"Non-compliant" with the WHO is a broad and often subjective term, as the organization lacks strong enforcement powers. Compliance (especially with the legally binding International Health Regulations (IHR) 2005, as amended) is largely voluntary and self-reported, with widespread gaps globally. Virtually all countries fall short in some areas of preparedness, reporting, or response, per assessments like Joint External Evaluations (JEE) and the Global Health Security (GHS) Index. No country achieves perfect compliance, and average implementation scores hover around 70% or lower in many evaluations.

Notable Cases of Non-Compliance or Opposition

• United States: Completed its formal withdrawal from the WHO in January 2026 (effective after one-year notice). It also formally rejected the 2024 IHR amendments. This represents the strongest form of disengagement by a former major contributor and founding member.
• Abstainers on the 2025 WHO Pandemic Agreement (adopted by 124 votes, 0 against, 11 abstentions; US did not participate due to withdrawal): Bulgaria, Egypt, Iran, Israel, Italy, Jamaica, the Netherlands, Paraguay, Poland, Russia, and Slovakia. Reasons cited included concerns over sovereignty, lack of consensus, unfinished elements (e.g., Pathogen Access and Benefit-Sharing), or needs for domestic review.

Broader Compliance Issues (IHR and Preparedness)

Many countries have documented shortfalls in IHR core capacities (e.g., surveillance, reporting, laboratory systems, points of entry, and emergency response). Common problems include:

• Delayed or incomplete outbreak notifications.
• Imposition of unjustified travel/trade restrictions (contrary to IHR).
• Low preparedness scores, especially in low- and middle-income countries, but gaps exist everywhere. During COVID-19, widespread non-compliance occurred across many nations regarding timely reporting, data sharing, and adherence to WHO recommendations on measures like travel restrictions. Liechtenstein (the other main non-member) is not bound by WHO obligations in the same way but coordinates health matters through neighbors like Switzerland. Taiwan participates in limited ways but faces political barriers to full engagement.

Key Context

• No comprehensive "blacklist" exists because enforcement is weak — WHO relies on diplomacy, technical assistance, and voluntary reporting (e.g., via SPAR self-assessments and JEEs).
• High-income countries often score better on paper but have implemented disproportionate measures or faced criticism for data-sharing issues. Low-resource countries frequently cite capacity limitations.
• Opposition or hesitation often centers on sovereignty, equity (e.g., access to vaccines/technology), or specific policies rather than outright rejection of the WHO. In summary, the US stands out for full withdrawal, a handful of countries signaled reservations via abstentions on the Pandemic Agreement, and partial non-compliance is common worldwide due to capacity gaps and the non-punitive nature of the framework. For the latest country-specific JEE or SPAR scores, check the WHO's official monitoring tools.