Introduction: The inauguration of Donald J Trump as President of the United States on 20 January will have far-reaching implications for health, globally and in Australia (as Croakey has previously reported).
A new book, which includes an examination of the health issues at stake, warns that Trump will hold unchecked power with voters having little opportunity to curb his exercise of power until the midterm elections in 2026.
“With Republican control of the House and Senate, there is virtually no likelihood Trump will be impeached or removed from office. Most importantly, the Supreme Court ruled in July 2024 that the President is immune from prosecution for ‘official acts’ he undertakes,” writes author Bruce Wolpe.
“If Trump ignores laws passed by Congress or refuses to abide by court decisions that would block his policies, Trump will be immune from accountability under those laws and court orders. Trump’s power in this presidential term, in other words, is the closest to absolute.”
In the foreword to his updated book, What Trump’s Second Term Means for Australia: The shocking consequences for us and the world, Wolpe raises questions about Australia’s alliance with the US, saying Trump “threatens to cripple America’s democracy”, with the potential for a bitterly divided continent to face “immense unrest”.
“Trump will command the biggest deportation of immigrants in American history and bring in the military to execute it,” writes Wolpe. “Trump will use the National Guard and perhaps US troops under the Pentagon to control protestors.”
Wolpe is a Senior Fellow (non-resident) at the United States Studies Centre at the University of Sydney. He worked with the Democrats in the US Congress during President Barack Obama’s first term, was a senior advisor for Prime Minister Julia Gillard, and was a senior executive at Fairfax Media 1998 – 2009.
The book includes examination of related health matters by Associate Professor Lesley Russell (Wolpe’s partner, to whom the book is dedicated), and an extract follows below.
Lesley Russell writes:
The health and healthcare focuses of the first edition of this book are:
- how the COVID-19 pandemic and the way it was managed highlighted the frailties of the public health and healthcare systems in Australia and the United States and the need to be better prepared for the next global health crisis
- the threats to reproductive health and abortion rights
- how Trump and his allies had politicised public health and demonised scientific and medical experts
- how disinformation and misinformation around public health issues is a growing international problem, and
- the impacts of the Trump Administration’s policies on global health initiatives.
Those concerns and threats have only grown since this book was first published and, as the make-up of the new Trump Administration emerges, health experts around the globe are rightly alarmed about what its policies will mean for health and healthcare.
The COVID-19 pandemic is far from over, despite political pronouncements to that effect.
It is a major contributor to excess mortality rates and will continue to be unless vaccination rates (with updated vaccines to account for the continual emergence of new variants) improve. In the United States, an average of 1,500 COVID-19 deaths a week were reported last year – this is comparable to fentanyl or firearms deaths. Long COVID has affected millions of Americans and Australians and is generating steep economic and social costs.
Meanwhile in North America the first human-to-human transmissions of H5N1 bird flu have been recorded. The virus has new mutations facilitating this transmission, and there are fears that, without appropriate actions, this could lead to widespread infections.
The United States also faces threats from m-pox, increasing numbers of measles outbreaks, and growing reports of tickborne diseases thought to be due to climate change. The consequences of climate change and the impact on health and the delivery of healthcare services have been strikingly demonstrated in 2024: severe storms, cyclones, wildfires and winter storms have resulted in the deaths of 418 people. Australia is not immune to any of these threats.
There is clear and growing evidence that the Dobbs decision from the US Supreme Court, which revoked the constitutional right to abortion, is not just harming reproductive health, but also means worsening health outcomes for American women as abortion bans force doctors to provide substandard care.
And the 2024 data show that the United States continues to be in a class by itself in the under-performance of its healthcare sector.
Trump returns to the White House and assumes responsibility for these wicked problems having spent the election campaign flip-flopping on abortion rights, access to IVF, and repealing Obamacare. He has tried to rewrite history with respect to his handling of the pandemic, denied any knowledge of the Heritage Foundation’s Project 2025 and played word games about whether he would cut Medicare entitlements. The Trump campaign demeaned transgender people, promised to undermine trans rights, and promulgated dreadful lies about schools secretly sending children for gender-affirming surgeries.
Trump’s capacity to manipulate the truth and to switch positions is now magnified by his Cabinet appointments. The choice of Robert F Kennedy Jr to be Secretary of Health and Human Services is described as “an indication of the contempt with which Trump holds the federal health establishment, including the National Institutes of Health and the Food and Drug Administration”.
“I’m going to let him go wild on health. I’m going to let him go wild on the food. I’m going to let him go wild on the medicines,” Trump has said, at the same time saying Kennedy could “do what he wants” with women’s healthcare. Trump has refused to rule out Kennedy’s plans to ban vaccines and has endorsed the removal of fluoride from water supplies.
Much of this, including Kennedy’s Make America Healthy Again agenda (but barring Kennedy’s status quo stance on abortion, which Trump has – to date – supported), is in line with the health proposals from Project 2025.
Add to this mix the “efficiency” operations of the Department of Government Efficiency and it’s easy to see how much damage could be done with huge budget cuts, onerous restrictions on access to programs like Medicaid, Veterans’ Health and food stamps, and a dangerous loosening of regulations designed to protect human and animal health.
A Republican-dominated Congress is almost certain to try to dismantle key aspects of Obamacare, regardless of Trump’s stance, and it is highly likely that the Republicans in Congress and the politicised Justice Department will engage in witch hunts of high-profile climate scientists and medical experts like Dr Anthony Fauci.
What else lies ahead?
There will be significant consequences for Australia. These come at a time when the Federal Government is confronted with addressing the recommendations from the COVID-19 Response Inquiry report – a key finding of which is that the Government must rebuild public trust in public health.
A significant aspect of this is transparency about data and improved communications to ensure people understand the benefits of public health protections such as vaccines.
Yet both federal and state levels of government have dramatically reduced reporting requirements for COVID-19 (data from the Australian Bureau of Statistics show that as of 1 October 2024, there were 4,056 deaths from COVID-19 in that year), vaccination rates for COVID-19 are depressingly low, childhood vaccination rates are falling, sexually transmissible infections are on the rise, and cases of whooping cough (a vaccine preventable disease) have passed 40,000 this year for the first time since recording began more than 30 years ago.
The promised Australian Centre for Disease Control has never been more needed, but the Albanese Government has been slow to deliver: its formal establishment, which will require enacting legislation, is not due until 1 January, 2026. Between now and then there is a federal election (and there are no guarantees of Coalition support for this new agency), and we can expect the Trump Administration to aggressively downgrade the US Centers for Disease Control and Prevention, which has been the gold standard for such agencies.
Trump Administration attacks on the Food and Drug Administration will potentially affect approvals of some medicines and medical devices in Australia, where the Therapeutic Goods Administration refers to FDA reviews to expedite approvals.
The pandemic highlighted a range of challenges for the management of Australia’s international relationships and revealed a serious vulnerability in medical supply chains, especially for protective equipment and vaccines. Trump’s insistence on America First was a factor in determining which countries got early access to COVID-19 vaccines and as president he signed an Executive Order requiring federal agencies to purchase American-made essential drugs and medical supplies. This time around that approach will surely be hardened. This will impact Australia’s vaccine manufacturers and supply chains.
The expectation is that Trump will also take a harder approach to the involvement of the United States in global health issues – this at a time when Pacific Island nations are threatened by climate change, there is a Marburg virus outbreak in Rwanda (which appears to have been successfully controlled due to support from the World Health Organization and a vaccine from the United States), there are endemic polio outbreaks in Afghanistan and disease threats in Gaza, and there is a global outbreak of measles.
The real impact of the return of Trump and Trumpism on Australia will emerge in the context of the next federal election.
We should expect to see issues such as abortion, fluoride in drinking water, vaccine mandates and access to treatment for gender dysphoria enter the debate; ideological positioning about universal access to key social services such as Medicare; and increased levels of misinformation, disinformation and vilification of scientific and medical expertise from those on the extremes of politics and on social media.
Further reading
Health Policy Watch: If US Pulls Out of WHO, Will Other Member States Step Up?
Croakey’s coverage of the 2024 US elections
See Croakey’s archive of articles on global health
