Brett Schaefer and Roger Bate explore prospects for reforming the troubled World Health Organization in ways that would entice the United States to rejoin the group.
There has been a frankly strange mutual disinclination to propose reforms or changes that the organization could adopt that would lead the US to reconsider its decision to withdraw, despite the fact that the WHO (explicitly through statements) and the US (implicitly through efforts to secure access to pathogens in its bilateral health agreements) acknowledge costs resulting from the US withdrawal. The most robust catalog of what the US would like to see changed was made by Secretary Robert Kennedy, Jr., to the World Health Assembly on 20 May 2025, which pointed to bureaucratic bloat, politicization, Chinese influence in relation to COVID and other matters, disproportionate reliance on US funding, and a focus on issues tangential to its core mission. He concluded, “Let’s return to the core focus of global health and global health security back to reducing infectious disease burden and the spread of diseases of pandemic potential.”
Historically, however, WHO reform efforts have been incremental, with limited evidence that major structural changes occur absent strong, coordinated pressure from influential member states. … If the United States presents clear demands, the incentives for reform improve significantly.
Unfortunately, as of yet, the US has not articulated specific demands. Based on US statements, which are mostly comprised of general criticisms, reforms that might lead the US to rejoin the WHO include: new leadership, especially if an American Director is elected to succeed Tedros; a narrower assessed budget focused on communicable diseases; a definitive autopsy of the COVID pandemic, specifically its origin; granting Taiwan a permanent invitation to participate fully in WHO technical activities and meetings and as an observer to the World Health Assembly; and clarification of pandemic response to mandate explicit consequences for failure to alert the international system of a potential public health emergency of international concern, failure to share genomic sequences and related data, and failure to grant immediate entrance and full cooperation to a WHO expert team.
