Global health in a Trumpian world

 

There is a saying that is often attributed as being of ancient Chinese origin: “May you live in interesting times.” (This is misinformation, by the way. The phrase was actually one coined by a British ambassador to China in the 1930s.)

In any case, as the dust settles over the results of the recent US presidential election, it may well just mean just that for the global health community.

The last time President Trump was in office, he began the process of pulling the US out of the World Health Organization, the largest global health agency.

Without the US – at 15%, the largest single contributor to the WHO budget and double the amount of the nearest next country – global health programmes worldwide are going to be taking a serious hit.

What would such a decrease in funding mean?

While withdrawal from the WHO would be a two-way loss, both in terms of a probable loss or significant reduction in US expertise to the global health community, in actual money this may mean a drop of a couple of hundred million US dollars to preventative WHO programmes that increase access to essential health and nutrition services as well as in research for HIV, hepatitis and tropical diseases. Contributions by the US make up about 40% of all these budgets.

President Biden retracted the US’s withdrawal from the WHO when he came into office. And while it is unclear whether a second Trump presidency will see another withdrawal, it is a challenge that may be looming over the global health horizon.

Another “interesting” personality who may have a large impact during the Trump presidency’s upcoming term will be Senator Robert F Kennedy Jr, who has been appointed to be the president’s man on healthcare.

Kennedy may be put in charge of the department of health and human services (HHS) (the equivalent of our health ministry), or at the very least be made a presidential advisor overseeing healthcare: a health “tsar” of sorts.

The challenge with Kennedy is his long-held contrarian beliefs on many global health issues, and even with science for that matter. He has long been a self-avowed vaccine sceptic (if not a full-blown anti-vaxxer) and has spoken up consistently against vaccines and vaccination, including touting claims of their link to autism.

Another wild allegation that Kennedy put forward during the recent presidential campaign was that fluoride, currently added into drinking water to prevent tooth decay, allegedly causes neurodevelopmental disorders, bone fractures, thyroid disease and even cancer.

While this allegation is completely baseless, it is something that Kennedy has claimed the Trump White House would implement on Day One in office, by advising all US water systems to remove fluoride from public water.

Other worrying actions by Kennedy may include disruptions at the Food and Drug Administration (FDA) and the Centres for Disease Control (CDC) – two eminent US institutions instrumental in global health governance and leadership – which he has accused of being “corrupt and beholden to foreign powers”.

Amidst President Trump’s clear promises of giving Kennedy the green light to “go wild on health…. go wild on food… go wild on medicines…”, there may be some roller-coaster turns ahead in terms of changes in health governance, drug approval processes and the mechanisms in which scientific discourse is incorporated into health-decision making. All of these will impact the global health landscape significantly, especially since both the FDA and the CDC are globally looked to in terms of decision-making in health.

Other impactful changes on public health policies in the US which may have global implications include the Trump administration’s almost certain move to continue de-funding reproductive health activities, both by US government agencies and US-funded agencies.

During President Trump’s first term, for example, the US Supreme Court overturned the right of individuals to have an abortion; and this had far-reaching consequences for reproductive health globally, including decreased funding (of up to US$70 million) to another UN agency, the UN Population Fund (UNFPA).

Another area of concern will be the possible loss of coverage for millions of US citizens as the second Trump administration considers withdrawing Obamacare health insurance protections and subsidies. These measures, which have been instrumental in providing equitable access to healthcare have also empowered and enabled equitable access strategies worldwide, and further enhancements may now be at risk.

Simply put, it is certain that global health in the next few years is going to face challenges from the prospect of an absent or reduced spectrum of US leadership and support.

In addition to this, it seems that the global science community itself may be at risk.

Having science-doubting advocates at the helm of the US health leadership is bound to empower anti-health science narratives including the anti-vaccine movement. These are challenges the global health community needs to be able to anticipate and prepare to take on.

However, Trump has always been able to surprise many with his “interesting” decisions, one of which was pro-global health.

Many may have forgotten that Trump was the one to champion and fund Warp Speed – the US$18 billion programme that developed Covid-19 vaccines so quickly and helped global health overcome its greatest challenge at the time – the Covid-19 pandemic.

So, for all of us global citizens who have quite a lot invested in global health, namely our health and existence, be prepared for the interesting times ahead! - FMT

The views expressed are those of the writer and do not necessarily reflect those of MMKtT.