Lawrence Gostin rends his garments on the Geneva Health Files substack

The article is written by Gostin, but his quotes and sidebars are unattributed, so they may be his or someone else's. I make comments.

Global Health Insecurity in a Second Trump Term [Guest Essay]

By Lawrence O. Gostin

Gostin is Distinguished University Professor, Georgetown University and Director, O’Neill Institute for National and Global Health Law, Washington, D.C., USA. He can be reached at gostin@georgetown.edu.

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I have worked in global public health since the first cases of HIV were reported in 1980. I have led the WHO Collaborating Center on Global Health Law, and worked in the White House and with US agencies like the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH). In all this time, I have never seen a darker day for global health than the election of Donald Trump to a second term.

Trump’s core “America First” values are anathema to the animating principles of global health—mutual solidarity, international cooperation, an abiding concern for marginalized and disadvantaged people, and equitable access to lifesaving public health tools. At his core, Trump disdains international institutions like the World Health Organization (WHO) and global agreements like the International Health Regulations (2005, amended in 2024) (IHR), a future Pandemic Treaty, and the Paris Agreement.

Notice how Gostin likes to tell us all the things he has done—but when it comes to things like the IHR amendments or Pandemic Treaty, suddenly his role has disappeared and he writes as if he had nothing to do with their creation.—Nass

In the next four years, the Trump administration will retreat from global health governance, slash financing, withdraw from international agreements, and direct funds toward anti-health priorities. All of this, and more, will have vast implications for health everywhere but particularly for the world’s most vulnerable.

Here are six areas of global health that will be severely disrupted by a second Trump term.

1.      WHO Membership and Financing

During the height of the COVID-19 pandemic, WHO was caught in the midst of a geopolitical conflict between two world superpowers. Trump falsely accused WHO of “siding with China”. And then Trump made what I called the most cataclysmic decision of any US president in my lifetime—giving the UN Secretary-General one year’s notice of the intention to withdraw from WHO.

More cataclysmic than the Cuban Missile Crisis, Vietnam, Iraq Wars, Afghanistan…?—Nass

President Biden reversed Trump’s decision on Day One, but now Trump has four years to withdraw if he chooses. Trump is likely to withdraw from WHO, as recommended by Project 2025, widely seen as the hyper-conservative blueprint for a second Trump administration.

That would be disastrous. WHO is the world’s health leader. It has been on the frontlines of nearly every health emergency since its founding, including recently vaccinating children against polio in the Gaza Strip and confronting mpox across Africa.

The U.S. is WHO’s largest Member State funder, representing nearly one-quarter of all WHO assessed dues. Without U.S. funding, or with “greater restrictions on federal dollars to WHO” as Project 2025 outlines, WHO’s programming would be hollowed out, endangering health everywhere.

Our assessed dues make up 3% of WHO’s budget—Nass.

2.      Global Health Treaties

Trump’s distain (where are the spell checkers?—Nass) for the WHO also puts critical WHO pandemic reforms at risk. Let’s begin with the IHR. The U.S. was one of the first movers in proposing IHR amendments in 2022. On the final day of the 2024 World Health Assembly on June 1, U.S. Health and Human Services Secretary Xavier Becerra threatened to walk if the final amendments were not adopted, and they were. That shows the determination and influence of the U.S when it actively engages.

I told you so—the US forced the world into the IHR amendments, minimal as they were at that point.

The 2024 amendments will not come into effect until September 19, 2025. As a state party, the U.S. will be bound by the amendments (including the historic guiding principle of equity) without Congressional approval or ratification. But the Trump administration can lodge a reservation (whereby a state reserves the right not to abide by certain treaty provisions) within 18 months of their adoption.

Here, Gostin notes the US will be bound by the amendments, while 2 paragraphs below he claims the opposite, that the WHO will not have authority over national pandemic policies. It must be hard for liars to keep their stories straight.—Nass

The 2024 Assembly, granted the Intergovernmental Negotiation Body (INB) one further year to negotiate the Pandemic Agreement. The INB recently determined that it will not be able to adopt the Pandemic Agreement at a special session of the World Health Assembly in December as stakeholders and WHO had hoped.

The rush to complete the Pandemic Agreement has been fueled by genuine fears that the Trump administration would torpedo the negotiations. Many Trump allies have stoked disinformation that the Pandemic Agreement would cede authority for domestic pandemic policy to WHO, undermining national sovereignty. These claims have been widely debunked, but are still driving domestic opposition to the Agreement within Make America Great Again (MAGA) circles and even establishment Republicans.

3.      Funding for Global Health

The U.S. is currently the largest funder of global health in the world, with a huge network of bilateral and multilateral funding as well as on-the-ground technical assistance and training.

The Institute for Health Metrics and Evaluation (fully funded by Bill Gates at U. Washington—Nass) reports that the U.S. was responsible for more than 40% of governments’ development assistance for health in 2023, providing more than $20 billion. U.S. global health agencies span from the United States Agency for International Development (USAID) and the CDC’s Center for Global Health through to the Fogarty International Center at the NIH.

The U.S. is a leading funder of core global health initiatives including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) – 36% of total funding since its launch – and GAVI, the Vaccine Alliance (19% of direct contributions in 2016-2020).

Moreover, the United States supercharges biomedical and behavioral health research, benefiting the world. NIH has a nearly $48 billion budget (2023), and a remarkable track record, including development of the mRNA COVID-19 vaccines. The Fogarty International Center has trained almost 8,500 scientists from low- and middle-income countries since 1989.

There is precedent for Trump slashing global health funding. His budget proposal for fiscal year 2018 would have slashed spending by $2.5 billion, or 23%. Longstanding bipartisan support protected against these cuts, but Republican control of Congress and the election of Trump-friendly MAGA candidates puts these programs at grave risk.

The future of the President’s Emergency Plan for AIDS Relief (PEPFAR) is of particular concern. PEPFAR has invested approximately $120 billion in the global HIV/AIDS response, the largest commitment by any nation to address a single disease in history, saving more than 25 million lives and accelerating progress in more than 50 countries. PEPFAR engages in crucial work supporting sexual health and fighting discrimination. A second Trump administration will, at minimum, put anti-abortion language in the PEPFAR reauthorization bill – perhaps embedding in authorizing language the global gag rule (see below) – or possibly even cut PEPFAR funding.  

From the State Dept archive: “As the U.S. Global AIDS Coordinator, Ambassador Birx oversees the implementation of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the largest commitment by any nation to combat a single disease in history, as well as all U.S. Government engagement with the Global Fund to Fight AIDS, Tuberculosis and Malaria. Serving as the U.S. Special Representative for Global Health Diplomacy, she aligns the U.S. Government’s diplomacy with foreign assistance programs that address global health challenges…”. We know Deborah Birx is an outright liar, because currently she claims that she knew all along the COVID vaccines would not prevent transmission, yet she was central in planning and carrying out the vaccine campaign that constantly lied to the American people about them—Nass

4.      Global Sexual and Reproductive Health

President Trump has taken credit for overturning Roe v. Wade, which undermined sexual and reproductive health and rights. (Roe v. Wade, was a landmark decision of the U.S. Supreme Court in 1973 in which the Court ruled that the Constitution of the United States protected a right to have an abortion, and ruled that unduly restrictive state regulation of abortion is unconstitutional.)

A second Trump term will threaten reproductive rights globally. Experts are “almost certain” that Trump would again cut funding to the UN Population Fund (UNFPA), the UN agency that works to ensure universal access to sexual and reproductive health care. This time the agency stands to lose over $160 million, more than double the amount cut during Trump’s first term.

Trump is likely to reinstate and expand the global gag rule, which would withhold critical health assistance to organizations that provide abortion-related services, even if they use their private funds. During his first term, Trump expanded the domestic gag rule to include all U.S. global health assistance, not only family planning assistance. The impact was documented in devastating detail. Expect a bolstered Trump to quickly reinstate the global gag rule, or even broaden it to cover all U.S. foreign assistance, not only health assistance.

5.      Climate Change

Climate change poses an existential risk to global health, with 2024 on track to be the warmest year on record—yet again. But during his second term, Trump’s suite of climate-impacting policies stands to be one of his deadliest and longest-lasting health legacies. In his first term, Trump withdrew from the Paris Agreement on climate change and weakened clean air standards. Expect all this again, but far more. Not only will he again withdraw from the Paris Agreement, but he has pledged to withdraw from the 1992 UN Framework Convention on Climate Change.

Excellent!—Nass

Trump’s policies will have a ripple effect across the globe, especially in low- and middle-income countries, which are paying the heaviest price for a problem caused by high-income countries. A slower U.S. clean energy transition, along with little climate financing, will exacerbate climate change and its health impacts.

6.      Global Influence of the CDC

The U.S. Centers for Disease Control and Prevention (CDC) will take the brunt of Trump’s ire, given its role during COVID-19. For almost a century, the CDC has engaged in global health diplomacy and action to protect and improve health security. With a network of offices in over 65 countries, the CDC’s work through funding and logistical support, field training, and emergency rapid response helps combat infectious diseases worldwide.

I cannot think of a more renegade, untruthful agency than CDC to take the brunt of Trump’s cost-cutting—Nass

A second Trump term will undercut the agency’s mission, scope, and independence. During Trump’s first term, the CDC faced significant scrutiny and pressure, interfering with CDC operations and censoring its communications.

When Trump returns to office, the CDC will face continued budget constraints and political meddling.

Project 2025 proposes splitting CDC into two agencies: one on data gathering, and another responsible for “limited” public health recommendations. Beyond all that, Trump is expected to empower Robert F. Kennedy Jr., perhaps the world’s most influential and well-funded anti-vaxxer. In the journal Science, I explain the profound impacts.

(See The Guardian: The appointment of Robert F Kennedy has horrified public health experts. Here are his three most dangerous ideas).

BTW, the author of this Guardian article is Devi Sridhar, another member of the globalist public health mafia that came to prominence over the past two decades.—Nass

Resistance Against the Trump Effect

A second Trump term will have sweeping adverse impacts on global health. Trump’s “America First,” anti-science agenda will be felt everywhere. The next four years will be some of the most dangerous and detrimental to global health in living memory.

Mitigating or preventing the worst impacts of a second Trump term requires fierce mobilization and resistance in the United States and worldwide. The resistance must be political through Congress and the judiciary. It must be bottom-up through social mobilization and peaceful civil society protest, assembly, and action.

And it must be global through the UN and its specialized agencies. Intergovernmental organizations (G7 and G20) and regional blocs (in Europe, Africa, Latin America, and Asia) should not simply fill the void in funding and diplomacy left by Trump, but should vastly increase global health financing and solidarity.

The surest antidote to Trump’s “America First,” is a united world, putting Equity First.

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I could not help adding this—Nass

https://www.theglobalfund.org/en/about-the-global-fund/history-of-the-global-fund/

“The Global Fund is one of the best and kindest things people have ever done for one another. It is a fantastic vehicle for scaling up the treatments and preventive tools we have today – to make sure they reach the people who need them.”

Bill Gates at the Opening Ceremony of the 16th International AIDS Conference