Trump abandoned the WHO. Biden will rejoin the health agency on day one.

Joe Biden’s transition team has confirmed the president-elect will reverse a Trump-era decision to withdraw from the World Health Organization on his first day in office, winning praise from experts who welcome the end of Trump’s isolationist approach.

In July, amid the deadly coronavirus pandemic, President Trump formally notified the United Nations of America’s intention to pull out from and stop funding the agency, accusing the WHO of being “a puppet of China.”

While the global health body’s role in the coronavirus response has been fraught, Georgetown Law global health professor Lawrence Gostin called the decision to withdraw during a pandemic “the most ruinous in modern presidential history.”

Trump’s July move wasn’t going to take effect for a year, since UN members are required to give 12 months’ notice. And at the time it was announced, Biden tweeted that if he were elected, he’d immediately rejoin WHO “and restore our leadership on the world stage.”

On Sunday, Biden’s press secretary told Vox the president-elect will proceed with that plan, keeping America’s membership in the only global body that can declare a pandemic and internationally mobilize to stop it.

Global health experts, including critics of WHO, welcomed the news. “The pandemic is a global event and we have one global health agency. It’s not perfect, but there is only one health body that has credibility across the planet and that’s the WHO,” said Gregg Gonsalves, assistant professor of microbial diseases at the Yale School of Public Health, who added he was “glad that [Biden] has jettisoned the isolationism of the Trump years.”

When asked for comment about the president-elect’s decision, the WHO directed Vox to a tweet in which the agency’s boss, Dr. Tedros Ghebreyesus, congratulated Biden and Vice President-Elect Kamala Harris and welcomed the opportunity to work with them:

From writing the playbook on how to respond to an epidemic, leading the effort to eradicate smallpox and stop polio, and funding the global fight against HIV/AIDS, America has long been the world leader in global health, contributing more money to it than any other country. These efforts date back more than a century, and include leadership in both establishing the WHO in 1948 — and being the agency’s largest contributor ever since.

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But Trump made withdrawing from multilateralism — including multilateral global health efforts — a priority of his administration.

Restoring America’s reputation in this arena will take more than rejoining the WHO, however — especially at a time when China’s been filling the void Trump left behind.

China filled the global health gap Trump’s America left open

Trump frequently bashed the WHO for cow-towing to China and used the agency as a scapegoat for his administration’s widely panned pandemic response, often confusing what the WHO has the power to do, University of Edinburgh’s global health chair Devi Sridhar writes in Foreign Policy. “The WHO cannot point fingers, do investigations, or force countries to reveal information if they don’t want to. It is a member-state body that works through consensus, soft norms, and diplomacy.”

Trump wasn’t alone in his criticisms of China and the health agency. As Vox, the New York Times and others have reported, China was slow to warn the world about the virus, and has been opaque about its investigations into the pandemic’s origins, muzzling doctors and other critics along the way. Instead of calling attention to these problems, the WHO has frequently praised China, and as the Times reported, traded moral authority for access to and leverage with a powerful country.

Even so, in backing away from the WHO, the Trump administration left a void in global health leadership. “If we weren’t part of WHO, other countries will step in and fill the void and the US will lose key relationships and influence around global health strategy,” said Tom Inglesby, director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health. And that’s exactly what has happened.

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When Trump announced his decision to pull funding from the agency, China’s President Xi Jinping pledged $2 billion to bolster the agency’s coronavirus pandemic response.

At the last minute before an October deadline, China also joined more than 170 countries that are part of Covax, the effort to develop and equitably distribute 2 billion doses of Covid-19 vaccines before the end of 2021.

Restoring America’s global health reputation “won’t happen overnight”

The US under Trump is one of the only major economies to not yet join Covax, and Biden’s transition team has not disclosed whether the new administration plans to participate in the effort. But global health experts viewed joining Covax — if Biden can get congressional approval to do so — as a key way America can begin to restore its global health reputation.

“[Biden will] have his hands full mending burned bridges in the international community, and it won’t happen overnight,” said Suerie Moon, co-director of the Global Health Centre at the Graduate Institute Geneva. “It’s not just weakened diplomatic relations — the US has also lost a lot of credibility as a source of public health expertise.”

Before the arrival of the coronavirus, the US was in an extremely strong position to respond to a pandemic in terms of resources and expertise. But Trump did not build on those advantages, instead claiming concerns about Covid-19 were overblown and politicizing the response to the pandemic.

As a result, America has had some of the worst Covid-19 outcomes in the world — the most cases and deaths reported of any country (almost 10 million cases and more than 237,000 deaths, as of November 9).

In addition to joining Covax, Moon and Gostin suggested the Biden administration should consider boosting financial support to WHO, and cooperating with Europe and China on updating the international rules that govern pandemic responses.

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“Biden says he wants to heal America but he has to heal our relationships with our allies and international institutions too,” Gostin said.

Another bold move would be sharing American health technology — such as vaccine discoveries — with the world to help end this pandemic, Moon added.

“A lot of this technology is privately held by companies, but much of it has been developed with federal tax dollars, with help from government scientists and public procurement guarantees,” she said. “This would be a powerful signal that a Biden presidency won’t be back to business as usual — when medicines were seen primarily as a US export — but that he’ll show real leadership in global health.”