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Countries Eye WHO Exit Despite Legal Uncertainty

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Several world leaders, including Argentina’s President Javier Milei and Hungary’s Viktor Orbán, have expressed their intentions to withdraw from the World Health Organization (WHO), following the United States’ decision to leave the global health body last month. However, the legal complexities of such a move present an unclear path forward.

No Clear Exit Mechanism in WHO Constitution

Unlike other international organizations, the WHO’s constitution—an international treaty signed by nearly every country—does not include a formal withdrawal clause. The organization was founded in 1946 with the intention of fostering universal cooperation in global health, making the idea of member states leaving a legal gray area.

“The idea in the field of public health was for the WHO to be as universal as possible,” said Stéphanie Dagron, an international law professor at the University of Geneva.

While the U.S. reserved the right to exit when it joined in 1948, no such provision exists for other nations. This means countries like Argentina and Hungary face legal uncertainty in their attempts to leave.

How Countries Could Withdraw

Despite the lack of a formal exit clause, international law provides some guidance. The 1969 Vienna Convention states that if a treaty does not specify withdrawal terms, member states must provide one year’s notice before leaving.

This suggests that Argentina and other nations would have to navigate a year-long process before officially cutting ties with the WHO, potentially slowing down their exit plans.

Pedro Villarreal, a researcher in global health law at the German Institute for International and Security Affairs, noted that while no clear precedent exists, withdrawal is still legally possible. “The fact that an international treaty does not envisage withdrawal does not mean that countries cannot withdraw,” he explained.

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Inactive Status: A Middle Ground?

While an outright departure remains uncertain, historical precedent suggests that nations could instead take on an “inactive” status. When the Soviet Union stopped participating in the WHO in 1949, it was not seen as a formal withdrawal but rather as a period of inactivity. The USSR later rejoined in 1956 without needing to ratify the constitution again.

Whether countries like Argentina or Hungary could follow a similar path remains an open question. Steven Solomon, the WHO’s principal legal officer, acknowledged the ambiguity, saying, “The question of whether withdrawal is possible, and if so, how it would be given effect, and under what conditions, is a matter of interpretation.”

Potential Consequences of Withdrawal

If countries were to go inactive or withdraw, they would face significant consequences. Member states are required to pay annual fees, and those that stop contributing could lose their voting rights at the World Health Assembly. More importantly, they may also forfeit access to WHO-backed health programs and initiatives.

For nations with struggling healthcare systems, this could mean reduced support in areas such as disease prevention, vaccine distribution, and emergency health response.

What Happens Next?

For now, no formal withdrawal requests have been submitted, and the topic is not currently on the agenda for the WHO’s next World Health Assembly in May.

“At the moment, it’s a political announcement,” Dagron said, emphasizing that any final decisions on withdrawal will likely involve further legal and diplomatic negotiations.

As more countries weigh their options, the global health community is left watching to see how this unprecedented situation unfolds.

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Health

More Europeans Take Up Sport, but Major Gaps Remain Across Countries

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More Europeans are exercising regularly than they were four years ago, but participation continues to vary sharply depending on where people live, their age, education and financial circumstances, according to a new European Commission survey.

The latest Eurobarometer survey on sport and physical activity found that 39% of respondents said they never exercise or play sport, down from 45% in 2022. Nearly half of the 26,508 people surveyed said they exercise or play sport every day or several times a week.

The results also showed wide differences between countries. Finland recorded the highest share of people exercising daily, at 21%, followed by Denmark at 20%. In both countries, another 59% of respondents said they exercise several times a week.

At the other end of the scale, 68% of respondents in Portugal said they never exercise or play sport. Greece and Romania followed, with 66% in each country reporting that they never take part in sport or exercise.

Time was the most commonly cited barrier among people who wanted to exercise more, with 37% identifying it as an obstacle. A lack of motivation or interest was mentioned by 26%, while 15% pointed to health problems or injury. Cost was cited by 12%.

Education and household finances were also closely linked to participation. Some 59% of people who continued their education until at least the age of 20 said they exercise or play sport several times a week. That compared with 23% among those who left education at 15 or younger.

Financial circumstances showed a similar divide. People who said they had the greatest difficulty paying their bills were twice as likely to report never exercising as those who rarely or never faced financial difficulties, at 54% compared with 26%.

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“More Europeans are getting active, but the opportunity to take part still depends too much on income, age and education,” said Roxana Mînzatu, Executive Vice-President for Social Rights and Skills, Quality Jobs and Preparedness.

The survey also highlighted a significant age gap. Nearly three-quarters of people aged 15 to 24 exercise or play sport at least several times a week, compared with 25% of those aged 75 and over. Health problems or injury were the main barrier for older respondents, while younger and middle-aged people were more likely to cite a lack of time.

Physical activity linked to everyday life also increased. Active commuting rose from 24% in 2022 to 37%, while 72% of respondents said they now walk for at least 10 minutes at a time.

The survey found, however, that some Europeans do not consider their neighbourhoods suitable for walking or cycling, potentially restricting opportunities for active travel.

Mînzatu said affordable sport and safe places to exercise should be available close to where people live, including for children from families unable to afford club fees, older people and those with disabilities.

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Congenital Infections Linked to Higher Risks of Autism and Intellectual Disability

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Children born with certain infections acquired during pregnancy face substantially higher risks of autism and intellectual disability later in life, according to a study of more than 3.7 million people in Sweden.

Researchers found that children with congenital infections were about three times more likely to be diagnosed with autism and more than seven times more likely to receive a diagnosis of intellectual disability than those without such infections.

The findings suggest that infections transmitted from a pregnant woman to her foetus may have lasting effects on brain development, although the study identifies an association rather than proving that the infections directly cause autism or intellectual disability.

The research focused on TORCH infections, a group that includes syphilis, rubella, toxoplasmosis, cytomegalovirus and herpesvirus. These infections can cross the placenta and affect the developing foetus, potentially increasing the risk of miscarriage, stillbirth and other pregnancy complications.

“Although these congenital infections are rare, some of them can be prevented, which makes them important from a public health perspective,” said Reneé Gardner of the Department of Global Public Health at Karolinska Institutet, who contributed to the study.

The researchers examined people born in Sweden between 1987 and 2021 and followed them for up to 30 years. Among the 3.7 million participants, 975 had been diagnosed with a congenital TORCH infection.

Although congenital infections accounted for only a small proportion of autism cases across the population, the risk among affected children was considerably higher. The researchers estimated that about one in five children born with a TORCH infection could later develop autism.

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The study also found elevated risks of intellectual disability across different levels of severity. The risk of severe to profound intellectual disability was as much as 30 times higher among children with a congenital infection than among those without one.

The researchers found evidence of an impact on educational outcomes even among people who were not diagnosed with autism or intellectual disability. A total of 420 participants with a TORCH infection showed poor school performance without receiving either diagnosis.

Congenital cytomegalovirus, or CMV, is the most common of these infections globally and affects roughly one in 150 newborns. Its burden is substantially greater in low- and middle-income countries.

The researchers said the findings highlight the importance of prevention, particularly in regions where these infections are more common. They pointed to vaccination programmes and other preventive measures as important tools for reducing congenital infections.

They also called for improved identification of affected newborns. Current screening systems, including those used in Sweden, may miss asymptomatic infections because universal screening for TORCH infections is not routinely carried out.

The authors said stronger screening and prevention strategies could help identify children at risk earlier and improve long-term support and care.

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AI Chatbots Make Faster, Less Nuanced Kidney Transplant Decisions Than Doctors

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Artificial intelligence chatbots may make faster and more confident decisions than human doctors when determining which patient should receive a life-saving kidney transplant, but a new study found that the systems often rely on fewer factors and show less sensitivity to the ethical complexity of such choices.

Researchers from Penn State University in the United States compared decisions made by large language models (LLMs) with choices made by people in earlier studies on kidney allocation. The researchers presented AI models with hypothetical cases based on existing datasets in which human participants had previously chosen between two patients competing for a single available kidney.

The patients were described using characteristics including age, health and drinking habits. Both were considered eligible for the transplant, requiring the decision maker to determine which patient should receive the available organ.

The researchers tested the AI systems in several ways. Some scenarios focused on individual characteristics, while others combined several traits to examine how the models handled competing considerations. In some tests, participants and AI systems were also given the option of flipping a coin, allowing researchers to assess indecision as part of moral decision-making.

Human participants generally placed greater importance on age, often favouring younger patients over older patients. Many of the AI models, however, placed greater weight on lower alcohol consumption.

Hadi Hosseini, the study’s lead researcher at Penn State University, said the findings showed that AI chatbots can diverge from human values when weighing characteristics of patients.

The researchers found that human decisions tended to consider several factors together and were more sensitive to context. LLMs, by contrast, frequently focused on a single characteristic when making their choices.

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Another difference involved uncertainty. Human participants were more likely to recognise that organ allocation can involve competing ethical considerations and that there may not be one objectively correct answer. AI models generally showed little hesitation and committed to one choice.

John Dickerson, chief executive officer of Mozilla.ai and a collaborator on the study, said humans recognise ambiguity when allocating scarce resources and use debate to shape how such decisions are made.

The findings come as AI systems are increasingly being used in healthcare for clinical workflows, diagnosis, treatment planning and decisions involving limited medical resources.

The researchers said kidney allocation presents a particularly important test because decisions over deceased-donor and living-donor organs involve medical, ethical and moral considerations.

Hosseini said the ethical stakes are high because decisions involving organ allocation can directly affect patients’ lives. He stressed that the study was not intended to encourage replacing professional medical judgment with AI.

Instead, the researchers said understanding how AI systems behave in high-stakes situations is becoming increasingly important as individuals, organisations and businesses use AI to make decisions or provide recommendations.

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