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GENEVA — In late Might, the American ambassador in Geneva, Andrew Bremberg, went on a rescue mission to the World Well being Group headquarters. He instructed its director normal, Tedros Adhanom Ghebreyesus, that regardless of weeks of threats that President Trump would give up the well being group, the connection might nonetheless be salvaged.

Mr. Bremberg hand-delivered an inventory of seven calls for that American officers noticed as the start of discreet discussions.

Hours later, Mr. Trump took the lectern outdoors the White Home and blew all of it up, asserting that america would depart the W.H.O. The announcement blindsided his personal diplomats and Dr. Tedros alike.

If Mr. Trump thought Dr. Tedros would relent beneath the stress of an American withdrawal, he was unsuitable. The W.H.O. chief has refused to make concessions or counteroffers, in line with American and Western officers. And Mr. Trump finally made good on his promise to desert a well being company that america helped type a half-century in the past.

With Mr. Trump’s election defeat, President-elect Joseph R. Biden Jr. seems able to rejoin the worldwide well being physique. However he’ll inherit a fractured relationship, and should shortly make selections about easy methods to overhaul a company that even staunch supporters say is in dire want of change.

Whereas the Trump administration’s calls for at the moment are moot, they provide a glimpse into each the rising American frustration with the W.H.O. and Mr. Trump’s private grievances. And as Mr. Biden indicators a return to multinational diplomacy, the Trump administration’s calls for provide a behind-the-scenes glimpse of the deal-making of a president who favored aggressive, unpredictable strikes over extra standard negotiations.

As has typically been the case throughout Mr. Trump’s presidency, his administration was divided, present and former officers mentioned.

Diplomats and veteran well being officers mentioned the record contained cheap requests which may have been simply negotiated by means of regular channels. (The W.H.O. has since made some modifications anyway.) But it surely additionally contained politically delicate, if not inappropriate calls for. “It doesn’t appear to disclose a transparent strategic imaginative and prescient,” mentioned Gian Luca Burci, a former counsel to the well being group who reviewed the record for The Occasions.

The consultants mentioned it was simple to see why, within the face of Mr. Trump’s withdrawal and his efforts to deflect blame for the pandemic, Dr. Tedros selected to not negotiate.

“It was an unlimited backfire, and it was sure to be,” added Lawrence Gostin, a Georgetown College legislation professor and longtime W.H.O. adviser who additionally reviewed the record. “It wasn’t a negotiation. It was blackmail.”

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The State Division didn’t straight handle its proposed phrases however mentioned it had acted in good religion in calling for wanted modifications. “At a important second when the W.H.O. management had the chance to rebuild belief amongst a few of its important member states, it selected a path that did the very reverse and demonstrated its lack of independence from the Chinese language Communist Get together,” Mr. Bremberg, the American ambassador in Geneva, mentioned in a press release.

The World Well being Group didn’t remark. A number of present and former Trump administration officers and Western diplomats spoke on situation of anonymity as a result of they weren’t licensed to reveal non-public conversations.

The American record was the product of months of rising irritation with Dr. Tedros, whom senior administration officers noticed as too fast to reward China or body the outbreak in methods favorable to Beijing. Dr. Tedros, for instance, introduced in January that China would share organic samples with the world. However he declined to talk up when China by no means made good on that promise.

Some European well being officers and diplomats shared the Trump administration’s issues, officers mentioned. However they regarded these as minor points within the midst of a pandemic.

Mr. Trump was notably centered on the problem of journey. The W.H.O. had a longstanding coverage of unrestricted journey. As well being consultants started reconsidering that coverage, Mr. Trump grew to become preoccupied with getting credit score for having halted some journey from China to america in February.

By April, as Mr. Trump toyed with withdrawing america from the W.H.O., two camps emerged in his administration, present and former officers mentioned. The primary group, which included Mr. Trump’s chief of employees, Mark Meadows, needed to depart and rally help for a well being company constructed round Western allies.

Others, like Mr. Bremberg; Alex M. Azar II, the well being secretary; and Adam Boehler, the pinnacle of the U.S. Worldwide Improvement Finance Company, argued that solely the W.H.O. was backed up by a world treaty. If america might get the well being company to make modifications, they mentioned, it made sense to remain.

That argument prevailed into Might, and Mr. Trump wrote a letter — which he launched on Twitter — with an ultimatum. He would depart the W.H.O. if it didn’t “decide to main substantive enhancements throughout the subsequent 30 days.”

Precisely what modifications Mr. Trump sought, nonetheless, remained unclear. The ultimate record emerged from discussions between the White Home, State Division and the Division of Well being and Human Providers. In Geneva, Mr. Bremberg consulted with European allies, who had been keen to maintain Mr. Trump from abandoning the well being group, Western diplomats mentioned.

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By late Might, the record stood at seven objects. The primary referred to as for investigations into the W.H.O.’s dealing with of the outbreak and the supply of the virus. American officers mentioned they noticed this as a simple request: Greater than 140 international locations had already endorsed these investigations.

In July, Dr. Tedros would do exactly that. He appointed Helen Clark, the previous prime minister of New Zealand, and Ellen Johnson Sirleaf, the previous president of Liberia, to steer an investigation into the response to the pandemic. A separate investigation into the virus’s origins is slowly getting underway.

Second, america requested Dr. Tedros to name on China to offer stay virus samples and cease censoring Chinese language medical doctors or journalists. This could have been a big break for the World Well being Group, which not often criticizes members. Dr. Tedros has instructed colleagues that he sees no profit in such criticism, particularly throughout a pandemic.

Conceding to the Trump administration’s demand would have meant permitting one nation to dictate the group’s posture towards one other. However in Washington, one senior White Home official recalled this as a key situation, a sign of Dr. Tedros’s independence.

The third merchandise requested Dr. Tedros to say that international locations had been proper to contemplate journey restrictions throughout the pandemic — a break from the longstanding recommendation that limiting journey wouldn’t gradual the virus however would hurt economies and delay medical therapy.

The W.H.O. had already begun to melt that stance by the point Mr. Bremberg delivered the record. In April, the group referred to as for “applicable and proportionate restrictions” on home and worldwide journey.

However Dr. Tedros interpreted the request as demanding that he apologize to Mr. Trump and say he was proper to limit journey from China, in line with public well being officers and diplomats who’ve talked to him. Dr. Tedros was cautious of being drawn into the American presidential marketing campaign, the place journey restrictions had been a rallying cry for the Trump marketing campaign.

Mr. Gostin, who agrees that the W.H.O. ought to research and revisit its journey steerage, mentioned it was inappropriate for america to attempt to strong-arm the change. He mentioned the record smacked of politics, not good well being coverage. “It was all about my nation, my politics, my election,” he mentioned.

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The fourth merchandise on the record referred to as for the W.H.O. to dispatch a staff to Taiwan to review its profitable pandemic response. Taiwan will not be a member of the well being group, and Beijing, which claims the self-ruled island as its personal, exerts super stress to maintain the W.H.O. from partaking with Taiwan’s authorities.

The American requests additionally referred to as for the W.H.O. to pre-qualify coronavirus medicine and vaccines to be used around the globe as soon as they had been licensed by main regulators in america, Canada, Europe or Japan. That might assist fast-track vital remedies, however it might even have been seen as permitting america to affect the well being group’s drug-approval coverage.

The Trump administration additionally requested Dr. Tedros to make sure that international locations like america that contribute closely to the W.H.O. are proportionally represented on the group’s employees. And it sought help for proposed modifications put ahead by the Group of seven — america, Germany, Japan, France, Britain, Canada and Italy. That request is moot, because the G-7 proposal has been folded into bigger overhaul efforts.

By the point Mr. Bremberg and Dr. Tedros met in Geneva, nonetheless, the political floor had shifted in Washington.

Mr. Meadows, the White Home chief of employees, believed that negotiations with Dr. Tedros had been an extended shot. Even when they succeeded, he argued, they’d take too lengthy and yield too little, one senior administration official recalled.

Mr. Trump had already deliberate a information convention criticizing China. Shortly earlier than the occasion, the president’s nationwide safety adviser, Robert C. O’Brien, joined Mr. Meadows, Secretary of State Mike Pompeo and Mr. Boehler in Mr. Meadows’s workplace within the West Wing, in line with the official. From that assembly emerged a plan: Mr. Trump would withdraw the nation from the World Well being Group.

Mr. Trump agreed, and added the announcement to the information convention. He had completed one thing related in 2018, asserting that he was quitting a United Nations postal pact, solely to reverse himself after successful concessions.

Dr. Tedros confirmed no urge for food for such deal-making. He instructed colleagues that he felt boxed in, caught between China and america. Talking to reporters quickly after Mr. Trump’s announcement, Dr. Tedros mentioned that American partnership had served humanity for many years.

“It has made an amazing distinction in public well being all around the globe,” he mentioned. “It’s W.H.O.’s want for this collaboration to proceed.”

Matt Apuzzo and Selam Gebrekidan reported from Geneva, and Noah Weiland from Washington.

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