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As President Trump threatens global health security, how can the world respond?

The global health community will have to contend with a vast increase in disinformation and science scepticism as the Trump Administration disrupts health governance in the United States and globally, leading scholars warned this week.

Global health experts and organisations have also cautioned that US withdrawal from the World Health Organization would have grave consequences for health, globally and in the United States.

Writing in the BMJ, Professor Kent Buse, Professor Larry Gostin, Professor Adeeba Kamarulzaman, and Professor Martin McKee urge the international community to stand up in support of the WHO.

Public health organisations, researchers, and civil society organisations must defend WHO and demonstrate its essential role in global health, to lay the ground for broad support for an eventual reversal of the Trump decision, whether by this administration or a future one, they say.

“Historically, the US has been the world’s largest global health funder, supporting programmes to fight AIDS, tuberculosis and malaria, pandemic preparedness and response, and to improve maternal and child health. Its withdrawal undermines not just WHO’s finances and programmes, but also America’s influence and standing in the world.”

Buse and colleagues describe the financial challenges ahead for the WHO, which has relied on the US as a core funder for more than 75 years.

WHO is already struggling to meet demand, recently launching a $US1.5 billion Heath Emergency Appeal, saying the resources were needed to address 42 ongoing health emergencies largely arising from climate change, conflict, displacement and disease outbreaks.

Stat News reports that a US withdrawal would deprive the Geneva-based institution of its biggest funder and a major contributor of scientific expertise, likely necessitating a massive restructure and reduction in the functions the WHO is able to perform.

When Trump announced plans to withdraw from WHO during his first presidency, several European countries helped fill the void in funding and leadership, but Buse and colleagues say this is unlikely to happen again, given political realities facing the leading donors, the European Union, France, Germany, and the United Kingdom.

“Moreover, the problems will likely be exacerbated if the Trump Administration reduces funding to other global organisations in the health and development sectors. We especially envisage a major reduction of funding for sexual and reproductive health.”

While philanthropic organisations and wealthy individuals may bridge some funding gaps, it is unrealistic to expect them to replace the US. Many BRICS nations, including Brazil, China, India, and South Africa, could increase their funding support, as could the Gulf States, the scholars write.

“Beyond increased funding, governments can directly support WHO by seconding public health experts to the organisation,” they say. “This would offset potential staffing shortages while ensuring continued technical collaboration between WHO and its member states.”

The President’s order to withdraw from the WHO – which may face legal challenges – also says the US will cease negotiations on the WHO Pandemic Agreement and amendments to the International Health Regulations, and that these agreements “will have no binding force on the United States”.

Opportunity costs

The human rights and health consequences of President Donald Trump’s actions in the first days of his second presidency will unfold over years and even lifetimes, although some actions – such as freezing health agency communications, and halting scientific meetings – are immediately evident.

Perhaps one of the most difficult impacts to quantify will be around the opportunity costs – the diversion of the resources of many health leaders and organisations into addressing the consequences of Trumpism rather than the actual issues at hand.

This comes at a time when the world is facing existential health threats from climate breakdown, threats of further pandemics and the undermining of human rights, social cohesion and evidence-based policies by the misinformation, disinformation and polarisation monetised by Trump’s media and Big Tech supporters.

Partners in Health said the US decision to withdraw from the WHO “recklessly endangers lives around the world, including the millions of patients who rely on PIH for care”.

“Sustained funding for the WHO is critical for responding to health emergencies which have little regard for national borders,” the PIH said in a statement.

“Notably, withdrawing from the WHO leaves the door open to emerging pandemics, putting billions of people at risk whether they call the United States home or not.”

The Independent Panel for Pandemic Preparedness and Response, which reviewed the international response to COVID-19 in 2020-2021, including WHO’s role, found that if anything, WHO should be more predictably and sustainably funded. It recommended stronger International Health Regulations that would lead to faster, more forceful reporting of outbreaks.

Co-Chairs of the Panel, Helen Clark and Ellen Johnson Sirleaf, said the US move was “a grave error”, which would put Americans at greater risk of outbreaks, death and economic losses, both from within and outside the US.

When a country exits the WHO, it abandons shared responsibility for preparedness and response to a pandemic threat, and also loses critical influence at the WHO to help to make the organization even stronger and a more effective gatherer of information and distiller of advice, they said.

“A US exit from the World Health Organization will undermine the capacity of the US and the world to be prepared and able to respond to health emergencies,” the Co-Chairs said in a statement.

They said that the H5N1 highly pathogenic avian influenza virus circulating in hundreds of herds of dairy cattle in the US and in flocks of wild and domestic birds presents a risk to the health of Americans and to people everywhere.

“One single mutation could trigger a fatal type of influenza that would spread at speed from person-to-person and signal the start of a new pandemic that would be deadlier and costlier than any outbreak seen in modern history. So far, the response to H5N1 in the United States has been inadequate. If efforts are not accelerated, the US could be the source of a new pandemic.”

In the US, the Consortium of Universities for Global Health warned that withdrawal from the WHO poses significant risks to public health, national security, and global stability.

“Over the past seven years, US leadership has been critical in implementing the most significant reforms in the WHO’s history, enhancing its accountability, transparency, and efficiency,” the statement said.

“Continued engagement ensures the US retains a critical voice in the direction of global health policies that directly affect national and international well-being.”

Post by the American Public Health Association

Rethinking global health landscape

Meanwhile, Lakshmy Ramakrishnan, an Associate Fellow with the Health Initiative at the Observer Research Foundation in India, says the US move provides “an impetus for India and the rest of the Global South to rethink the global health landscape, which undoubtedly needs reform”.

China will likely fill the US funding vacuum, and has already begun altering the healthcare landscape through its Health Silk Road, she said.

Further, she says that BRICS can address health through a bottom-up approach and through localisation, where foreign aid is channelled through local organisations.

“Finally, taking into consideration the adverse outcomes that resulted from the politicisation and securitisation of COVID-19 and the rampant disinformation and misinformation campaigns that ensued, the Global South can endeavour to ensure that science is communicated responsibly and countries like India take concrete steps in incorporating biosecurity into national security frameworks to be on par with global counterparts.”

Ramakrishnan said she expects that funds to the US Agency for International Development (USAID), the National Institutes of Health’s Fogarty International Center and programmes devoted to HIV/AIDS, malaria, and tuberculosis will likely be slashed. Contributions to the United Nations Population Fund (UNFPA) and the President’s Emergency Plan for AIDS Relief (PEPFAR), which focus on reproductive health and HIV prevention, respectively, are likely to be affected.

A ‘global gag rule,’ or a funding blockade to foreign organisations that aid in providing access to abortions may be reimposed, while the recently revived initiative on cancer therapies – Cancer Moonshot – is likely to be terminated, she said.

The WHO said it hoped the US would reconsider its planned withdrawal.

“For over seven decades, WHO and the USA have saved countless lives and protected Americans and all people from health threats. Together, we ended smallpox, and together we have brought polio to the brink of eradication. American institutions have contributed to and benefited from membership in WHO.

“We hope the United States will reconsider and we look forward to engaging in constructive dialogue to maintain the partnership between the USA and WHO, for the benefit of the health and well-being of millions of people around the globe.”

Meanwhile, President Trump’s nominee to lead HHS, Robert F Kennedy Jr, will stand for his confirmation hearing next Wednesday, though his prospects for confirmation are unclear.

More commentary

Further reading

Science: Trump hits NIH with ‘devastating’ freezes on meetings, travel, communications, and hiring

The Conversation: The US intends to leave the World Health Organization. What happens next?

BMJ: The US withdrawal from the WHO: a global health crisis in the making

BBC: US exit from WHO could see fifth of budget disappear

Health Policy Watch: Trump May Face Lawsuit Over US Withdrawal from WHO

Time: What Leaving the WHO Means for the U.S. and the World

AP News: Trump wants to pull the US out of the World Health Organization again. Here’s what may happen next

STAT: Trump orders U.S. to withdraw from World Health Organization

The Guardian: ‘Sowing seeds for next pandemic’: Trump order for US to exit WHO prompts alarm


See Croakey’s previous coverage of the US election and health

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