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GENEVA – At the end of May, US Ambassador to Geneva Andrew Bremberg went on a rescue mission to the headquarters of the World Health Organization. He told his chief executive, Tedros Adhanom Ghebreyesus, that despite weeks of threats to resign President Trump from the healthcare organization, the relationship could still be saved.
Mr. Bremberg hand delivered a list of seven requests that the US authorities saw as the start of quiet discussions.
Hours later, Mr Trump took the lectern in front of the White House and blew everything up, announcing that the United States would be leaving the WHO. The announcement blinded his own diplomats and Dr Tedros.
If Mr. Trump thought Dr. Tedros would give in to the pressure of a US withdrawal, he was wrong. The WHO leader has refused to make any concessions or counter-offers, according to US and Western officials. And Mr. Trump has finally kept his promise to ditch a health care agency the United States helped create half a century ago.
With Mr. Trump’s electoral defeat, President-elect Joseph R. Biden Jr. looks set to join the global health body. But he will inherit a fractured relationship and must quickly make decisions on how to overhaul an organization that even for its staunch supporters is in desperate need of change.
While the Trump administration’s demands are now moot, they offer insight into both Americans’ growing frustration with the WHO and Mr. Trump’s personal grievances. And as Mr. Biden signals a return to multinational diplomacy, the Trump administration’s demands offer a behind-the-scenes look at reaching a deal with a president that favored aggressive and unpredictable moves over more conventional negotiations. .
As was often the case during Mr. Trump’s presidency, his administration was divided, current and former officials said.
Diplomats and health veterans said the list contained reasonable demands that could have been easily negotiated through normal channels. (The WHO has made changes since.) 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 lawyer for the health organization who reviewed the list for The Times.
Experts said it was easy to see why, in the face of Mr Trump’s withdrawal and his efforts to deflect blame for the pandemic, Dr Tedros chose not to negotiate.
“It was a huge backlash, and it was inevitable,” added Lawrence Gostin, Georgetown University law professor and longtime WHO adviser who also reviewed the list. “It was not a negotiation. It was blackmail.
The State Department did not directly address the proposed terms, but said it had acted in good faith in requesting the necessary changes. “At a critical time when WHO leadership has had the opportunity to rebuild trust among some of its critical Member States, it has chosen a path that has done the opposite and demonstrated its lack of independence from to the Chinese Communist Party, ”Mr. Bremberg, the US Ambassador to Geneva, said in a statement.
The World Health Organization 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 Dr Tedros, whom senior administration officials deemed too quick to praise China or frame the epidemic in a manner favorable to Beijing. Dr Tedros, for example, announced in January that China would share biological samples with the world. But he refused to speak when China never kept that promise.
Some European health officials and diplomats shared the concerns of the Trump administration, officials said. But they viewed them as minor issues in the midst of a pandemic.
Mr. Trump was particularly focused on the issue of travel. WHO has a long-standing unrestricted travel policy. As health experts began to reconsider the policy, Mr Trump became concerned about getting credit for cutting off some trips from China to the United States in February.
In April, as Mr. Trump toyed with the US withdrawal from the WHO, two camps emerged in his administration, current and former officials said. The first group, which included Mr Trump’s chief of staff, Mark Meadows, wanted to leave and rally support for a health agency built around Western allies.
Others, like Mr. Bremberg; Alex M. Azar II, the Secretary of Health; and Adam Boehler, the head of the US International Development Finance Corporation, argued that only the WHO was backed by a global treaty. If the United States could get the health agency to make changes, they said, it made sense to stay.
This argument prevailed until May, and Mr. Trump wrote a letter – which he posted on Twitter – with an ultimatum. He would leave the WHO if it did not “commit to making major fundamental improvements in the next 30 days”.
It is unclear what changes Mr. Trump was seeking, however. The final list is the result of discussions between the White House, the State Department, and the Department of Health and Human Services. In Geneva, Bremberg consulted with European allies, eager to prevent Mr Trump from abandoning the health care organization, Western diplomats said.
At the end of May, the list had seven points. The first called for investigations into the management of the epidemic by the WHO and the source of the virus. U.S. officials said they saw this as an easy request: more than 140 countries had already approved these investigations.
In July, Dr. Tedros would do just that. He appointed Helen Clark, former Prime Minister of New Zealand, and Ellen Johnson Sirleaf, former President of Liberia, to lead an investigation into the response to the pandemic. A separate investigation into the origins of the virus is underway.
Second, the United States has called on Dr Tedros to call on China to provide live virus samples and stop censoring Chinese doctors or journalists. It would have been a major break for the World Health Organization, which rarely criticizes its members. Dr Tedros told his colleagues he saw no benefit in such criticism, especially during a pandemic.
Giving in to the Trump administration’s demand would have meant allowing one country to dictate the organization’s stance towards another. But in Washington, a senior White House official recalled this as a key condition, a signal of independence from Dr Tedros.
The third point asked Dr Tedros to say that countries were right to consider travel restrictions during the pandemic – a break with long-held advice that limiting travel would not slow the virus but hurt economies and delay the medical treatment.
WHO had already started to soften this position by the time Mr. Bremberg handed in the list. In April, the organization called for “appropriate and proportionate restrictions” on domestic and international travel.
But Dr Tedros interpreted the request as demanding that he apologize to Mr Trump and say he was correct in restricting travel from China, according to public health officials and diplomats who spoke to him. . Dr Tedros feared he would be drawn into the US presidential campaign, where travel restrictions were a rallying cry for the Trump campaign.
Mr Gostin, who agrees the WHO should study and revise its travel guidelines, said it was inappropriate for the United States to try to bolster change. He said the list smacked of politics, not good health care policy. “It was all about my country, my politics, my elections,” he said.
The fourth item on the list asked the WHO to send a team to Taiwan to study the success of its response to the pandemic. Taiwan is not a member of the health organization, and Beijing, which claims the autonomous island as its own, is exerting enormous pressure to prevent the WHO from engaging with the Taiwan government.
U.S. requests also called on the WHO to prequalify coronavirus drugs and vaccines for use worldwide once they have been cleared by major regulators in the United States, Canada, Europe or in Japan. This could help speed up 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 has also asked Dr Tedros to ensure that countries like the United States that contribute heavily to the WHO are proportionately represented in the organization’s staff. And he asked for support for the changes proposed by the Group of 7 – the United States, Germany, Japan, France, Great Britain, Canada and Italy. This request is moot, as the G-7 proposal has been incorporated into larger review efforts.
However, when Mr. Bremberg and Dr. Tedros met in Geneva, the political terrain had changed in Washington.
Mr Meadows, the White House chief of staff, believed negotiations with Dr Tedros were a long way off. Even if they were successful, he argued, they would take too long and not earn enough, a senior administration official recalled.
Mr. Trump had already scheduled a press conference criticizing China. Shortly before the event, the President’s National Security Advisor Robert C. O’Brien joined Mr. Meadows, Secretary of State Mike Pompeo and Mr. Boehler in Mr. Meadows’ office in the wing west, according to the manager. From that meeting emerged a plan: Mr. Trump would remove the country from the World Health Organization.
Mr. Trump agreed and added the announcement at the press conference. He had done something similar in 2018, announcing he was quitting a United Nations postal pact, only to overthrow after winning concessions.
Dr. Tedros has shown no appetite for such transactions. He told his colleagues he felt locked in, stuck between China and the United States. Speaking to reporters shortly after Mr Trump’s announcement, Dr Tedros said the US partnership had served humanity for decades.
“It has made a big difference in public health around the world,” he said. “WHO wants this collaboration to continue.”
Matt Apuzzo and Selam gebrekidan brought back from Geneva, and Noah weiland from Washington.
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