NEW YORK (AP) — The U.S. has finalized its withdrawal from the World Health Organization, one year after President Donald Trump announced America was ending its 78-year-old commitment, federal officials said Thursday.

But it’s hardly a clean break.

The U.S. owes more than $130 million to the global health agency, according to WHO. And Trump administration officials acknowledge that they haven’t finished working out some issues, such as lost access to data from other countries that could give America an early warning of a new pandemic.

The withdrawal will hurt the global response to new outbreaks and will hobble the ability of U.S. scientists and pharmaceutical companies to develop vaccines and medicines against new threats, said Lawrence Gostin, a public health law expert at Georgetown University.

“In my opinion, it’s the most ruinous presidential decision in my lifetime,” he said.

The WHO is the United Nations’ specialized health agency and is mandated to coordinate the response to global health threats, such as outbreaks of mpox, Ebola and polio. It also provides technical assistance to poorer countries; helps distribute scarce vaccines, supplies and treatments; and sets guidelines for hundreds of health conditions, including mental health and cancer.

Nearly every country in the world is a member.

U.S. officials helped lead the WHO’s creation, and America has long been among the organization’s biggest donors, providing hundreds of millions of dollars and hundreds of staffers with specialized public health expertise.

On average, the U.S. pays $111 million a year in member dues to the WHO and roughly $570 million more in annual voluntary contributions, according to the U.S. Department of Health and Human Services.

In an executive order issued right after taking office, Trump said the U.S. was withdrawing from WHO due to the organization’s mishandling of the COVID-19 pandemic and other global health crises. He also cited the agency’s “failure to adopt urgently needed reforms” and its “inability to demonstrate independence from the inappropriate political influence of WHO member states.”