The Future of the WHO—and How the United States Can Shape It

Commentary by J. Stephen Morrison and Paul Friedrichs

Published January 20, 2026

The United States will soon exit the World Health Organization (WHO), but not forever. Now is the time to think carefully about next steps. Important work lies ahead.

In the next few days, the United States will officially terminate its relationship with the WHO. But that is not the end of the story. The United States still retains strong national interests in what happens in the WHO into the future. It still needs to protect Americans against dangerous outbreaks in remote places where there is little visibility. It still needs to shape global norms and guidance and deter dominance by China and Russia. And the United States has an obligation to ensure U.S. biopharmaceutical and medical product manufacturers are able to win reliable access to markets in low- and middle-income countries, over which the WHO has influence.

On Inauguration Day last year, President Trump issued an executive order calling for the termination of U.S. membership in the WHO. Withdrawal of member states is a one-year process. On January 22 of this year, the Trump administration is expected to announce both a clean break with the WHO and the intention to work with allies to devise an "alternative international health system."

Such dramatic action is happening for many reasons. It flows from a deeply felt anti-United Nations and anti-multilateral sentiment, as evinced in the administration's recent announcement that it is ending ties to 66 UN and international organizations, conventions, and treaties. It is a reminder, six years after the advent of the Covid-19 pandemic, of the persistent, unresolved anger at the WHO for its alleged subservience to China. It stems from an animus against the current WHO director-general, Dr. Tedros Adhanom Ghebreyesus; realistically, there will be no restoration of U.S. membership in the WHO until after his second and final term ends on July 1, 2027. It grows out of frustration with the WHO's resistance over many years to enact much-needed reforms.

What then should be U.S. priorities following the expected U.S. withdrawal from the WHO this month?

First and foremost, the United States should begin mapping a path to restoration of U.S. membership in mid-2027.

To that end, the United States should actively engage in shaping the selection of the next WHO director-general, as the campaign swings into action in the fall of this year. The goal should be to build consensus behind the very best candidate who will commit to advancing further reforms of the WHO and who is aligned with U.S. priorities. That may be awkward and difficult, but not impossible. There are many promising candidates, from Saudi Arabia, Qatar, Indonesia, Brazil, and Belgium, and many diplomatic avenues available to U.S. diplomats to engage in Washington and in national capitals. To not engage is to leave the field open for excessive influence by China and Russia, who will seek a WHO leader aligned with their priorities. Credible candidates are already planning visits to Washington, D.C.

A second, related priority should be clearly defining the next reform agenda for the WHO. Thus far, the Trump administration has not been very forthcoming on exactly what reforms it prioritizes. It is now time for the Trump administration to answer that question. And for every serious candidate for WHO director-general to do the same.

In 2025, under the acute pressure of the U.S. termination of funding and announcement of withdrawal, the WHO undertook a series of emergency actions. The biannual budget was cut 21 percent from $5.3 billion to $4.2 billion, the senior leadership team was halved, the workforce is expected to be shrunk by up to a quarter, and the number of departments was reduced from 76 to 34. WHO's mission was narrowed considerably, giving considerable weight to setting norms and standards and surveillance of dangerous outbreaks.

President Trump rightly can and should claim credit for driving these measures-and now build on them. Deeper reform is still needed. Lacking still is a coherent vision of how the WHO is to best perform in the next decade. A related, outstanding challenge matters most to U.S. biopharmaceutical and medical product manufacturers: reforming the WHO's prequalification process of vetting and approving new medications, diagnostics, therapies, personal protective equipment, and other medical products. The administration's consultations with U.S. industry should intensify, in building consensus on a much speedier and transparent mechanism for approval, in normal times as well as during dire emergencies.

Third, the United States should continue its technical cooperation with the WHO on polio, influenza, and other dangerous outbreaks. Over the course of 2025, the WHO demonstrated its openness to cooperate and share critical data with the United States, in a period when the United States has curtailed many of its overseas surveillance capabilities. These outbreaks do not respect borders, and it is in the U.S. national interest to help contain outbreaks before they spread among Americans.

In parallel, the United States should continue its efforts to develop bilateral compacts with over 70 countries that will enhance surveillance and other aspects of health security, under the America First Global Health Strategy. And the United States should fund and staff U.S. Centers for Disease Control and Prevention country and regional offices and revitalize U.S. Department of Health and Human Services health attachés in major capitals. But even if fully successful, these bilateral agreements and global staff cannot replace the reach of the WHO, especially in geographies where the United States does not have bilateral relationships.

Finally, Congress's intent to restore funding for many science and global health programs is a laudable and important action. Congress should take steps to signal its intent to restore funding to the WHO in the future, tied to further reform. That would be an inducement to the WHO and other member states to take the possibility of a U.S. return seriously, and to listen more carefully to U.S. calls for deeper reform. And it should lay the groundwork for an eventual successful transition back into U.S. membership, with sustained funding.

The U.S. exit from the WHO will not make Americans healthier, more prosperous, and more secure. But this break potentially opens the way for the next phase of reform. Achieving a smart transition back into U.S. membership, aligned with a new director-general who shares U.S. values and agrees upon a robust vision of WHO reform, is a path that will advance U.S. interests.

J. Stephen Morrison is a senior vice president at the Center for Strategic and International Studies (CSIS) in Washington, D.C., where he directs the Global Health Policy Center. The Honorable Paul Friedrichs, Major General (ret.), is a senior adviser with the CSIS Global Health Policy Center and previously served as the inaugural director of the White House Office of Pandemic Preparedness and Response Policy.

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