Keeping up with the news exploding from the Trump Administration is “like drinking from a firehose”, Dr Lesley Russell writes this week, documenting the wide-ranging health concerns at stake.
After her column was filed, there was another explosion – the sound of President Trump declaring that the United States would permanently relocate more than two million Palestinians living in the Gaza Strip and then redevelop it into the “Riviera of the Middle East”. The plan would breach international law and has been described as ethnic cleansing.
Amidst all the bleak developments, the column also brings news of beauty, achievements, and dutiful dogs.
The quotable?
For me, it has never been more urgent to speak out. Trump has made clear what he plans to do and I suspect it will be even worse than he suggests. There will be long-term consequences for health, healthcare and social justice globally.”
Lesley Russell writes:
What a dreadful period these last two weeks have been for politics both here in Australia and in the United States!
Like many, my immediate reaction is to stick my head in the sand or crawl under the doona – to ignore it all and read a good book. But what is happening has serious consequences for everyone, regardless of our own political ideologies, socio-economic status and where we live.
So, to my regret, The Health Wrap has a continuing focus on what Trump is doing and how this is has an echo chamber in Australia.
But first, some good news: something beautiful and awe-inspiring – the rebuilt Notre Dame Cathedral
It isa reminder of how a community of artisans and skilled tradesmen funded by international donations and with the support of national politicians can restore something that was badly damaged.
I am just back from a wonderful week in cold and wet Paris. We went specifically to see Notre Dame. I was there watching that sad night in April 2019 when it burned, and I have followed the efforts to rebuild and restore the 860-year-old icon closely.
This YouTube video of President Macron and his wife touring the cathedral ahead of its opening, and talking with the people who did all the work, is well worth two hours of your time.
While there is still considerable work to be done outside the building, inside it is beautiful cream stone and the glorious colours of stained glass.
Words and photos don’t adequately explain how magnificent it is.
Under siege
President Trump has begun his second term with an explosion of executive orders that has his political opponents, the media and the public struggling to keep up with the implications.
On top of that, the Department of Government Efficiency (DOGE) – a temporary and unofficial organisation led by Elon Musk and housed within the Executive Office of the President – is running amok within the bureaucracy.
This shock and awe approach is deliberate – both to prove that Trump will deliver on what he has promised (or at least some of what he has promised) and to intimidate those (political opponents at home and abroad) who would stand up to him.
Many of his executive orders are confusing and some suspect that too is deliberate. Trump expects many of these orders to be challenged and to ultimately end up in the US Supreme Court, where he expects judgements in his favour. He apparently sees this as a better form of governing than working with the US Congress where Republican margins are slim.
Keeping up with what is happening is like drinking from a firehose, even for a political tragic like me.
Here’s a summary of just some of the issues that have affected health and healthcare and social justice policies in the United States.
Freeze on federal spending
A two-page Office of Management and Budget memo looking to freeze US$3 trillion in federal spending triggered much confusion, including a national shutdown of the Medicaid payment system. The memo was eventually rescinded and it was also stayed by a federal judge.
However, uncertainty and alarm remain among federally-funded community health centres and federal assistance programs such as the Supplemental Nutrition Assistance Program and the Special Supplemental Nutrition Program for Women, Infants, and Children.
Note that Trump’s preferred method of changing government priorities through “impoundment” is illegal under a law passed by the Congress in 1974 when President Nixon tried to do this.
Attacking equity initiatives
Last week Trump issued an Executive Order “Ending Illegal Discrimination and Restoring Merit Based Opportunity”. The White House press office claimed the American people had given Trump a mandate “to remove DEI [Diversity, Equity, Inclusion] from our federal government and reinstate a system based on merit.”
Too often Trump implies that that diversity equals incompetence and he is aligned with those who use DEI as a pejorative to attack non-white and female leaders as unqualified for their positions.
But the evidence is clear that it is essential to have a healthcare workforce which represents the race/ethnicity, gender, sexual orientation, immigration status, physical disability status, and socioeconomic level of the community in order to deliver the best possible care to diverse patient populations.
Slashing the public workforce
Trump and Musk are looking to significantly downsize the federal government workforce. It might be more accurate to call this a purge.
Working from home has been eliminated, trans people will be pushed out of the military (it’s not clear if this is also the case for the US Public Health Service Commissioned Corps, which under the Biden Administration was led by a trans woman, Dr Rachel Levine), some two million employees have already been offered redundancy, many senior, non-political staff have been summarily dismissed, and stringent loyalty tests will be applied to those who remain in employment.
These efforts will hollow out scientific, medical and public health expertise in the Federal Government.
Website changes and deletions
There are now many examples of where this and other significant deletions and additions have been made to government websites.
The most egregious and worrying of the new website changes are the data and information that have disappeared from the website of the Centers for Disease Control and Prevention (CDC). This includes datasets related to HIV, LGBTQ people, youth health behaviours and vaccines.
Also gone is AtlasPlus, an interactive tool for the analysis of CDC data on HIV, STDs, TB and viral hepatitis, and the Social Vulnerability Index that searchers and public policy leaders use to identify communities that are vulnerable to the effects of disasters and public health emergencies.
There’s a KFF analysis of the health data taken offline here.
Cessation of health-related reports and communications
The Trump Administration has directed that the CDC and all other agencies of the Department of Health and Human Services should cease all public reports and communications.
There are media reports that the CDC has instructed its scientists to retract or pause the publication of any research manuscript being considered by any medical or scientific journal, not merely its own internal periodicals.
The move aims to ensure that no “forbidden terms” appear in the work.
Threats to the US Agency for International Development
There is huge concern at the global level about what the Trump Administration has planned for international aid. Lifesaving health initiatives and medical research projects around the world have been shut down in response to the Trump Administration’s 90-day pause on foreign aid and stop-work orders.
As the protests mounted, Secretary of State Marco Rubio issued an exemption to the funding freeze for “lifesaving humanitarian assistance,” including what a State Department memo called “core lifesaving medicine”.
However, those running HIV and tuberculosis treatment programs, including PEPFAR, have been told that they cannot resume work until they receive written instruction that the waiver applies specifically to them. As far as I am aware, currently only PEPFAR has received such a waiver.
It appears that Trump is planning to issue an Executive Order dismantling USAID and moving its work to the State Department. (Legally he can’t do this without an act of Congress, but when did that matter to Trump?) He has claimed that the agency is “run by lunatics”.
It’s not only Trump gunning for USAID. It is quite frightening what Elon Musk and his DOGE officials are up to. Last weekend brought reports that two top security officials at USAID were removed after they refused to allow DOGE representatives access to restricted spaces and highly classified information at the agency.
Musk claims he has Trump’s approval to completely shut down the US Agency for International Development (USAID) and abolish the jobs of the 10,000 people who work there.
An article in The Australian outlines concerns about what this means for aid work in areas where Australia is involved, such as the Pacific, and how this US retreat leaves open opportunities for Chinese intervention.
Imposition of tariffs
Trump’s imposition of tariffs on China, Mexico and Canada is in a state of flux – on again, off again – as he plays the international bully.
If fully implemented, these efforts are expected to affect the availability and costs of medicines, medical devices and medical equipment.
Medical equipment is among the top ten American imports from Mexico; about 13.6 percent of US-marketed medical devices are manufactured in China; and the United States imports a substantial amount of active pharmaceutical ingredients from China.
Additionally Trump has indicated his intentions to introduce a “tariff wall” around pharmaceuticals, with the goal of encouraging domestic pharmaceutical manufacturing. That might affect Australia’s ability to purchase prescription drugs and vaccines from the United States.
Attacks on trans gender care
Trump’s executive orders include efforts to eradicate “gender ideology” and recognise only two sexes – male and female, bar trans people from military service, and restrict trans gender care for minors. This is accompanied by attacks on doctors who provide care to trans gender care.
He has called for a halt to the use of federal money to support gender-affirming medical care for transgender youth under 19 years old although this is yet to be implemented.
Another executive order bars schools from helping students who are socially transitioning.
A number of these issues have also been covered elsewhere in Croakey.
- Chaos, confusion and uncertainty: a dangerous recipe for global health.
- As diversity, equity and inclusion initiatives come under global attack, racism is called out in Australian universities.
- As President Trump threatens global health security, how can the world respond?
- The latest edition of The Zap.
As I talk with friends and colleagues in the United States (and here in Australia too), I’m somewhat shocked that they are mostly stunned into silence and even apathy. They’re intimidated about standing up and speaking out.
As an awful example, I just found out that the American Society for Microbiology, a huge professional organisation which nominated and supported me to be a Congressional Science Fellow back in 1984-1985, has scrubbed all mention of DEI from its website.
For me, it has never been more urgent to speak out. Trump has made clear what he plans to do and I suspect it will be even worse than he suggests. There will be long-term consequences for health, healthcare and social justice globally.
An editorial In JAMA, ‘How Should Health Care and Public Health Respond to the New US Administration?’, outlines how scientific, medical and public health individuals and societies, journals, academic institutions, and advocacy organisations must quickly decide how to respond or even whether to respond to the new US Administration.
Australians must also make these decisions.
Will Kennedy get up as Secretary of Health and Human Services?
As I write this, the US Senate Finance Committee has just voted, along party lines, to send the nomination of Robert F Kennedy Jr to be the Secretary of Health and Human Services (HHS) forward to the full Senate.
The final vote on his confirmation is expected next week.
There was a hope, perhaps even an expectation, that he would not get the support of Republican Senator Bill Cassidy, a former doctor who sits on the Finance Committee, who pushed Kennedy to stop invoking the debunked link between vaccines and autism. Kennedy refused to do that, yet Cassidy voted for him and presumably will do so again on the Senate floor.
It now seems increasingly likely that Kennedy will be confirmed.
Three Republican Senators – Lisa Murkowski from Alaska, Susan Collins from Maine, and Mitch McConnell from Kentucky – are seen as potential swing votes. Will McConnell, who had polio as a child and is very pro-vaccines, speak out? And Collins has voted in committee to support Tulsi Gabbard’s controversial nomination as Director of National Intelligence, so maybe she doesn’t she Kennedy’s nomination as controversial either.
It’s an understatement to say that Kennedy’s confirmation hearings to become Secretary of Health and Human Services (HHS) did not inspire confidence.
As former Baltimore Health Commissioner Dr Lean Wen wrote recently, Kennedy’s answers to senators’ questions were both absurd and dangerous. The bar was set uniquely low and yet he showed that he is a uniquely dangerous choice to head up HHS.
He flip-flopped on vaccines. His answers on the healthcare system, particularly Medicare, Medicaid and the Affordable Care Act, showed his poor understanding of how these work. He got the programs mixed up. He got the numbers mixed up. He got the financing mixed up.
As expected, the Senators’ responses to Kennedy were split along party lines, centred largely on his history of challenging vaccine safety and on his pledge to support Trump’s anti-abortion stance.
Kennedy for his part, lied with impunity, insisting that he wasn’t anti-vax (it turns out he had vaccinated his own children while urging other parents not to do this) and that he would support the Trump Administration on abortion. He called abortions“tragedies”, despite having said in 2023 that: “We need to trust women to make that choice, because I don’t trust government to make any choices…particularly when it comes to bodily autonomy.”
The graft and grift of this Administration is highlighted by the fact that a letter sent to the Senate in support of Kennedy, supposedly signed only by physicians, includes the names of doctors who have had their licenses revoked, suspended or faced other discipline and also the names of people who were not medically qualified.
This letter had some 800 signatories. A separate letter, sent in opposition to Kennedy’s nomination was signed by over 18,000 US doctors.
It’s notable that neither the American Medical Association or the American Academy of Pediatrics, groups with tremendous influence in Washington, are among the professional societies for physicians that have spoken out about Kennedy’s nomination.
The silence conflicts with their record of work to restore trust in vaccinations and combat disinformation. It makes the editorial in JAMA referenced above even more poignant.
New York Times columnist Nicholas Kristoff has pointed out that Kennedy has good ideas about promoting healthy school lunches and discouraging ultra-processed foods and he’s right to ask questions about why there are increases in obesity, diabetes and autism.
But he summed up Kennedy dangers thus: “If there is a pandemic, then vaccines will be essential. Perhaps the single best thing that President Trump did in his first term was to start Operation Warp Speed, a public-private partnership that accelerated the development of Covid-19 vaccines and saved many lives.
“What would happen if there were a need for another Operation Warp Speed, but this time the point man on health was suspicious of vaccines – including those that arrested the last pandemic?”
For me, the big problem is that there will be no-one on the Kennedy staff or the Trump staff to rein in the worst, most unscientific, impulses of these two men – and we have already seen just how bad these can be.
Abortion rights continue to be undermined
One of the many disconcerting findings from Robert F Kennedy Jr’s Senate hearings was that he has completely abandoned his previous support for abortion rights.
He told Senators he will hire pro-life deputies and support Trump’s abortion policies, including around the medication mifepristone which is used for medical abortions.
(Trump’s positions on abortion in general and the availability of medical abortions in particular have been hard to pin down. He equivocated during the election campaign, depending on who he was talking to. Already as President he has revoked two executive orders signed by President Biden, which protected access to abortion pills and women’s ability to travel to states where the procedure is not banned for care.)
Kennedy insinuated that there were safety issues with mifepristone, despite research showing it is very safe and effective. Abortion opponents have falsely claimed that mifepristone is unsafe, referencing studies that have been retracted by scientific publishers because of flawed methodology.
“President Trump has asked me to study the safety of mifepristone,” he said. “He has not yet taken a stand on how to regulate it. Whatever he does, I will implement those policies.”
Kennedy’s suggestion that mifepristone’s safety should be further studied offers a sign that his HHS may be open to curbing access to the drug.
Conservatives are currently lobbying both federal courts and the Trump administration to roll back access to mifepristone and make it functionally inaccessible, if not withdrawn from the market altogether.
Over 60 percent of US abortions are medical abortions, and many women in states that have acted to make surgical abortions unavailable are solely reliant on this method, mostly with the medication delivered via telehealth and mail services.
Efforts are underway to limit this. In December the state of Texas sued a New York doctor for prescribing and mailing abortion pills to a woman near Dallas. This launches a new era in state efforts to limit abortion.
The Texas Attorney General is suing the New York doctor in state civil court, claiming she practiced medicine in Texas without a Texas license and improperly aided an abortion.
The case, and any future ones like it, involves complicated legal questions, including whether a Texas judge can even hear the case and whether New York or Texas law should apply.
Australian version of the playbook
There’s a lot of discomforting American news in this edition of The Health Wrap. I’m about to add to readers’ discomfort by outlining how Australia is at risk for many of the same issues we see Trump et al driving in the United States.
With an election looming (the bet seems to be on 12 April), political leaders are already in election mode.
Opposition Leader Peter Dutton appears to have adopted several Trumpian positions.
These include: slashing the number of public servants; eliminating public service diversity jobs; promising to “get Australia back on track” with a vow to focus on law and order; and pledging to axe the First Nations Ambassador position.
Dutton has argued that cultural diversity and inclusion advisory positions, change managers and internal communications specialists “do nothing to improve the lives of everyday Australians”.
On 22 January, mining magnate Gina Rinehart, who has pushed a “dig baby dig” approach to mining, echoing Trump’s “drill baby drill”, declared: “If we are sensible we should set up a DOGE immediately to reduce government waste, government tape and regulations.”
Just a few days later, on 25 January, Dutton announced Jacinta Nampijinpa Price’s appointment as the Shadow Minister for Government Efficiency, this despite the fact that Adelaide Liberal Member of Parliament James Steven is the Shadow Assistant Minister for Government Waste Reduction.
This week The New York Times carries an article from its Australian correspondent headed ‘Australia’s top conservative follows Trump’s playbook’.
It does – fortunately – then go on to say that this is only “up to a point” and “Australia’s electorate isn’t America’s”.
But the article does outline how Dutton is following the Trump playbook: lashing out at the “woke brigade” of banks, grocery stores and a chain of pubs for addressing environmental and Indigenous issues; lamenting about young men being disenfranchised and ostracised by diversity initiatives; and setting up a Shadow Minister for Government Efficiency.
Hunger and pregnancy complications
A paper, recently published in JAMA Network Open, shows those who go hungry or worry about getting food while pregnant are at higher risk of complications such as preeclampsia and gestational diabetes.
Researchers did not find similar risks among those who received food assistance while pregnant.
The analysis used data from an online health survey of more than 19,300 pregnant Kaiser Permanente members in California.
The reasons for the higher complications rate are unclear: less healthy diets, inconsistent eating habits and the stress of worrying about food could play a role.
The United States already has dreadful rates of maternal mortality. Now, with food supplement programs under threat from the Trump Administration, this is likely to worsen.
Poor nutrition during pregnancy also leads to low birthweight babies.
A 2022 paper from Australian researchers pushed the importance of routine screening for food insecurity in Australian antenatal settings. This is not currently done and, as the researchers highlight, food insecurity is not easily measured.
It also begs the question about how those providing antenatal care could address this problem if and when it is identified.
The good news is that researchers, from the Center for Nutrition & Health Impact in Omaha, Nebraska, and the Institute for Physical Activity and Nutrition at Deakin University in Melbourne, are working together to develop a comprehensive household food security tool to measure food insecurity among parents of young children (ages 0-5) and pregnant women in both countries.
The Mums and Bubs Deadly Diets Project, working in Western Australia and Queensland, is researching the nutrition needs and priorities for Indigenous women during pregnancy. 
Puberty blockers under scrutiny
As my Croakey colleague Charles Maskell-Knight recently noted in The Zap, Health Minister Mark Butler has announced a review of healthcare, including the use of puberty blockers, for trans and gender diverse children and young people.
He has asked the NHMRC to undertake a comprehensive review of the Australian Standards of Care and Treatment Guidelines for trans and gender diverse children and adolescents and to develop new national guidelines.
This will be a prolonged process: interim advice on the use of puberty blockers will not be completed until the middle of 2026.
As Maskell-Knight highlighted, Butler’s announcement came just a few says after Trump issued an executive order ending funding for gender-affirming care for American children aged under 19 (the order describes this as “mutilation”) and an announcement by the Queensland Government that it would pause the use of puberty blockers and hormone therapies for children with gender dysphoria pending a fresh review into these treatment pathways.
Previously, on 11 December 2024, the United Kingdom Government had announced that it was making existing emergency measures banning the sale and supply of puberty-suppressing hormones indefinite, following official advice from medical experts.
For non-experts in this area, it is very hard to work through what is a political or ideological decision and what is based on valid concerns about medical safety and ethics.
In a media release following Butler’s announcement, medical experts, health bodies and LGBTIQ+ groups cautiously welcomed the Federal Government’s review the treatment guidelines for trans and gender diverse young people. But they said the process must be led by the experts, remain free of political interference and not block continued care across the country.
An article in The Conversation highlights that Australian courts have already extensively tested questions about the legitimacy of gender-affirming care, the conditions under which it can be provided, and the scope and limits of parental powers to authorise it.
Between 2004 and 2017, every minor who wanted to access gender-affirming care had to apply for a judge to approve it. Medical professionals, human rights organisations and some judges condemned this process.
In a landmark 2017 case, the Family Court of Australia ruled that judicial oversight was not required because gender-affirming treatments meet the standards of normal medical care.
Elsewhere, in The Guardian, concerns have been raised that the cessation or limitation of hormone treatments for gender dysphoria is discriminatory and has the potential to cause harm.
A letter is circulating, asking politicians to ban all such treatments. This is led by political conservatives also opposed to gay marriage, including former Prime Minister Tony Abbott and the Family First Party.
Dutton has backed the Queensland Government’s right to conduct its own inquiry into gender transition therapies and said that the states had their “own constitutional rights” to take action.
Writing in The Sydney Morning Herald, Dr Eloise Brook, CEO of the Australian Professional Association for Trans Health (AusPath), outlined how many in the trans community and those who care for them hope that the NHMRC review will be a turning point, and an opportunity to move beyond the fearmongering and misinformation that have too often clouded discussions of gender-affirming care.
See also this Croakey article: Queensland Government urged to lift “cruel and unnecessary” restrictions on gender affirming care.
Private sector disputes
The stoush between private health funds and private hospitals has been addressed in previous editions of The Health Wrap and The Zap. However, there is news on several fronts.
First the good news. Healthscope private hospitals have (finally) reached an agreement over hospital cover payments. That means no out-of-pocket payments for Bupa customers getting care in Healthscope facilities.
But it’s not all good news: Healthscope still has no agreement with private health insurance (PHI) fund AHSA.
On a second front – readers may recall that last year the Australian Government undertook a financial health check of private hospitals. This was in response to disputes between private hospital companies and PHI funds and private hospitals pushing their concerns about the rising costs of proving services,
The report, released in November, was not very informative, largely because of voluntary (ie selective) provision of financial data only a fraction of private hospitals.
In response, Health Minister Butler set up a Private Health CEO Forum but basically left it up to the hospitals and the funds to ensure the private sector’s long-term viability, saying “there will be no silver bullet from Canberra”.
The Government is now planning a private hospital data collection framework, based on the financial health check, “to enable the Department to better understand the ongoing viability and financial pressures in the private hospital sector”.
Seems reasonable – you have to understand a problem to solve it – but the private hospitals are objecting, strongly, calling the demand for data “insulting”.
An ongoing, probably insoluble, saga!
Good news in Indigenous health
It’s always a pleasure to read about the marvellous and extensive work of the Lowitja Institute.
Take the time in the week ahead to read the 2024 Annual Report and rejoice in how it is embodying the hopes (or is it the commands) of Dr Lowitja O’Donoghue:
“I want the Institute to achieve real, tangible and immediate outcomes. Not rarefied research that will never be applied.”
Best of Croakey
It’s five years since Croakey published our first article on COVID-19, with more than 1,300 articles since published. As part of the ongoing #COVIDfiveyears series, Alison Barrett looks back on what has been learnt.
There is also an interview with Dr Paul Kelly: On politics and health, trust and vaccine misinformation: former Chief Medical Officer reflects upon COVID-19 pandemic
And you can access Croakey’s COVID-19 archives here.
The good news story
In the United Kingdom there is something called the Medical Detection Dogs Charity. It trains dogs in bio-detection, taking advantage of the acute bio-sensitivity of a dog’s nose to detect disease.
A number of dogs are being trained to sniff out Parkinson’s disease, pseudomonas, infections, COVID-19, heart conditions like postural orthostatic tachycardia syndrome [POTS], and, most recently, bowel cancer.
Read more about this approach to early cancer detection here.
Croakey thanks and acknowledges Dr Lesley Russell for providing this column as a probono service to our readers. Follow her on Twitter at @LRussellWolpe. Russell is Adjunct Associate Professor at the Leeder Centre for Health Policy, Economics and Data, University of Sydney.
Previous editions of The Health Wrap can be read here.
