What have other U.S. states done to maintain international public health cooperation since the federal withdrawal from WHO?
Executive summary
Several U.S. states have publicly moved to preserve international public health ties after the federal government’s formal withdrawal from the World Health Organization on January 22, 2026, most visibly through state-level outreach and steps to plug gaps in global surveillance; however, reporting documents only a handful of concrete state actions (notably Illinois), and broader patterns remain poorly catalogued in available sources [1] [2]. Federal officials frame the exit as a shift toward bilateral, non-WHO engagement and continued global leadership, while WHO and many public-health experts caution that the split risks undermining coordinated disease surveillance and response [3] [4] [5] [6].
1. States pushing back and building their own bridges: Illinois as the clearest example
Illinois swiftly framed the federal exit as dangerous and announced concrete steps to sustain international ties, saying the state would make preparations to join the WHO Global Outbreak Alert and Response Network (GOARN) to preserve access to global surveillance, rapid alerts and expert networks—an explicit attempt to keep Illinois connected to international outbreak reporting even as the U.S. government disengages [1] [2]. Governor J.B. Pritzker and state health officials publicly criticized the federal withdrawal as “reckless” and emphasized state actions to protect residents, signaling a willingness for subnational diplomacy in health when federal channels close [2] [1].
2. Federal strategy versus state-level improvisation: competing narratives
The Biden-adjacent administration’s official position (as presented by HHS, CDC and the State Department) is that U.S. leadership in global health will continue through direct bilateral agreements, partnerships with NGOs, the private sector and faith-based groups, and targeted biosecurity initiatives outside WHO structures—language repeatedly used in federal fact sheets and press releases announcing the withdrawal [4] [3] [7] [8]. Federal spokespeople and State Department documents also pointed to multiyear bilateral health cooperation pacts concluded in late 2025 as evidence of continuity, even as federal statements promised no regular participation in WHO-managed events beyond withdrawal functions [9] [10]. That federal framing sets up a patchwork reality in which some states like Illinois will seek direct entry points into WHO-affiliated networks while Washington pursues its own country-to-country deals [9] [1].
3. International actors’ responses and the practical consequences for states
WHO leadership and outside observers have warned that the U.S. exit is a loss for global public health and that cooperation is still necessary for dealing with viruses and non-communicable diseases, raising questions about how subnational or bilateral alternatives can match WHO’s convening power [11] [5]. Practical consequences noted in reporting include the immediate fiscal hit to WHO programs—U.S. unpaid voluntary contributions totaling hundreds of millions—and the logistical reality that states acting alone still depend on international platforms for standardized surveillance and coordinated outbreak response [12] [6]. Illinois’ stated plan to join GOARN implicitly recognizes that states cannot replicate WHO’s global networks by themselves and need formal entry points into multilateral systems [1].
4. Limits of current reporting and what remains unknown
Existing coverage documents at most a few state-level responses and federal promises of bilateral engagement; beyond Illinois’ announced GOARN preparations, sources do not provide a comprehensive list of other states’ initiatives or evidence that many states have the legal, diplomatic or financial capacity to form equivalent international links [2] [1] [6]. Reporting also leaves unresolved whether federal bilateral agreements will substitute effectively for WHO-mediated coordination at the state level, and whether states will be able to secure direct pathogen-sharing agreements, data feeds or participation in WHO technical networks without central U.S. representation [9] [10].
5. How to weigh competing perspectives
Policy advocates criticizing the withdrawal argue states’ moves reflect necessary damage control to preserve public safety and surveillance capacity, pointing to Illinois’ outreach as a model for subnational resilience [2] [1]. Federal officials insist that targeted, accountable bilateral engagements and investments in biosecurity will protect Americans and partners—an approach that may avoid WHO political entanglements but raises questions about scale and multilateral legitimacy [4] [3]. WHO and global health voices counter that splintered cooperation risks slower detection and weaker responses to cross-border threats, an outcome states are trying to blunt but cannot fully erase without broader international frameworks [5] [11].