In late May, the US ambassador in Geneva, Andrew Bremberg, went on a rescue mission to the World Health Organization headquarters. He told its director-general, Tedros Adhanom Ghebreyesus, that despite weeks of threats that President Donald Trump would quit the health organization, the relationship could still be salvaged.
Bremberg hand-delivered a list of seven demands that US officials saw as the beginning of discreet discussions.
Hours later, Trump took the lectern outside the White House and blew it all up, announcing that the United States would leave the WHO. The announcement blindsided his own diplomats and Tedros alike.
If Trump thought Tedros would relent under the pressure of a US withdrawal, he was wrong. The WHO leader has refused to make concessions or counteroffers, according to American and Western officials. And Trump ultimately made good on his promise to abandon a health agency that the United States helped form a half-century ago.
With Trump’s election defeat, President-elect Joe Biden appears ready to rejoin the global health body. But he will inherit a fractured relationship and must quickly make decisions about how to overhaul an organization that even staunch supporters say is in dire need of change.
While the Trump administration’s demands are now moot, they offer a glimpse into both the growing US frustration with the WHO and Trump’s personal grievances. And as Biden signals a return to multinational diplomacy, the Trump administration’s demands offer a behind-the-scenes glimpse of the deal-making of a president who favoured aggressive, unpredictable moves over more conventional negotiations.
As has often been the case during Trump’s presidency, his administration was divided, current and former officials said.
Diplomats and veteran health officials said the list contained reasonable requests that might have been easily negotiated through normal channels. (The WHO has since made some changes anyway.) But it also contained politically sensitive, if not inappropriate, demands.
“It doesn’t seem to reveal a clear strategic vision,” said Gian Luca Burci, a former counsel to the health organization who reviewed the list for The New York Times.
Experts said it was easy to see why, in the face of Trump’s withdrawal and his efforts to deflect blame for the pandemic, Tedros chose not to negotiate.
“It was an enormous backfire, and it was bound to be,” added Lawrence Gostin, a Georgetown University law professor and longtime WHO adviser who also reviewed the list. “It wasn’t a negotiation. It was blackmail.”
The State Department did not directly address its proposed terms but said it had acted in good faith in calling for needed changes.
“At a critical moment when the WHO leadership had the opportunity to rebuild trust among some of its critical member states, it chose a path that did the very opposite and demonstrated its lack of independence from the Chinese Communist Party,” Bremberg, the US ambassador in Geneva, said in a statement.
The WHO did not comment. Several current and former Trump administration officials and Western diplomats spoke on condition of anonymity because they were not authorized to disclose private conversations.
The US list was the product of months of growing irritation with Tedros, whom senior administration officials saw as too quick to praise China or frame the outbreak in ways favourable to Beijing. Tedros, for example, announced in January that China would share biological samples with the world. But he declined to speak up when China never made good on that promise.
The WHO had also quietly acquiesced to Beijing’s conditions before an international mission in February and ceded control of an investigation into the virus’s origins.
Some European health officials and diplomats shared the Trump administration’s concerns, officials said. But they regarded these as minor issues in the midst of a pandemic.
Trump was particularly focused on the issue of travel. The WHO had a long-standing policy of unrestricted travel. As health experts began reconsidering that policy, Trump became preoccupied with getting credit for having halted some travel from China to the United States in February.
By April, as Trump toyed with withdrawing the United States from the WHO, two camps emerged in his administration, current and former officials said. The first group, which included Trump’s chief of staff, Mark Meadows, wanted to leave and rally support for a health agency built around Western allies.
Others — like Bremberg; Alex Azar, the health secretary; and Adam Boehler, head of the US International Development Finance Corp. — argued that only the WHO was backed up by a global treaty. If the United States could get the health agency to make changes, they said, it made sense to stay.
That argument prevailed into May, and Trump wrote a letter — which he released on Twitter — with an ultimatum. He would leave the WHO if it did not “commit to major substantive improvements within the next 30 days.”
Exactly what changes Trump sought, however, remained unclear. The final list emerged from discussions between the White House, State Department and the Department of Health and Human Services. In Geneva, Bremberg consulted with European allies, who were eager to keep Trump from abandoning the health organization, Western diplomats said.
By late May, the list stood at seven items. The first called for investigations into the WHO’s handling of the outbreak and the source of the virus. US officials said they saw this as an easy request; more than 140 countries had already endorsed these investigations.
In July, Tedros would do just that. He appointed Helen Clark, the former prime minister of New Zealand, and Ellen Johnson Sirleaf, the former president of Liberia, to lead an investigation into the response to the pandemic. A separate investigation into the virus’s origins is slowly getting underway.
Second, the United States asked Tedros to call on China to provide live virus samples and stop censoring Chinese doctors and journalists. This would have been a significant break for the WHO, which rarely criticizes members. Tedros has told colleagues that he sees no benefit in such criticism, especially during a pandemic.
Conceding to the Trump administration’s demand would have meant allowing one country to dictate the organization’s posture toward another. But in Washington, one senior White House official recalled this as a key condition, a signal of Tedros’ independence.
The third item asked Tedros to say that countries were right to consider travel restrictions during the pandemic — a break from the long-standing advice that limiting travel would not slow the virus but would harm economies and delay medical treatment.
The WHO had already begun to soften that stance by the time Bremberg delivered the list. In April, the organization called for “appropriate and proportionate restrictions” on domestic and international travel.
But Tedros interpreted the request as demanding that he apologize to Trump and say the president was right to restrict travel from China, according to public health officials and diplomats who have talked to him. Tedros was wary of being drawn into the US presidential campaign, where travel restrictions were a rallying cry for the Trump campaign.
Gostin, who agrees that the WHO should study and revisit its travel guidance, said it was inappropriate for the United States to try to strong-arm the change. He said the list smacked of politics, not good health policy.
“It was all about my country, my politics, my election,” he said.
The fourth item on the list called for the WHO to dispatch a team to Taiwan to study its successful pandemic response. Taiwan is not a member of the health organization, and Beijing, which claims the self-ruled island as its own, exerts tremendous pressure to keep the WHO from engaging with Taiwan’s government.
The US requests also called for the WHO to prequalify coronavirus drugs and vaccines for use around the world once they were authorized by major regulators in the United States, Canada, Europe or Japan. That could help fast-track important treatments, but it could also have been seen as allowing the United States to influence the health organization’s drug-approval policy.
The Trump administration also asked Tedros to ensure that countries like the United States that contribute heavily to the WHO are proportionally represented on the organization’s staff. And it sought support for proposed changes put forward by the Group of 7 — the United States, Germany, Japan, France, Britain, Canada and Italy. That request is moot, as the G-7 proposal has been folded into larger overhaul efforts.
By the time Bremberg and Tedros met in Geneva, however, the political ground had shifted in Washington.
Meadows, the White House chief of staff, believed that negotiations with Tedros were a long shot. Even if they succeeded, he argued, they would take too long and yield too little, one senior administration official recalled.
Trump had already planned a news conference criticizing China. Shortly before the event, the president’s national security adviser, Robert O’Brien, joined Meadows, Secretary of State Mike Pompeo and Boehler in Meadows’ office in the West Wing, according to the official. From that meeting emerged a plan: Trump would withdraw the country from the WHO.
Trump agreed and added the announcement to the news conference. He had done something similar in 2018, announcing that he was quitting a United Nations postal pact, only to reverse himself after winning concessions.
Tedros showed no appetite for such deal-making. He told colleagues that he felt boxed in, stuck between China and the United States. Speaking to reporters soon after Trump’s announcement, Tedros said that US partnership had served humanity for decades.
“It has made a great difference in public health all around the world,” he said. “It is WHO’s wish for this collaboration to continue.”