Trump’s second term threatens US leadership on global health

Donald Trump’s return to the US presidency threatens to shake things up and down
some cases undermine Washington’s commitments to global efforts to improve public health, according to several organizations and officials.

Plans by Trump’s transition team to again trigger a withdrawal from the World Health Organization reflected a broader suspicion of international bodies, they said, casting doubt on America’s contribution to scientific research, infectious disease control and pandemic preparedness.

John-Arne Røttingen, CEO of the Wellcome Trust, one of the largest foundations funding health research, said: “American health leaders bring enormous technical expertise, leadership and influence, and their potential loss from the world stage would have catastrophic consequences and leave US and global health weaker as a result.”

Experts also worry that the second Trump administration will reject scientific best practices and spread disinformation globally. They cite Trump’s nomination of Robert F Kennedy Jr., a prominent anti-vaccine campaigner, as Health and Human Services secretary.

Discouraging vaccination campaigns would threaten “millions of lives worldwide,” said Peter Maybarduk, director of access to medicine at Public Citizen, a US-based consumer group. “Disinformation could roll back one of humanity’s most important achievements of the last 100 years.”

A person close to Trump’s transition team said: “I don’t think President Trump cares much about what self-styled global health experts say. The American people voted resoundingly against the elites and those who shoved their know-it-better attitude down its throat American people.”

Health experts have already warned that Trump plans to start the process of leaving the WHO on the first day of his administration on January 20, ending unfinished business from his first term and potentially crippling
vital programs.

People close to the stalled negotiations on a WHO-brokered treaty on pandemic preparedness also worry that the new administration will sign the treaty’s death sentence.

The United States is the largest funder of WHO and the Global Fund to fight HIV, tuberculosis and malaria. It funds home-grown programs such as Pepfar, which tackles HIV in more than 50 countries.

A reduction in US funding would come at a bad time for non-profits, which are already battling cuts from other rich country donors as the memory of the Covid-19 pandemic fades.

Gavi, the vaccine alliance, is trying to raise at least 9 billion. USD for its next five-year funding cycle, and the Global Fund is asking for pledges for its replenishment round by October. Dianne Stewart, the Global Fund’s head of donor relations, said funding for health was either “shrinking or stagnating”.

Some NGOs will also be affected by the expected reinstatement of the “global gag rule,” which stops US funding to organizations that provide or promote abortion services. In Trump’s first administration, it caused MSI Reproductive Choices and the International Planned Parenthood Federation to deny funding.

US domestic agencies, such as the National Institutes of Health and the Centers for Disease Control and Prevention, fund scientific research globally.

Dr. Bernard Ogutu, head of research at the Kenya Medical Research Institute, which receives funding from the NIH, CDC and the US Army, said the threat of reduced funding was a “double tragedy” as many countries, including Kenya, suffered a “meltdown” of their economies.

Kennedy’s nomination has caused particular concern in Australia, which provided experts and equipment to help thwart a 2019 measles outbreak that killed dozens of children in the Pacific island of Samoa.

To have met anti-vaccine activists in Samoa earlier that year, Kennedy was accused of fueling distrust as authorities tried to rebuild confidence in the vaccination program. Two children had died the previous year after measles, mumps and rubella (MMR) was mistakenly mixed with a muscle relaxant. Kennedy denied any responsibility for the subsequent measles outbreak.

The risk of more deadly episodes like the Samoa measles outbreak would increase if the Trump administration attacked the credibility of childhood jabs such as the MMR vaccine, experts warn.

It was “hugely worrying” that vaccine skeptics like Kennedy in the Trump administration seemed “unable to interpret or acknowledge the robust scientific evidence”, said Margie Danchin, a pediatrics professor and vaccinologist at Melbourne University.

For now, global health organizations hope to avoid Trump’s attention. Some are privately rallying sympathetic Republicans in Congress and compiling reports arguing that overseas funding also helps protect Americans.

Bjørn Lomborg, chairman of the Copenhagen Consensus Center think tank, has called on Trump’s healthcare team to focus on “smarter spending” to improve the effectiveness of US aid.

Improved care for newborns and mothers was one area where targeted spending could make a big difference, he said. About 2.3 million babies a year die in their first month, and 300,000 mothers die in childbirth each year, according to UN figures.

“That is precisely Trump’s strength. He’s not afraid to piss off a lot of people and say ‘we’ve got to do the smarter stuff first,’” he added.

If the US cuts health care funding, it is not obvious who will fill the gap. Lawrence Gostin, a professor of global health at Georgetown Law, said European leaders had told him that neither the European Union nor individual countries were likely to leave.

The prospect of China dominating global bodies could worry Trump, but Beijing also remained “ambivalent” about agencies like the WHO, argued Jeremy Youde, a political scientist at Portland State University.

Gostin said “China has a very different idea of ​​global health and multilateralism than the United States”.

The Gates Foundation, a major force in global health and the WHO’s second-largest funder, has yet to pledge to increase its donations.

For Ayoade Alakija, a global health specialist and president of the Swiss-based diagnostics NGO Find, the potential US retreat is a “clarion call” to leaders of developing countries to invest in their own countries.

Health care was “threatened from a multilateral perspective”, she said. “We saw that during Covid, and you can almost say Trump is at least honest (in thinking), ‘I don’t care about all of you.'”

Additional reporting by Oliver Barnes in New York