Four US states and New York City have joined a World Health Organization (WHO) network designed to track and respond to disease outbreaks around the world. The move follows the United States’ withdrawal from the WHO in January. State and New York City officials said the new partnership is intended to maintain access to international outbreak intelligence and strengthen preparedness efforts.

The American entities said they were dismayed at the Trump administration’s announced withdrawal from the WHO, which became final in January. They are not formally joining the WHO but are becoming partner institutions with the WHO’s Global Outbreak Alert and Response Network (GOARN).

Through GOARN, the states and New York City aim to have more direct access to surveillance data and to more quickly prepare for potential pandemics.

California was the first to join in late January. It was followed by Illinois, New York City, New York, and Wisconsin.

“The Trump administration’s withdrawal from WHO is a reckless decision that will hurt all Californians and Americans,” said California Governor Gavin Newsom, a Democrat, in announcing that his state was joining GOARN.

“We are ensuring that our public health leaders — and the public — have the information, expertise, and partnerships they need to protect the people of our state,” said Illinois Governor J.B. Pritzker in a statement.

Wisconsin Governor Tony Evers said in a State of the State address, in which he also announced joining WHO’s GOARN, “…. We must do what we can to keep our kids, our families, and our communities healthy and safe…”

Timely Data = Faster Response

GOARN, established in 2000, brings nations and almost 300 partners — including academic institutions, nongovernmental organizations, Red Cross societies, and health departments around the world — together to quickly identify and respond to public health threats.

It remains unclear how the CDC’s role may evolve following the United States’ withdrawal from the WHO.

Timely data access is key for the New York City Health Department, one of the largest public health agencies in the world, said Acting Health Commissioner and Chief Medical Officer Michelle Morse in a statement. New York City monitors the health of more than 8.5 million residents and has over 12 million international visitors each year.

“Infectious disease knows no boundaries,” said Morse.

New York City expects to have access to weekly GOARN meetings, she said.

California, Illinois, Wisconsin, New York, and New York City all said they expect direct access to outbreak intelligence, to have opportunities for technical collaboration with international partners, and to participate in training and best-practice exchanges.

There is no monetary cost for the states and New York City to join GOARN.

Strategic and Operational Considerations

Two former CDC officials said that it’s likely both a political statement and a smart move for these states and New York City to make a more direct alliance with a WHO network.

Because the United States has withdrawn from the WHO, “it’s unclear what is the role of CDC with some of these networks,” said Debra Houry, MD, MPH, who served as CDC chief medical officer and deputy director for program and science until she resigned under pressure in August.

Former CDC colleagues told her that they have been participating with GOARN and other WHO networks but that they also are awaiting “further guidance from the department on whether activities like that can continue,” Houry told Medscape Medical News.

If the states and New York City are at the table, they can get better “situational awareness,” said Houry.

Demetre C. Daskalakis, MD, MPH, former director of the CDC’s National Center for Immunization and Respiratory Diseases, who left the agency with Houry, said the states may be seeking additional assurance of timely data flow to inform public health planning.

Those entities can’t trust that “data is going to stream in a way that will be helpful in a timely fashion for them to make their own public health plans,” Daskalakis told Medscape Medical News. He also pointed to reduction in health grants at the state level.

States and New York City “are doing the right thing to be able to keep awareness and to make sure that there’s not something that CDC is not sharing,” he said.

Will US Entities Give Back?

The states said they expected to offer benefits to GOARN, which is the expectation of the network partners.

For instance, Illinois said it would provide epidemiologic and laboratory capacity, including expanded genomic sequencing and wastewater surveillance built during COVID, and “rapid deployment expertise.”

Grant Boyken, a spokesperson for the California Department of Public Health, said that staff have been attending weekly GOARN operational calls since September and also gave a presentation recently on the state’s experience with H5N1 avian influenza, focusing on the coordinated One Health approach California used in its response to a 2024-2025 outbreak.

New York touted its ability to support GOARN through its Wadsworth Center, which has advanced diagnostic testing, genomic sequencing, antimicrobial resistance monitoring, and reference services. New York City said it could provide technical expertise and “capacity building” through remote or in-person support.

However, W. Ian Lipkin, MD, director of the Center for Infection and Immunity (CII) at the Columbia University Mailman School of Public Health in New York City, said he’s dubious that any of the three states or New York City would send on-the-ground support to respond to an outbreak abroad.

The value of states joining the WHO is unclear, Lipkin told Medscape Medical News. Network partners are expected to send staff or resources to the outbreak location, he said. “The only way it really is helpful for the group is if you send people who are capable of doing diagnostic work, or you send money to support missions,” he said.

GOARN “is supposed to be a two-way street,” said Lipkin.

The CII has been a member of GOARN since it began, helping with pathogen discovery, surveillance, and deploying diagnostics, said Lipkin. CII has identified more than 2500 viruses, and its scientists have assisted with dozens of outbreaks, from a suspected Marburg virus outbreak in Angola, to a 2003 SARS outbreak in China, to Middle East respiratory syndrome in Saudi Arabia, to encephalitis in India.

The GOARN partners “work together collectively to reduce risk, not just risk for California or Illinois or New York,” he said. “It’s reducing risk for the world.”

Houry reported receiving consulting fees from the state of California. Daskalakis disclosed serving as a director, officer, partner, employee, advisor, consultant, or trustee for Sanofi Pasteur, AstraZeneca, ViiV, Wellness Equity Alliance, and Roon.

Alicia Ault is a St. Petersburg, Florida-based freelance journalist whose work has appeared in many health and science publications, including Smithsonian.com. You can find her on X @aliciaault and on Bluesky @aliciaault.bsky.social.