GENEVA — In late May, the American 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 Trump would quit the health organization, the relationship could still be salvaged.
Mr. Bremberg hand-delivered a list of seven demands that American officials saw as the beginning of discreet discussions.
Hours later, Mr. Trump took the lectern outside the White House and blew it all up, announcing that the United States would leave the W.H.O. The announcement blindsided his own diplomats and Dr. Tedros alike.
If Mr. Trump thought Dr. Tedros would relent under the pressure of an American withdrawal, he was wrong. The W.H.O. leader has refused to make concessions or counteroffers, according to American and Western officials. And Mr. Trump ultimately made good on his promise to abandon a health agency that the United States helped form a half-century ago.
With Mr. Trump’s election defeat, President-elect Joseph R. Biden Jr. 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 American frustration with the W.H.O. 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 glimpse of the deal-making of a president who favored aggressive, unpredictable moves over more conventional negotiations.
As has often been the case during Mr. 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 W.H.O. 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 Times.
The 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 an enormous backfire, and it was bound to be,” added Lawrence Gostin, a Georgetown University law professor and longtime W.H.O. 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 W.H.O. 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,” Mr. Bremberg, the American ambassador in 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 American list was the product of months of growing irritation with Dr. Tedros, whom senior administration officials saw as too quick to praise China or frame the outbreak in ways favorable to Beijing. Dr. 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.
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.
Mr. Trump was particularly focused on the issue of travel. The W.H.O. had a longstanding policy of unrestricted travel. As health experts began reconsidering that policy, Mr. Trump became preoccupied with getting credit for having halted some travel from China to the United States in February.
By April, as Mr. Trump toyed with withdrawing the United States from the W.H.O., 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 and the health secretary, Alex M. Azar II, argued that only the W.H.O. 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 Mr. Trump wrote a letter — which he released on Twitter — with an ultimatum. He would leave the W.H.O. if it did not “commit to major substantive improvements within the next 30 days.”
Exactly what changes Mr. 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, Mr. Bremberg consulted with European allies, who were eager to keep Mr. 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 W.H.O.’s handling of the outbreak and the source of the virus. American officials said they saw this as an easy request: More than 140 countries had already endorsed these investigations.
In July, Dr. 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 Dr. Tedros to call on China to provide live virus samples and stop censoring Chinese doctors or journalists. This would have been a significant break for the World Health Organization, which rarely criticizes members. Dr. 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 Dr. Tedros’s independence.
The third item asked Dr. Tedros to say that countries were right to consider travel restrictions during the pandemic — a break from the longstanding advice that limiting travel would not slow the virus but would harm economies and delay medical treatment.
The W.H.O. had already begun to soften that stance by the time Mr. Bremberg delivered 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 right to restrict travel from China, according to public health officials and diplomats who have talked to him. Dr. Tedros was wary of being drawn into the American presidential campaign, where travel restrictions were a rallying cry for the Trump campaign.
Mr. Gostin, who agrees that the W.H.O. 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 W.H.O. 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 W.H.O. from engaging with Taiwan’s government.
The American requests also called for the W.H.O. to pre-qualify 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 Dr. Tedros to ensure that countries like the United States that contribute heavily to the W.H.O. 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 Mr. Bremberg and Dr. Tedros met in Geneva, however, the political ground had shifted in Washington.
Mr. Meadows, the White House chief of staff, believed that negotiations with Dr. 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.
Mr. Trump had already planned a news conference criticizing China. Shortly before the event, the president’s national security adviser, Robert C. O’Brien, joined Mr. Meadows, Secretary of State Mike Pompeo and Adam Boehler, the head of the U.S. International Development Finance Corporation, a foreign aid agency, in Mr. Meadows’s office in the West Wing, according to the official. From that meeting emerged a plan: Mr. Trump would withdraw the country from the World Health Organization.
Mr. 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.
Dr. 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 Mr. Trump’s announcement, Dr. Tedros said that American partnership had served humanity for decades.
“It has made a great difference in public health all around the world,” he said. “It is W.H.O.’s wish for this collaboration to continue.”
Matt Apuzzo and Selam Gebrekidan reported from Geneva, and Noah Weiland from Washington.