U.S. Seeks Leadership in WHO Reform amid Exit Plans

The Trump administration has been exploring significant reforms within the World Health Organization (WHO), including advocating for an American to lead the agency, as a condition for continued U.S. membership. According to sources familiar with the discussions and a proposal document, the plan was presented to Trump's advisors before his inauguration on January 20.

The document suggested that the U.S. swiftly announce its withdrawal from the WHO and adopt a radically different approach to its engagement with the organization. Among its key recommendations was positioning a U.S. official as director-general when Tedros Adhanom Ghebreyesus’s term concludes in 2027. One of Trump's first executive actions upon taking office was to formalize the U.S. departure, which would strip the WHO of its largest financial contributor by January 2026. The order cited alleged mismanagement of the COVID-19 pandemic and undue influence by other nations, accusations that the WHO has denied.

Although Trump later indicated that the U.S. might reconsider its departure if the WHO underwent substantial reforms, he did not specify the required changes. Discussions on reforming the agency had been ongoing before Trump's tenure, but it remains uncertain whether his administration will implement further recommendations.

A White House spokesperson stated that the administration is reviewing existing processes and healthcare bodies to introduce necessary reforms but did not comment on specific discussions regarding the WHO. The proposal, developed by an independent policy expert for Trump's transition team, argued that the WHO has become the most disorganized and ineffective UN agency. It criticized the organization's failure to implement past reforms, leading to a decline in management and scientific expertise. While acknowledging that withdrawing from the WHO could harm American interests, the proposal suggested that remaining within the organization without substantial changes would be equally detrimental.

In response, WHO officials rejected these criticisms, highlighting ongoing reforms aimed at improving financial independence, governance, and transparency. A WHO representative emphasized that the agency has undergone its most significant transformations under the current leadership and remains committed to further improvements if requested by member states.

A Push for U.S. Leadership

The proposal also recommended appointing a U.S. special envoy in 2025 to negotiate potential WHO reforms before the scheduled withdrawal. Currently, WHO coordination is managed by the State and Health Departments. The special envoy would advocate for a U.S. official to lead the WHO for the first time in history, arguing that American leadership could enhance efficiency and safeguard U.S. financial contributions.

The WHO’s executive board selects director-general candidates, and the final choice is made by member states through a voting process. Despite the U.S. being the largest financial contributor to the WHO—providing around 18% of the agency's funding—its influence over leadership decisions has historically been limited. The U.S. has already ceased collaboration with the WHO in some areas, including restricting communication between the organization and the Centers for Disease Control and Prevention (CDC). However, a U.S. delegation remains present at WHO meetings, particularly in budget discussions.

Opposition to the withdrawal has emerged from both lawmakers and public health advocates, with some considering legal challenges to reverse the decision. Experts argue that maintaining U.S. involvement in the WHO while pushing for internal reforms would be the most strategic approach.