TIME 100 HEALTH - Titans

AS DIRECTOR-GENERAL OF the World Health Organization (WHO), navigating uncertainty is part of Tedros Adhanom Ghebreyesus' job. Health threats don't give warnings, and the viruses and pathogens responsible for them aren't always predictable.

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TEDROS ADHANOM GHEBREYESUS GLOBAL-HEALTH ARCHITECT

But even he was surprised by President Donald Trump's Executive Order on Jan. 20, Trump's first day in office, announcing the U.S. was immediately withdrawing from the WHO and would cease communication with the organization. Most importantly, it would send no further funds, including what it owed for the 20242025 period. Ghebreyesus was in Tanzania at the time, helping officials there manage an outbreak of Marburg virus (kin to Ebola) that killed the handful who were infected. While Trump had also attempted to withdraw from the WHO during his first term, there was no indication that he would continue those efforts. "There was no heads-up," Ghebreyesus says of the decision. He learned about it while watching the news-and has still not heard from Trump.

In a series of in-depth interviews at WHO headquarters in Geneva, Ghebreyesus tells TIME that Trump's abrupt decision, and the reasons given in the Executive Order-including the WHO's mishandling of the COVID-19 pandemic and its failure to implement reforms-"don't make sense. We haven't done anything to be treated that way by the U.S." And because the U.S. has historically been the largest funder of the WHO, providing around 10% of its budget-nearly $1.3 billion each year-its absence is decimating the organization's bottom line. On April 22, Ghebreyesus told WHO employees that the shortfall caused by a U.S. withdrawal required a 25% cut in staff costs.