American Global Health Leadership in a Second Trump Administration

Since the end of World War II, the United States has been unparalleled global health leader through both Republican and Democratic administrations. US public health agencies have set the scientific gold standard for biomedical research, medical product approvals, and public health. They fund international research, support resilient health systems and work alongside scientific agencies to prepare for a pandemic.

It is all that, and much more in great danger In a second Trump administration, together broad implications for the health of the whole world, especially for the most vulnerable.

Let’s start with funding, where President-elect Donald Trump promises to cut global health care. Elon Musk, the incoming chief adviser to the “Department of Government Efficiency”, already expressed support for eliminating all foreign aid. And 2025 projectWidely seen as a right-wing blueprint for a second Trump administration, it makes humanitarian aid subject to sharp criticism, “deep cuts“. Trump’s latest budget in 2020 proposed cuts to global health programs 34 percentincluding maternal and child health, nutrition, family planning and infectious diseases. While bipartisan support for global health avoided deep funding cuts at the time, today Congress is much more aligned with Trump’s “America First” agenda, including hostility to foreign aid.

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This is bad news because the US is the world’s largest health funder, providing four times more bilateral international health care than Germany, the next largest government provider. . In 2022 they gave more than the US 12 billion dollars to support low- and middle-income countries in financing global health initiatives through a large network of bilateral and multilateral financing, as well as local technical assistance and training.

As a result, the US is a major funder of key global health initiatives, including the Global Fund to Fight AIDS, Tuberculosis and Malaria; since the organization was launched, the US has given. 36 percent of its total funding– and Gavi, the Vaccine Alliancewhich increases equitable access to life-saving vaccines (about 24 percent contributions from 2021 to 2025).

National Institutes of Health a A budget of 48 billion dollarsthat invests in biomedical and behavioral health research that benefits the world. of the agency outstanding record successes include the development of antiretroviral therapies against HIV/AIDS and mRNA technologies, such as COVID vaccines. The Centers for Disease Control and Prevention took the lead in the ongoing campaign to eradicate smallpox and polio. He has been trained by NIH’s Fogarty International Center almost 8,500 scientists From low and middle income countries since 1989.

The President’s Emergency Plan to Fight AIDS began in 2003 under then-President George W. Bush (PEPFAR) must be reauthorized in March 2025. PEPFAR has invested 120 billion dollars In the global response to HIV/AIDS. This is the largest single disease commitment by any nation in history, saving more than 25 million lives. Congress could cut PEPFAR funding or cut funding to protect sexual and reproductive health and prevent discrimination, all of which are key to stopping HIV/AIDS.

At the height of the COVID pandemic, Trump did one of us (Gostin) called cataclysmic decision: to send a letter to the Secretary General of the United Nations expressing his intention to withdraw from the World Health Organization. While President Joe Biden reversed the decision, Trump now has four years to withdraw recommended 2025 according to the project.

However, Trump has another option: make a deal. The US should remain a member while the WHO undertakes essential governance reforms, such as increased transparency and accountability.

It will almost certainly reduce US financial support to the WHO to a level equal to or below China’s contributions. If Trump chooses to eliminate or reduce funding, the consequences could be devastating. The US belongs to the WHO the largest financier of member statesrepresenting 22 percent of all quotas established by the WHO. Without US funding, or “increased cuts in federal dollars to WHO,” as the 2025 Project outlines, the organization’s programming would fall flat, and its pandemic response capabilities would be reduced, putting health everywhere at risk. And given the financial and political pressures in Europe, governments there may not be able to compensate for the loss of US contributions.

If countries believe, as we do, that NOR is essential, they should stand up and fight for the agency. We cannot imagine a world without the empowered WHO, with its constitutional mandate on the right to health for all.

WHO was Born in 1948 with powers to negotiate health treaties such as the Framework Convention on Tobacco Control. On June 1, 2024, the World Health Assembly adopted a major revision of its International Health Regulations (IHR), which ensures early detection and notification of disease outbreaks and scientific exchanges. Not only did the US push for the IHR negotiations, the nation’s Secretary of Health and Human Services, Xavier Becerra, threatened to walk if his latest amendments were not accepted—and they were. This shows US determination and influence when actively involved.

These 2024 amendments will not take effect September 19, 2025. Because of his mistrust of international agreements, President-elect Trump may make strong reservations about the IHR or withdraw entirely. Regardless, US national security is at stake as IHR strengthens pandemic preparedness and response. America must remain a party for the good of the nation and the world.

The 2024 World Health Assembly gave the Intergovernmental Negotiating Body (INB) one more year to negotiate a new Pandemic Agreement. With the Geneva negotiations at a standstill, the question is whether Trump will block any US participation, as he previously asserted that the Pandemic Agreement would benefit other countries at the expense of the US. US sovereignty has been widely claimed condemn.

Inevitably, a second Trump term will threaten reproductive rights worldwide. He is almost certainly to again cut funding to the UN Population Fund (UNFPA), the UN agency that works to ensure universal access to sexual and reproductive health services. This time the agency will lose more than $160 million, more than double Amount reduced in Trump’s first term.

Also, Trump is likely to reset or expanding the global gag rule, which strips healthcare providers of any abortion-related services, even if they use non-U.S. funds. In his first term, with devastating effectTrump expanded the domestic gag rule to include all US global health care, not just family planning support, as the rule had been applied under previous Republican administrations. A second Trump administration will not only quickly reinstate the global gag rule, but also expand it even further to cover all US foreign aid.

Finally, CDC is support for cuttinggiven the politics surrounding the role it had during the pandemic. For more than three quarters of a century, the agency has worked to protect and improve health safety. With a network of offices More than 65 countrieshas one essential role in funding and logistical support, field training and rapid emergency response. Along with reduced funding, there is a risk that the CDC’s political leadership will not act consistently with the recommendations of the agency’s scientists.

Since the creation of the WHO, the world has embraced international cooperation in the field of health. During those decades, the US was a unique global health leader, recognizing that we all live on one planet and face common health threats. In other words, we are all in this together on health and environmental issues. This ideal of international cooperation and solidarity will be sorely tested in the next four years.

This is an opinion and analysis article, and the views expressed by the author(s) are not necessarily their own. American scientific