The speed and scale of the Trump Administration’s assault on health and scientific governance and related institutions, programs and services is so overwhelming, it is difficult to track at both the micro and macro levels.
Indeed, many observers believe this is the point: to overwhelm with ‘shock and awe’ so that responses are fractured, distracted and ineffective. So that people tune out from all the noise.
The sheer volume of extreme pronouncements also serves to obscure the experiences of those people and communities who are most affected in the United States and elsewhere, whether because they are losing access to life-saving treatments, or living in fear of deportation and incarceration, or facing hardship, discrimination and uncertainty in other ways.
This post aims to link Croakey readers into some of the most recent developments, and wider reading. What is happening in the US has global repercussions for health and healthcare, including in Australia.
For example, Trump’s weaponisation of trade and aid policy has clear implications for global health and Australia, according to an analysis by the Australian Fair Trade and Investment Network (AFTINET).
“Overall these policies could not only disrupt global trade, but weaken global action to address the climate crisis, increase the threat of war, increase global inequality and decrease access to life-saving medicines for low income countries,” said AFTINET.
“AFTINET will continue to urge the Australian Government to cooperate with other governments to support trade justice policies based on human rights, labour rights, environmental standards including climate action and equitable access to medicines.”
Dangerous timing
As many have noted, the chaotic disruption affecting health agencies and research in the United States and more widely comes amid infectious diseases outbreaks and growing climate disruption.
“Five years after a novel virus rocked the world, killed millions, and continues to sicken people; amid ongoing outbreaks of bird flu and mpox and tuberculosis, public health and scientific research are being gutted in America – and it’s happening more quickly than even experts thought possible.” The New Republic, 29 January
Meanwhile, the American Public Health Association this week joined a legal action to block the White House Office of Management and Budget from pausing all agency grants and loans.
“This reckless action by the Administration would be catastrophic for non-profit organisations and the people and communities they serve,” Diane Yentel, Chief Executive of the National Council of Nonprofits, said in a related statement.
“From pausing research on cures for childhood cancer to halting housing and food assistance, shuttering domestic violence and homeless shelters, and closing suicide hotlines, the impact of even a short pause in funding could be devastating and cost lives.”
Dr Georges C. Benjamin, Executive Director of the American Public Health Association, said the funding pause threatened “to stall essential public health and prevention programs and research”.
“Halting these funds stymies progress and is a matter of life and death,” he said.
The Office of Management and Budget subsequently rescinded its call for the pause on payments for federal grants and other programs, but confusion remains about the immediate aftermath and longer term situation.
Chaos and confusion also reign for those reliant on National Institutes of Health funding.
On 22 January, the Trump Administration directed federal health agencies, including the NIH, to pause all external communications, cancel scheduled scientific meetings including grant review processes.
The impact, one Yale University expert warned, could include the loss of “a whole generation of scientists” amid uncertainty about the future of so much scientific research at Yale and with the salaries of researchers in jeopardy.
The NIH is the largest public funder of biomedical research in the world, the expert said, and provided 53 percent of research grants funding at the Yale School of Public Health.
Global disruption
Global health agencies and programs and the communities they serve also face confusion and disruption.
Partners in Health denounced the US State Department’s recent directive to immediately stop work on the majority of existing foreign aid programs following an executive order that paused any new aid for 90 days.
“This reckless halt threatens decades of progress in global health equity including the suspension of the President’s Emergency Plan for AIDS Relief (PEPFAR), which has been instrumental in combating HIV/AIDS worldwide for over 20 years,” said a PHI statement.
While the Trump Administration subsequently exempted “life-saving assistance” from the stop work order issued to all foreign aid recipients, widespread confusion remained about which programs could continue operating, Health Policy Watch reported on 29 January.
US Secretary of State Marcus Rubio announced the foreign aid waiver, defining humanitarian assistance as “core to life-saving medicine, medical services, food, shelter, and subsistence assistance, as well as supplies and reasonable administrative costs as necessary to deliver such assistance”.
However, he warned that the resumption was temporary, and did not apply to programs that involve “abortions, family planning conferences, gender or DEl [diversity, equity and inclusion] ideology programs, transgender surgeries, or other non-life-saving assistance”.
The foreign aid waiver followed concern from the World Health Organization and others about clinics providing antiretroviral (ARV) medicine and other HIV services being told to immediately cease operations over the past few weeks.
Despite the partial reversal, many projects funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR) said they remained unclear about whether they could resume providing ARV medicine and other services to people with HIV.
The WHO said a funding halt for HIV programmes could put people living with HIV at immediate increased risk of illness and death and undermine efforts to prevent transmission in communities and countries.
“Such measures, if prolonged, could lead to rises in new infections and deaths, reversing decades of progress and potentially taking the world back to the 1980s and 1990s when millions died of HIV every year globally, including many in the United States of America.”
Solidarity matters
With the WHO itself also facing an uncertain future, the World Medical Association (WMA) has called for “robust support” for the agency.
The WMA warned that the announced exit of the US from the WHO “will not only leave a huge budget hole, it will more importantly produce a significant political vacuum, which may have far more negative impact than just the decline in funds”.
“The WMA urges global leadership, particularly major economic powers, to demonstrate unwavering commitment to the WHO through sustained financial support and constructive engagement,” said the association’s president, Dr Ashok Philip.
“The WHO remains our most essential instrument for addressing global health challenges. While reform is imperative, withdrawal or diminished support would critically compromise international health security.”
Writing in the BMJ this week, global health experts urge the international community to reject Trump’s apparent plans to establish an alternative institution to the WHO.
“While this idea may seem superficially attractive to those seeking to rescue something from the chaos that he seeks to create, it would be very dangerous to give it any support, even tentatively,” write Professor Kent Buse, Professor Christina Pagel, Professor Adeeba Kamarulzaman, and Professor Martin McKee.
“We are convinced that engaging in a parallel structure to WHO will weaken global responses to common health challenges. We urge the international community to advocate reversing this decision and, if alternatives to WHO are established, to eschew them in favour of reinvigorated collaboration through WHO’s existing structures.”
The article also contains this telling advice about Trump: “…even if what he says should not be taken at face value, it should be taken seriously”.
Meanwhile, amid the spectacle surrounding the confirmation hearings of Robert F Kennedy Jr, a large nursing union in the US has urged the Senate to reject his confirmation as secretary of the Health and Human Services Department.
“For nurses across the United States, memories of COVID’s deadliest days are still painfully fresh, and we know that having strong leadership in the federal agencies tasked with protecting public health is a matter of life and death,” said Nancy Hagans, RN, president of National Nurses United (NNU).
“Kennedy has a long track record of anti-science positions and opposition to measures that keep people healthy and safe. He’s the wrong candidate for the job, his nomination puts lives at risk, and our patients deserve better.”
No doubt many health professionals in Australia and other countries are having similar thoughts.
Other commentary
See also these comments by Dr Atul Gawande, who previously ran Global Health at USAID.
See Croakey’s archive of articles on the US election and global health
