One day after the United States formally withdrew from the World Health Organization (WHO), Gov. Gavin Newsom announced that California would independently join its disease network, becoming the first, and currently only, U.S. state to establish a direct relationship with this United Nations agency.
The decision marks an unprecedented break from federal foreign policy and positions California as the sole U.S. participant in the WHO’s Global Outbreak Alert and Response Network (GOARN). The platform is known for coordinating international responses to emerging public health threats, notably its contributions to the eradication of smallpox and the reduction of polio cases by over 99%.
“The main body of the WHO is just for United Nation member states, so California can’t join that,” said Eran Bendavid, a Stanford professor of medicine and health policy. “Instead, it’s joining a portion of the WHO, so really the symbolism there is probably more important than the actual practical implications, and the symbolism, of course, is that California doesn’t agree with the actions of the United States. And certainly no state, as far as I can tell, has ever done this before.”
The withdrawal
When President Donald Trump first announced that the U.S. would be leaving the global health body via Executive Order 14155 on Jan. 20, 2025, ending an almost 80-year partnership, the decision was not entirely unexpected.
“The U.S. has been, generally speaking, acting more independently: pulling away from big international treaties and large multinational cooperations like the Paris Agreement, and even going against NATO partners. And I think the WHO is in line with that, and its primary reason is more about the ‘going it alone’ general foreign policy attitude of the federal government right now than anything,” Bendavid said.
Still, the administration has cited specific complaints against the WHO as part of its justification, namely the organization’s mishandling of the COVID-19 pandemic, according to a Department of Health and Human Services (HHS) press release. Officials criticized the international agency for failing to promptly warn the U.S., one of its founding members, health leaders, and largest financial contributors, of the emerging threat, as well as failing to remain sufficiently independent from the influence of other member states.
The fallout has reverberated across the global health community.
“More than just unprecedented, it’s a huge blow to the WHO,” Bendavid said. “Coordinating health concerns between countries is a big job, and without U.S. support, you just don’t have as much agreement. Obviously, with anything that happens in the world, the U.S. is going to be a major player, so without the U.S., it’s substantially weaker.”
But concerns aren’t just for the organization itself. For healthcare providers, the departure has raised questions about access to global health data and coordinated instruction, particularly in the event of another public health emergency.
“Being in the health field, I know how important it is to collaborate and to work on an international level, especially after the pandemic and everything that we learned from that experience, not just as a country, but as a whole world. So, I was surprised to see that we’re pulling away from an organization that tries to connect different countries and provide resources and data to help healthcare,” said Dr. Chaudy Sotoudeh, a family physician at Sutter Health.
Sotoudeh expresses further concern over the effects that losing a longstanding relationship with the WHO might have on her own office.
“As a physician, when I’m trying to provide the best care possible, I’m looking at many avenues of resources to try to make the best judgment call and provide the best standard of care for my patients, with the WHO being one of them,” Sotoudeh said. “So, by pulling out of it, now there’s some uncertainty. Does it put us at a disadvantage and put people’s health at risk? It does worry me about how this will impact my own patients in the room, the decisions I’ll have to make, and the guidance that I’m giving because I may not have the same tools as I previously did to make healthcare decisions.”
The response
By establishing a new connection through GOARN, California will maintain access to the WHO’s global health alerts and guidance, even as the federal government steps back, choosing to rely instead on external public health relationships with countries and trusted medical organizations for information.
“I think it’s a good thing for California,” said Carlmont junior Anna Romanovsky. “If there were to be another pandemic, I’d feel a lot more protected here than if I were somewhere that didn’t have this connection.”
Romanovsky’s perspective reflects a broader sense of approval for the decision across the state.
“I think, by and large, there’s a lot of support for what the governor is doing. Certainly, his actions are much more in the spirit of collaboration and global cooperation, which I think is generally a fairly popular position,” Bendavid said. “But the implications of it are to be determined. The government has shown that it has more influence and power over funding decisions than I think most people thought possible or even thought was unconstitutional, but turns out the president can do with just a brush of the pen. So, I’m sure there are going to be points of contention with California.”
However, disagreements between the state and federal government aren’t a new phenomenon. California’s recent decision continues a broader pattern of divergence from federal public health policy, with the state splitting from the Centers for Disease Control and Prevention (CDC)’s vaccine recommendations late last year as part of its own West Coast Health Alliance (WCHA) and with the passing of Assembly Bill (AB) 144.
“Our governor and the U.S. president are very much at odds. Whenever one says one thing, you can pretty much know that the other person’s going to say the opposite,” Bendavid said. “But how far are we going to take these tensions? I don’t think this one is going to be a major split between California and the federal government, but it could be, and it certainly adds fuel to the fire of the general sense of discontent.”
On the topic of whether more states will follow California’s recent actions, Bendavid points out that the state holds a unique position of influence.
“California has a stature and power that goes well above and beyond other states,” Bendavid said. “So, I think other states are not powerful enough to make these kinds of decisions. The consequences for a smaller state of any kind of federal action are going to be too prohibitive.”
Sotoudeh believes it is also due to the nature of the state, seeing California’s openness to change as an advantage for taking this type of independent action.
“We’re very much a collaborative state. I think a lot of people even come to California for that reason; they want to work here because there is that cohesive culture. We’re willing to stand up for what we believe because we’re willing to accept different ideas. If it’s in the best interest of our state and our people, then we’ll do it,” Sotoudeh said.
Trying to come back together
“Even though I don’t know exactly what this will entail, I feel comforted that it sends a message that California wants to collaborate; we’re sending an olive branch to organizations that are striving to help the health of our world. We, as a state, have a priority to protect and to advocate for that because if things are happening in our country, we want to be able to access international communities and spaces to share that knowledge so that things can be handled promptly and effectively,” Sotoudeh said. “It’s not just how we will benefit as Californians; it’s also how we can serve our global community. I find relief in that we’re still wanting to maintain some connection there.”
While the current actions of both the federal government and California may be more symbolic than operational, the split between the two levels does create challenges for healthcare coordination and overall public trust.
“I think anytime there is a separate message coming from the government compared to a local or state level, it’s going to create confusion, not just for people, but even for clinicians and the healthcare world,” Sotoudeh said. “We have to be able to trust the resources that we have so we are very aware of all the messaging that’s out there and all the information that’s being provided by different organizations to figure out what we can do best.”
Bendavid shares a similar concern.
“In general, I would rather this country didn’t have states going in such stark opposition to the federal government. I would rather have us be one country, especially when it comes to international treaties and international organizations, but everything is changing,” Bendavid said.
For now, the U.S. continues to navigate another tension between state and federal policy. With California now moving independently on global health, the challenge will be maintaining reliable medical responses nationwide.
“We’re all human beings, our bodies are not that much different from each other, and we are all susceptible to the same elements,” Sotoudeh said. “I think the more we collaborate with each other, the more we can protect our health. I hope that, as a world, we can all embrace that and move towards this collaboration. We’re stronger when we work together to improve health.”
