Health system leaders and planners should be considering the potential implications of a Trump presidency, which include risks for Australia of conflict, economic hardship, and disruption to vital health supplies, writes Dr Mark Wenitong.
He also stresses the importance of acting on the lessons from the COVID-19 pandemic, including the need for strong national leadership with consistent, transparent communications, and action to address fake news.
Mark Wenitong writes:
While we await the United States election outcome, it’s worth considering some of the potential issues for Australia’s public health system, as they will likely be significant.
If Kamala Harris is elected, I think she will be Business as Usual and Obama-ish, even if she is a bit green.
If Donald Trump is elected, the outcomes are unpredictable, but his election will almost certainly drag down the US economy (and Australia’s) if he does what he says he will do, regarding concentrating on domestic production rather than global issues.
The implications of Trump’s isolationist approach to foreign policy are worrying. The US has already left a vacuum in the Pacific Nations under Trump’s first presidency, and Australia followed (remember the joke by then Immigration Minister Peter Dutton about the impacts of climate change on our Pacific neighbours).
As a direct result, China (and Russia) now have strong footprints in Pacific nations.
Australia is rightly trying to get back some momentum through the work of Australia’s Ambassador for First Nations People, Justin Mohamed, but China has already built infrastructure in the region and likely also Pacific debt, exerting power. It should also be noted that several of the Pacific nations have diplomatic ties with Taiwan.
Geopolitically dangerous
Geo-strategically the Pacific islands are an obvious staging area for Chinese aggression towards the US if needed. There may also be implications for US shipping exports to Australia via the Pacific.
Conflict between US and China under Trump could be devastating for Australia. We are on the doorstep. And the closest US ally. We have Pine Gap and a new US Air Force “mission planning” and operations centre is to be built at Darwin.
The Department of Defence has recently confirmed Australia provided support for the US strikes on underground bunkers used by Yemen’s Houthi rebels “through access and overflight for US aircraft in northern Australia”. We could be in a firing line directly or indirectly.
A significant proportion of our medical technology from Europe comes via the Red Sea which is now unstable and is affecting our imports. Alternate routes will cost us more and take longer.
Our security situation will be much more unstable under Trump than Harris. But both would likely continue the Biden Administration’s type of support of Taiwan if China were to move on Taiwan, even if, under Trump, the US would need to get something back in exchange. This would be a risk for us.
South East Asia is our backyard.
A North Korea missile could easily reach Australia, though Darwin port is leased by China, and not even North Korea would likely be incompetent enough to attack Chinese owned infrastructure. But war is war.
The United States (not the French) intends to sell Australia three nuclear-powered submarines “from as soon as the early 2030s”, so Australia will have defence capability in 10 years when the these subs will apparently protect us from all foreign sea powers.
So I think the combination of a Trump Government in the US and a conservative government in Australia (who would likely blindly support Trump) is much more geopolitically dangerous for Australian than any major health issues such as the next pandemic.
With the complex international war theatres at the moment, things could go badly in Russia/Ukraine, the Middle East or the South China Sea/South East Australasia. The overall effect is likely too complex to predict, as now that North Korea has entered the Ukraine conflict, it further increases tensions with the West in our backyard in SE Asia. Many of the countries and leaders involved in current conflicts are not predictable at all.
Wars breed famine and disease as well. Australia is very lucky to have 10,000 km ocean to protect us because our Government can’t.
Health system impacts
Conflict notwithstanding, the effects on Australia’s public health and medical systems could be significant. (Post pandemic, we already have deficits in long acting benzathine benzylpenicillin Bicillin for rheumatic heart disease.)
Under either leader, Australia still needs to respond to the public health deficits and leadership issues that were identified during the pandemic.
If India is unaffected, Australia may still have access to drug precursors as India also exports to Australia as China and US do. But of course it also depends on any acute specific medical drug needs and who has them.
While we manufacture some antibiotics and medicines in factories in Australia, the base materials generally come from China or US and India, and most premade medications are imported. Even the sub-continent countries around India are having military skirmishes and instability currently, so much of our supply chain is under threat.
I think we should be spending more diplomatic time with our close neighbours in SE Asia including India and China, as well as the US. They all have human rights concerns – Uyghurs and Black Lives Matter. China already has vested local geo-economic interests in Australia obviously, and geo-strategically, Australia is part of South East Asia.
If Trump loses, I would not rule out some form of internal US conflict. The US is a nation where people have historically killed each other in civil war, and we already know Trump will not accept defeat.
Any internal conflict or labour or civil unrest could have an impact on Australian health imports. The largest imports of medical technology are from the US. Other American exports to Australia include financial services, travel services, telecoms/computer/information services, among others.
Any disruption could cause significant health system deficits in Australia.
COVID lessons
The Lancet Commission on lessons for the future from the COVID-19 pandemic found that in the US, the political far-right promoted anti-science rhetoric, as shown by their opposition to COVID-19 vaccines and anti-COVID-19 prevention measures.
By some estimates, between 100,000 and 200,000 Americans lost their lives because they refused COVID-19 vaccinations. The Commission says that “this anti-science movement has globalised with tragic consequences”.
This mentality has major implications under a Trump Government, where the leadership at the top may encourage non-evidence-based, anti-health messages, mainly because so many Australians are influenced by social media and leadership from the US. The impact of social media is NOT an insignificant issue, as we also know from the Voice referendum.
It is likely there will be another global pandemic based on the same issues as the last (global travel etc and now war zones with refugee health issues and infectious disease outbreaks) but we may find ourselves less equipped to cope, especially if US production is affected.
Should we be looking at alternate medical technology suppliers now such as Germany or China?
Assuming we would also lose the Chinese medical supplies in a conflict with the US, alternates also have dependencies and European supply outputs from countries like Germany, and are generally dependent on energy resources from Ukraine.
Recommendations
From an Australian public health perspective, we need to understand the intricate global linkages between countries with their own health policies and health hardware production and vulnerabilities, as well as the unpredictable impacts of wars, refugees and elections, with the potential to drive further pandemics or direct constriction of health hardware.
Australia at a public health level can plan more coherently than most other countries because of our relative isolation due to our ocean borders.
No matter what happens at the US election, how can we optimise our situation in a world that looks like it is self-destructing?
It is essential to identify leadership, politically and in public health. We learned from the pandemic that we need strong national leadership with consistent messaging, and that health decisions that affect us nationally should not be up the states and territories to develop indiscriminately, regardless of our constitution and state/territory politics.
We should not need to have a Prime Minister sworn in as every minister in a non-transparent manner. And the key leaders at a structural level (not as individuals) should be identified now.
A Centre for Disease Control (CDC) in Australia makes huge sense but the political leadership and support of this is more important to ensure coherent public health planning, preparation and responses to another pandemic or global health issue.
What planning regarding alternate resources should we have in place NOW, if we can predict the types of issues that will arise from a destabilised world from a Trump-style leader or a failed US coup.
These include at least medication precursors, medication production lines/factories in Australia (there’s already plenty but dependent on external precursors), health hardware/medical technology stockpiles as appropriate.
We need to work out who are our alternative partners if the US China and Germany can’t deliver.
We need to develop a coherent health disaster plan now and stick to it. With one lead. We need to maximise the potential benefits of our geographic isolation.
We need to ensure our state /territory data is linked and comparable now.
We need to apply the real learnings of the last pandemic, including the importance of transparent communications and tackling fake news. And we may be having to do this while we are embedded with a Fake News President.
Author details
Dr Mark Wenitong is from the Kabi Kabi tribal group of south Queensland. He has long experience in working to improve Aboriginal and Torres Strait Islander health, including in the community controlled sector and in policy. He is a past President and founder of the Australian Indigenous Doctors’ Association and is interested in primordial prevention, social and emotional well-being, early childhood, Aboriginal and Torres Strait Islander chronic disease, microbiome, epigenetics, refugee health and prison health.
See Croakey’s archive of articles on the US election and health
Finally, someone looking ahead and theorising practically about worldwide issues affecting Australia. One can only hope that someone in a position to ‘see’ and do something, does act now, before various crisis start. Doesn’t the Govt.,. have people working this stuff? Getting paid to do such! Fer gawd’s sake! Thanks Dr. Wenitong.