The Trump administration is advancing discussions on a sweeping reform of the World Health Organization (WHO), including a push to install an American as the agency’s next director-general.
The proposal, reviewed by Reuters, underscores the administration’s dissatisfaction with WHO’s leadership and effectiveness, raising questions about whether the United States will maintain its membership in the global health body.
U.S. Push for Leadership at WHO
A policy document drafted ahead of Trump’s January 20 inauguration recommends an immediate declaration of U.S. withdrawal from WHO, while simultaneously advocating for aggressive reforms.
Among the key objectives is securing American leadership at the helm of the organization when the current director-general, Tedros Adhanom Ghebreyesus, completes his term in 2027.
One of Trump’s first executive orders upon taking office formalized the U.S. departure from WHO, a move that would strip the organization of its largest financial contributor by January 2026.
The order accuses WHO of mismanaging the COVID-19 pandemic and being overly influenced by other nations, allegations that the organization has repeatedly denied. Despite this, Trump has hinted at a possible reversal if WHO undergoes substantial reform, though specifics remain unclear.
“The Trump administration will continue to review current processes and healthcare bodies to implement needed reforms,” said White House spokesperson Kush Desai, declining to comment on specific WHO-related discussions.
The reform document paints WHO as “the most chaotic, least effective UN agency” and criticizes its failure to implement necessary structural changes over the past two decades. It asserts that these shortcomings have resulted in declining scientific expertise and mismanagement, weakening the agency’s global health leadership.
While acknowledging that leaving WHO may come with consequences for U.S. interests, the proposal argues that staying in a dysfunctional organization is equally detrimental unless reforms are achieved.
WHO Defends Its Record Amid U.S. Criticism
WHO Director of Transformation Søren Brostrøm dismissed the characterization, asserting that the agency has undergone “fundamental” reforms under Tedros’ leadership.
“We have reformed totally, and we know we are still in progress,” Brostrøm said, highlighting initiatives to reduce reliance on donor influence, empower country-level directors, and enhance financial transparency.
Brostrøm defended WHO’s ability to manage global health crises, stating, “If member states have additional requests for reform, we will try to deliver.”
To facilitate negotiations before the planned 2026 exit, the proposal recommends appointing a U.S. special envoy in 2025. This official would report directly to Trump and oversee talks with WHO about potential changes.
Currently, U.S. engagement with WHO falls under the jurisdiction of the State Department and the Department of Health and Human Services. The proposed envoy would adopt a more forceful role in advocating for American leadership, marking a significant shift in U.S.-WHO relations.
“There is no formal reason why [an American cannot lead WHO], and the lack of American leadership at the top of WHO has been a critical factor in the wasting of American funds and the decline of the organization’s efficiency,” the proposal states.
Brostrøm noted that any WHO member state can nominate a candidate for director-general. The agency’s executive board selects a shortlist, and the final leader is determined by a two-thirds majority vote from member states.
The Financial and Diplomatic Impact of a U.S. Exit
The United States is WHO’s largest financial backer, contributing around 18% of its overall funding, including $400 million in voluntary contributions and $130 million in assessed dues based on economic size. WHO has warned that without alternative funding sources, it may be forced to cut programs and services.
The U.S. has already scaled back its engagement with WHO, including halting collaboration between the agency and the U.S. Centers for Disease Control and Prevention (CDC), a longstanding partner in global disease response efforts.
Nonetheless, a U.S. delegation is currently attending WHO’s executive board meetings in Geneva, which run from February 3 to 11, to influence upcoming budget decisions and program priorities.
Trump’s WHO exit strategy has faced sharp opposition from public health experts and lawmakers. Last week, 43 U.S. legislators urged the administration to reconsider, arguing that American withdrawal could compromise both national and global health security.
Legal challenges to block the move are also being explored by public health activists, who argue that continued U.S. participation is crucial.
“It would be in America’s best interests to remain and push for reforms,” said Lawrence Gostin, a professor of global health at Georgetown University and director of the WHO Collaborating Center on National and Global Health Law.
