The Trump administration has been considering a plan for reform at the World Health Organization, including putting an American in charge, in order for it to remain a member of the global health agency, according to two sources familiar with the plan and a proposal document reviewed by Reuters.
The document, shared with President Donald Trump's advisors before his Jan. 20 inauguration, recommended that the United States quickly announce its withdrawal from the WHO and adopt a "radical new approach" for dealing with the agency, including pushing for a U.S. official to serve as director general when Tedros Adhanom Ghebreyesus's term ends in 2027.
Trump's executive order to exit the WHO was among his first policy moves upon taking office. It would lead the global health agency to lose its single-biggest funder by Jan. 2026. The order accuses the organization of mishandling the COVID-19 pandemic and being unduly influenced by other nations, which the WHO denies.
Trump has since suggested the U.S. could return if the WHO was "cleaned up," without providing details on what that would require.
The reform proposal has been under discussion since before Trump took office, but it is not clear whether his administration will adopt any of its other recommendations, the two sources said.
The Trump administration "will continue to review current processes and healthcare bodies to implement needed reforms," White House spokesperson Kush Desai said in a statement to Reuters. He did not comment on any discussions regarding WHO.
Compiled by an outside policy expert at the request of Trump's transition team, the proposal concludes that the WHO has become "the most chaotic, least effective UN agency."
The WHO has failed to execute on reforms proposed over the last two decades, leading to a deterioration in management and scientific expertise, the document says.
It acknowledges that leaving the WHO would hurt American interests but argues that the same is true of staying in the organization unless it is reformed.
WHO's director of transformation, Søren Brostrøm, rejected the criticisms in an interview with Reuters, saying that the agency has undertaken its most fundamental reforms to date under Tedros.
"We have reformed totally, and we know we are still in progress," he told Reuters, citing moves to increase its independence from donors by reforming its funding model, giving more autonomy to country directors outside of headquarters and providing more transparency on spending.
The WHO's work may be more complex compared to other UN agencies because of its wide remit, he said, but stressed that its responses to health crises were far from chaotic.
"If member states… have additional requests for reform, we will try to deliver," he added.
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