspend the ‘voting privileges and services to which a Member is entitled,’” Hermes said.
Hermes said that wouldn’t immediately affect contracts or memorandums of understanding to which the U.S. already is a party.
“If the U.S. actually withdrew from the treaty it entered into to join the WHO, which it can do after a one-year notice period, then that might have more significant consequences, depending on the terms of the specific contracts,” he said.
“The overall American influence on the WHO recommendation would likely diminish insofar as Americans would no longer be in decision-making roles,” Hermes said.
Which Flu Strain?
Decisions about which influenza strains should go into the annual vaccine stem from WHO meetings. The organization convenes in February to select the vaccine for the Northern Hemisphere and in September for the Southern Hemisphere.
The U.S. plays a critical role in the year-round surveillance data that drives those decisions. The Centers for Disease Control and Prevention houses one of the WHO’s five collaborating centers for reference and research on influenza. The CDC didn’t respond to a request for comment about whether its role would change in light of Trump’s announcement.
Those data then drive flu vaccines developed by companies such as as GlaxoSmithKline and Sanofi, which must decide which influenza strains to target about six months ahead of the flu season.
GSK expects to supply about 50 million doses to the U.S. market for the upcoming season, the company said in a statement provided to Bloomberg Law. That would be an increase from the 46 million it provided for the 2019-2020 influenza season.
CDC Director Robert Redfield has said the U.S. expects to continue discussions with the WHO despite Trump’s announcement. “We continue to have a close collaboration with the WHO,” he told House lawmakers June 4.
Those statements are puzzling to public health professionals.
“The U.S. seems to be saying they will continue to participate, just not pay anything,” former CDC Director Thomas Frieden told Bloomberg Law in an email. “I think it’s unclear at this point” whether the agency will actually lose its seat at the table.
The U.S.'s annual contribution to the WHO over the last 10 years has ranged from about $200 million to about $500 million, according to the Kaiser Family Foundation.
Holmes agreed the WHO needs reform but said a withdrawal likely means the U.S. wouldn’t be involved in any forthcoming changes. “If the U.S. withdraws, that reform would go on without U.S. input, which is a huge lost opportunity,” he said.
The U.S. is by far the top contributor to the WHO’s budget, about 51% of which comes from member states, according to a 2018-2019 report. With less money, the global agency could become less effective at combating other diseases like polio and measles.
“A weakened WHO will be less likely to coordinate the vast range of responses in addition to this acute pandemic that we’re facing, and experts are predicting resurgences of both polio and measles if the WHO is weakened and unable to perform its essential coordination role,” Holmes said.
For example, global health response has almost reached a point where polio can be eradicated, said Kwan Kew Lai, an infectious disease physician at Harvard Medical Faculty Physicians.
“If we are pulling out resources from WHO, I’m afraid that those kind of infectious diseases might just go on to increase again in countries or spreading to other countries, similarly with measles,” she said at the IDSA briefing.
“We’re kind of running a race against measles in many countries, and we’re losing a little bit because of the pandemic because we’re unable to continue with a vaccination program of WHO,” she said.