The likely next secretary of state, Sen. Marco Rubio, once said of the World Health Organization: “The WHO is a corrupt, radical institution that was powerless to stop Covid-19 spreading beyond China.” That was in 2022. In 2020, at the height of the Covid-19 pandemic, then-President Trump pulled U.S. funding and membership from the WHO, also slinging accusations of pandemic mismanagement. Now, it’s likely he’ll again pull the U.S. from the WHO early in his new administration.
Such a move would be a mistake. To be sure, Rubio is right in his review of how the WHO mismanaged the emergence and spread of Covid from China. But pulling out of the WHO is the wrong answer to the right question: How do we make the WHO an effective organization serving the public health needs of people around the world? Because that’s not what it is today.
The WHO needs deep reforms. But by exiting the WHO and pulling funding, the U.S. loses any leverage to enact those reforms. And doing so would weaken the WHO, leaving the U.S. less safe.
Much of the problem stems from its own confusion around its mission. Is it a membership organization with 193 member-states, most of which are low- and middle-income? Or is it the world’s public health agency?
When these two missions conflict, the WHO usually chooses to focus on being a membership organization. And, like most membership organizations, it is loathe to criticize its own members — unless, of course, it is politically expedient to do so. That explains why the WHO never really criticized China for its handling of Covid (but is often quick to criticize the U.S.).
There are other signs of an organization with deep cultural problems. Early in the Covid pandemic, the WHO denied that the virus spread through aerosols, a mistake that substantially harmed efforts to control the spread. Mistakes happen. But even when evidence accumulated that the virus was spreading through the air, the WHO refused to correct its mistake, taking years to finally acknowledge what everyone already knew.
Beyond Covid, there were errors with how it has handled mpox. The U.S. offered mpox vaccines to stem the tide of that disease in the Democratic Republic of Congo in early 2023, but the WHO, through regulatory delays, did not authorize those vaccines until late 2024, allowing mpox to spread wildly in DRC and elsewhere.
With all its flaws, the WHO remains a source of crucial coordination and collaboration. It plays an essential role in low- and middle-income countries, especially, and can be effective in that role with a more defined set of responsibilities and limits. Globally, WHO sets norms around essential medicines and treatments. It supports coordination in cross-national health emergencies, providing critical technical assistance to countries that lack the resources to take action alone. These are important functions, and the WHO should do them better. Consider that in the U.S., the Centers for Disease Control and Prevention is the go-to for local officials needing help and information in a disease outbreak. In low- and middle-income countries, there is no place to go but the WHO. Weakening the WHO would make it harder to contain outbreaks around the world and increase the risk of a local outbreak becoming a global one.
Abandoning the organization would create a leadership vacuum that others, especially China, would surely fill — to our detriment and the world’s. Global disease surveillance would be diminished, along with our influence and expertise in global health policy, and our national security. And we would have no voice in helping shape or create a better, more effective WHO, which should be our goal.
Instead of removing the U.S. from global leadership, President Trump should use the leverage he has to advance reforms for a better WHO.
First, the WHO should focus on four core functions: 1) supporting national capacity building through technical advice; 2) rapid early response and assessment of outbreaks (including potential emergency declarations); 3) establishing technical norms, standards, and guidance; and 4) convening the global community to set goals, mobilize resources, and negotiate rules.
Beyond outbreaks, the WHO should maintain its broad definition of health, but substantially scale back its expansive range of activities to focus on these core functions. In practice, this might mean that the WHO works with countries to identify and respond to disease outbreaks but does not try to serve as a global regulator of medicines and vaccines — not when other regulators like the Food and Drug Administration in the U.S. and the European Medicine Agency in Europe have much more capacity to do this well.
Second, there must be reforms to the WHO financing model. As part of this, the WHO should create a transparently implemented policy that provides clear guidance about when to accept or reject voluntary contributions at headquarters, regional, and country offices. Right now, too many donors get to set WHO priorities, making the organization unfocused and ineffective.
Third, changes are needed around personnel and human resources impacting the people who lead and staff WHO. There should be term limits for leadership, with no re-election allowed for the director-general. To build in more continuity, the WHO could lengthen the term of the director-general to seven years — but removing the possibility of re-election allows the leader to focus on doing what is right, as opposed to focusing on getting re-elected. Labor rules must be reformed to address deep bureaucratic problems with staff turnover, to ensure that only the best people are engaged and retained.
Finally, there is a need for an investigator general, appointed from outside the WHO, to study and report on the effectiveness of the organization, its staff, and leadership. (I also suggested this after examining the WHO response to Ebola in 2016.) This inspector general, modeled after those in each of the U.S. Cabinet agencies, should be independently funded and publicly report on an ongoing basis its investigations and assessments.
In the shadow of a pandemic — at a time when its impact is still felt — the U.S. should use its leverage to strengthen the WHO. There are more pandemics and other health crises ahead, and the U.S. and the world need an effective global organization to help guide and inform how we prevent, prepare and respond to them. The WHO depends on U.S. expertise to do just that. Covid taught the world that viruses and diseases respect no borders. Sen. Rubio is right that we need a better WHO. But we can’t address the global challenges we face by leaving the WHO and fighting alone.
Ashish K. Jha is the dean of the Brown University School of Public Health and former White House Covid-19 response coordinator.