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For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions" /> <meta name="DC.AccessRights" content="restricted" /> <meta name="DC.Relation" content="10.1136/bmj.q2485" /> <meta name="DC.Relation" content="10.1136/bmj.q2654" /> <meta name="DC.Relation" content="10.1136/bmj.r116" /> <meta name="DC.Description" content="The second Trump presidency will be disruptive for global health, so threats must be anticipated and opportunities seized argue Kent Buse and Martin McKee If the 2024 US presidential election was difficult for pollsters to call, the impact of Donald Trump’s second term on global health is even more difficult to predict. He is notoriously unpredictable. Nonetheless, his actions in his first term as president, the 900-page blueprint for his second term known as Project 2025,1 and his campaign rhetoric provide some clues. Given his predilection for chaos,2 it is impossible to know which ideas will become reality, but the world should plan for the worst and hope for the best as Trump prepares to deliver the “promised golden age of America.”3 Here, we reflect on the potential consequences for global health. Trump is a self-declared nationalist and is explicit about an “America first” foreign policy. With Republican control of both Houses of Congress, a partisan Supreme Court, and what Steve Bannon, one of Trump’s closest strategists, has previously described as “the deconstruction of the administrative state,”4 he will face few constraints. Trump is no friend of the multilateralism underpinning global health in the …" /> <meta name="DC.Contributor" content="Kent Buse" /> <meta name="DC.Contributor" content="Martin McKee" /> <meta name="article:published_time" content="2024-11-21" /> <meta name="article:section" content="Opinion" /> <meta name="citation_title" content="Trump 2.0: what implications for global health?" /> <meta name="citation_abstract" lang="en" scheme="teaser" content="<p>The second Trump presidency will be disruptive for global health, so threats must be anticipated and opportunities seized argue Kent Buse and Martin McKee</p>" /> <meta name="citation_journal_title" content="BMJ" /> <meta name="citation_publisher" content="British Medical Journal Publishing Group" /> <meta name="citation_publication_date" content="2024/11/21" /> <meta name="citation_mjid" content="bmj;387/nov21_21/q2607" /> <meta name="citation_id" content="387/nov21_21/q2607" /> <meta name="citation_public_url" content="https://www.bmj.com/content/387/bmj.q2607" /> <meta name="citation_abstract_html_url" content="https://www.bmj.com/content/387/bmj.q2607.abstract" /> <meta name="citation_full_html_url" content="https://www.bmj.com/content/387/bmj.q2607.full" /> <meta name="citation_pdf_url" content="https://www.bmj.com/content/bmj/387/bmj.q2607.full.pdf" /> <meta name="citation_issn" content="1756-1833" /> <meta name="citation_journal_abbrev" content="BMJ" /> <meta name="citation_doi" content="10.1136/bmj.q2607" /> <meta name="citation_pmid" content="39572063" /> <meta name="citation_volume" content="387" /> <meta name="citation_article_type" content="Editorial" /> <meta name="citation_section" content="Opinion" /> <meta name="citation_author" content="Kent Buse" /> <meta name="citation_author_institution" content="Global Health 50/50, Cambridge, UK" /> <meta name="citation_author" content="Martin McKee" /> <meta name="citation_author_institution" content="London School of Hygiene and Tropical Medicine, London, UK" /> <meta name="citation_reference" content="Project 2025. Presidential Transition Project. Mandate for Leadership: The Conservative Promise. 2024 [Available from: https://www.project2025.org/policy/ accessed 12th November 2024." /> <meta name="citation_reference" content="Wagner J, Phillip A. Chaos Theory of Donald Trump: Sowing Confusion Through Tweets: Yale GlobalOnline; 2016 [Available from: https://archive-yaleglobal.yale.edu/content/chaos-theory-donald-trump-sowing-confusion-through-tweets accessed 12th November 2024." /> <meta name="citation_reference" content="Smith D. Trump’s ‘golden age of America’ could be an unrestrained imperial presidency: The Guardian; 2024 [Available from: https://www.theguardian.com/us-news/2024/nov/09/president-trump-election-maga accessed 12th November 2024." /> <meta name="citation_reference" content="Brooke D. My unsettling interview with Steve Banon: NY Times; 2024 [Available from: https://www.nytimes.com/2024/07/01/opinion/steve-bannon-trump.html accessed 12th November 2024." /> <meta name="citation_reference" content="US State Department. Update on U.S. withdrawal from the World Health Organization 2020 [Available from: https://2017-2021.state.gov/update-on-u-s-withdrawal-from-the-world-health-organization/ accessed 12th November 2024." /> <meta name="citation_reference" content="Smith D. Trump halts World Health Organization funding over coronavirus 'failure': The Guardian; 2024 [Available from: https://www.theguardian.com/world/2020/apr/14/coronavirus-trump-halts-funding-to-world-health-organization accessed 12th November 2024." /> <meta name="citation_reference" content="Toosi N. Trump aides consider creating alternative to WHO: Politico; 2020 [Available from: https://www.politico.com/news/2020/04/10/trump-aides-debate-demands-who-179291 accessed 12th November 2024." /> <meta name="citation_reference" content="World Health Organization. Results Report 2022-23. Programme Budget 2023 [Available from: https://open.who.int/2024-25/contributors/contributor accessed 12th November 2024." /> <meta name="citation_reference" content="KFF. The U.S. Government and Global Health 2024 [Available from: https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-and-global-health/ accessed 12th November 2024." /> <meta name="citation_reference" content="Gray G. How can we help stop deadly drug-resistant infections spreading?: The Guardian; 2024 [Available from: https://www.theguardian.com/global-development/2024/oct/29/drug-resistant-infections-debt-relief-millions-lives-amr accessed 12th November 2024." /> <meta name="citation_reference" content="Trump Administration Proposes To Cut PEPFAR Funding, Reduce U.S. Contribution To Global Fund. (accessed 15th November 2024) https://www.kff.org/news-summary/trump-administration-proposes-to-cut-pepfar-funding-reduce-u-s-contribution-to-global-fund/" /> <meta name="citation_reference" content="Igoe M. What the US election means for global development. Devex. (accessed 15th November 2024) https://www.devex.com/news/what-the-us-election-means-for-global-development-108556" /> <meta name="citation_reference" content="citation_journal_title=BMJ;citation_author=M. McKee;citation_author=C. Pagel;citation_author=K. Buse;citation_title=Disinformation enabled Donald Trump’s second term and is a crisis for democracies everywhere;citation_volume=387;citation_year=2024;citation_pmid=39532499;citation_doi=10.1136/bmj.q2485" /> <meta name="citation_reference" content="Tumin RRFK Jr. Lays Out Possible Public Health Changes Under Trump: NY Times; 2024 [Available from: https://www.nytimes.com/2024/11/06/us/politics/rfk-jr-trump-health.html accessed 12th November 2024." /> <meta name="citation_reference" content="Zimmer B. Crisis = danger + opportunity: The plot thickens: Language Log; 2007 [Available from: http://itre.cis.upenn.edu/~myl/languagelog/archives/004343.html accessed 12th November 2024." /> <meta name="citation_reference" content="Global Health 50/50. Boards for all? A review of power, policy and people on the boards of organisations active in global health 2022 [Available from: https://globalhealth5050.org/2022-report/ accessed 12th November 2024." /> <meta name="citation_reference" content="citation_journal_title=Lancet;citation_author=M. McKee;citation_author=S. Field;citation_author=S. Vella;citation_author=H. Legido-Quigley;citation_author=M. Kazatchkine;citation_title=The EU has a global health strategy: the challenge will be in the implementation;citation_pages=1025-7;citation_volume=402;citation_year=2023;citation_pmid=37743751;citation_doi=10.1016/S0140-6736(23)00328-8" /> <meta name="citation_reference" content="citation_journal_title=J Health Polit Policy Law;citation_author=SL. Greer;citation_author=AB. Amaya;citation_author=H. Jarman;citation_author=H. Legido-Quigley;citation_author=M. McKee;citation_title=Regional International Organizations and Health: A Framework for Analysis;citation_pages=63-92;citation_volume=47;citation_year=2022;citation_pmid=34280296;citation_doi=10.1215/03616878-9417456" /> <meta name="citation_reference" content="citation_journal_title=Obes Rev;citation_author=R. Pérez-Escamilla;citation_author=CK. Lutter;citation_author=C. Rabadan-Diehl;citation_title=Prevention of childhood obesity and food policies in Latin America: from research to practice;citation_pages=28-38;citation_volume=18;citation_year=2017;citation_pmid=28741904;citation_doi=10.1111/obr.12574" /> <meta name="citation_reference" content="Washington Examiner. Trump and Republican Senate victory spell ruin for WHO pandemic accord https://www.washingtonexaminer.com/policy/healthcare/3224382/trump-republican-senate-spell-ruin-who-pandemic-accords/#google_vignette" /> <meta name="twitter:title" content="Trump 2.0: what implications for global health?" /> <meta name="twitter:card" content="summary" /> <meta name="twitter:description" content="The second Trump presidency will be disruptive for global health, so threats must be anticipated and opportunities seized argue Kent Buse and Martin McKee If the 2024 US presidential election was difficult for pollsters to call, the impact of Donald Trump’s second term on global health is even more difficult to predict. He is notoriously unpredictable. Nonetheless, his actions in his first term as president, the 900-page blueprint for his second term known as Project 2025,1 and his campaign rhetoric provide some clues. Given his predilection for chaos,2 it is impossible to know which ideas will become reality, but the world should plan for the worst and hope for the best as Trump prepares to deliver the “promised golden age of America.”3 Here, we reflect on the potential consequences for global health. Trump is a self-declared nationalist and is explicit about an “America first” foreign policy. With Republican control of both Houses of Congress, a partisan Supreme Court, and what Steve Bannon, one of Trump’s closest strategists, has previously described as “the deconstruction of the administrative state,”4 he will face few constraints. Trump is no friend of the multilateralism underpinning global health in the …" /> <meta name="og-title" property="og:title" content="Trump 2.0: what implications for global health?" /> <meta name="og-url" property="og:url" content="https://www.bmj.com/content/387/bmj.q2607" /> <meta name="og-site-name" property="og:site_name" content="The BMJ" /> <meta name="og-description" property="og:description" content="The second Trump presidency will be disruptive for global health, so threats must be anticipated and opportunities seized argue Kent Buse and Martin McKee If the 2024 US presidential election was difficult for pollsters to call, the impact of Donald Trump’s second term on global health is even more difficult to predict. He is notoriously unpredictable. Nonetheless, his actions in his first term as president, the 900-page blueprint for his second term known as Project 2025,1 and his campaign rhetoric provide some clues. Given his predilection for chaos,2 it is impossible to know which ideas will become reality, but the world should plan for the worst and hope for the best as Trump prepares to deliver the “promised golden age of America.”3 Here, we reflect on the potential consequences for global health. Trump is a self-declared nationalist and is explicit about an “America first” foreign policy. With Republican control of both Houses of Congress, a partisan Supreme Court, and what Steve Bannon, one of Trump’s closest strategists, has previously described as “the deconstruction of the administrative state,”4 he will face few constraints. Trump is no friend of the multilateralism underpinning global health in the …" /> <meta name="og-type" property="og:type" content="article" /> <meta name="og:image" property="og:image" content="https://www.bmj.com/sites/default/files/highwire/bmj/388/8457.cover-source.jpg"/> <meta name="twitter:card" content="summary_large_image"><meta name="twitter:image" property="twitter:image" content="https://www.bmj.com/sites/default/files/sites/defautl/files/attachments/bmj-article/2024/11/donald_trump_august_2020_pa-54855522.jpg"><meta name="twitter:title" content="Trump 2.0: what implications for global health?" /><link rel="alternate" type="text/plain" title="Full Text (Plain)" href="/content/387/bmj.q2607.full.txt" /> <script>window.dataLayer = window.dataLayer || [];window.dataLayer.push({"page":{"hwTitle":"Trump 2.0: what implications for global 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class="pane-content"> <div class="highwire-article-citation highwire-citation-type-highwire-article node1103615" data-node-nid="1103615" id="node-1103615--2999123002" data-pisa="bmj;387/nov21_21/q2607" data-pisa-master="bmj;bmj.q2607" data-apath="/bmj/387/bmj.q2607.atom"><cite class='highwire-cite highwire-citation-bmj-article-top'> <span class='highwire-cite-article-type'>Opinion</span> <h1 class="highwire-cite-title" id="page-title">Trump 2.0: what implications for global health?</h1> <span class='highwire-cite-journal'>BMJ</span> <span class='highwire-cite-published-year'>2024</span>; <span class='highwire-cite-volume-issue'>387</span> <span class='highwire-cite-doi'> doi: <a href="https://doi.org/10.1136/bmj.q2607">https://doi.org/10.1136/bmj.q2607</a></span> <span class='highwire-cite-date'>(Published 21 November 2024)</span> <span class='highwire-cite-article-as'> Cite this as: <span class="italic">BMJ</span> 2024;387:q2607 </span> </cite> </div> </div> </div> <div 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class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><div class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">Kent Buse</span><span class="contrib-role">, co-founder</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">1</a>, </li><li class="last" id="contrib-2"><span class="name">Martin McKee</span><span class="contrib-role">, professor of European public health</span><a id="xref-aff-2-1" class="xref-aff" href="#aff-2">2</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address><sup>1</sup>Global Health 50/50, Cambridge, UK</address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address><sup>2</sup>London School of Hygiene and Tropical Medicine, London, UK</address></li></ol></div><div class="teaser"><p id="p-1">The second Trump presidency will be disruptive for global health, so threats must be anticipated and opportunities seized argue Kent Buse and Martin McKee</p></div><p id="p-2">If the 2024 US presidential election was difficult for pollsters to call, the impact of Donald Trump’s second term on global health is even more difficult to predict. He is notoriously unpredictable. Nonetheless, his actions in his first term as president, the 900-page blueprint for his second term known as Project 2025,<a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a> and his campaign rhetoric provide some clues. Given his predilection for chaos,<a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a> it is impossible to know which ideas will become reality, but the world should plan for the worst and hope for the best as Trump prepares to deliver the “promised golden age of America.”<a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a> Here, we reflect on the potential consequences for global health.</p><p id="p-3">Trump is a self-declared nationalist and is explicit about an “America first” foreign policy. With Republican control of both Houses of Congress, a partisan Supreme Court, and what Steve Bannon, one of Trump’s closest strategists, has previously described as “the deconstruction of the administrative state,”<a id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4</a> he will face few constraints.</p><p id="p-4">Trump is no friend of the multilateralism underpinning global health in the post-war period. In his first term Trump initiated withdrawal from the World Health Organisation (WHO), blaming it for bungling the response to covid-19 and accusing it of being too close to China.<a id="xref-ref-5-1" class="xref-bibr" href="#ref-5">5</a> It was reported that plans for an alternative to the WHO were being developed.<a id="xref-ref-6-1" class="xref-bibr" href="#ref-6">6</a><a id="xref-ref-7-1" class="xref-bibr" href="#ref-7">7</a> While his electoral defeat stopped the withdrawal process, Trump froze US funding for WHO—a major blow as the US was WHO’s largest government donor.<a id="xref-ref-8-1" class="xref-bibr" href="#ref-8">8</a> Any future cuts would damage an organisation, which despite many flaws, is vital to global health and is already underfunded even as demands on it grow.</p><p id="p-5">In his first term, Trump cut funding to the United Nations Population Fund (UNFPA) and declined to participate in the vaccine sharing initiative COVAX. Given Trump’s nomination of vaccine sceptic Robert F. Kennedy Jr as health secretary, funding to the GAVI Alliance may be at risk. And given the role of sexual and reproductive health in HIV responses, the Global Fund could be in his sights.</p><p id="p-6">If the administration remains engaged in global health, difficult times can be expected. Risks include reduced contributions to international health organisations and pressure to modify intellectual property regimes and trade agreements to support US corporate interests. There are concerns about the future of the eventual outcome of the long-negotiated pandemic accord.<a id="xref-ref-9-1" class="xref-bibr" href="#ref-9">9</a></p><p id="p-7">The US government is the largest provider of development assistance for health.<a id="xref-ref-10-1" class="xref-bibr" href="#ref-10">10</a> Trump will likely cut this budget and impose restrictions on the use of remaining funds. The risks to organisations engaged in sexual and reproductive health rights is well recognised, but areas like antimicrobial resistance may also be vulnerable.<a id="xref-ref-11-1" class="xref-bibr" href="#ref-11">11</a> Until 2016, PEPFAR, the US government's HIV fund, enjoyed bipartisan support. Trump attempted to cut its funding during his first term, but was blocked by Congress.<a id="xref-ref-12-1" class="xref-bibr" href="#ref-12">12</a> Since then, it has become a political bargaining chip and its future appears to hang in the balance, given that Trump has greater sway over the republican dominated Congress.</p><p id="p-8">What remains of the global health budget may be spent very differently, with implications for equity. Faith-based groups are likely beneficiaries, with implications for sexual and reproductive health. Similarly, we might expect development assistance to countries to be even more conditional on policies favouring US corporations, such as privatisation of health care and scaling back health and safety regulations.<a id="xref-ref-13-1" class="xref-bibr" href="#ref-13">13</a> We have written about the implications of disinformation elsewhere.<a id="xref-ref-14-1" class="xref-bibr" href="#ref-14">14</a></p><p id="p-9">Trump’s policies in other areas have implications for global health. Increased tariffs would disrupt global supplies of medicines and their raw ingredients, increasing prices. Before the election, Trump said he would let R.F. Kennedy “go wild on health,”<a id="xref-ref-15-1" class="xref-bibr" href="#ref-15">15</a> potentially eviscerating the Centres for Disease Control, Food and Drug Agency, National Institutes for Health, and the Environment Protection Agency. This would also affect foreign jurisdictions that rely on their normative functions.</p><p id="p-10">In this context, we urge the health community to advocate for a rules-based international order and strive to ensure public health responses are guided by international norms such as the Right to Health or the Right to a Healthy Environment or commitments on the rights of women and children.</p><p id="p-11">It is equally important that the international community support WHO and other entities to develop international norms and standards governing risks that evolve and emerge, from disinformation to new pathogens. For what it is worth, the public health community should strongly advocate for continued US support to and cooperation with WHO. They both need each other. At the same time, public health advocates must advocate for Europe and other partners to bridge the WHO funding gap. A previous US President, J.F. Kennedy said that the Chinese word for crisis also means opportunity. He was not quite right as the word has a slightly different meaning, but it does convey a sense of change.<a id="xref-ref-16-1" class="xref-bibr" href="#ref-16">16</a></p><p id="p-12">Trump’s withdrawal from global health opens spaces for others. Over a third of board seats in global health organizations are held by Americans, with only 2% by women from low-income countries.<a id="xref-ref-17-1" class="xref-bibr" href="#ref-17">17</a> Other countries must fill these spaces—building alliances and fighting for evidence-informed norms and commitments in multilateral forums. Europe must revisit its global health strategy<a id="xref-ref-18-1" class="xref-bibr" href="#ref-18">18</a> and other regional blocs must invest in global health.<a id="xref-ref-19-1" class="xref-bibr" href="#ref-19">19</a> Trump’s proposed tariffs could empower governments to adopt stronger public health policies like marketing restrictions, taxes, and bans on unhealthy food in schools, emulating initiatives in Latin America and the Caribbean.<a id="xref-ref-20-1" class="xref-bibr" href="#ref-20">20</a></p><p id="p-13">Trump 2.0 will be extremely disruptive for global health, but he will not be around forever. For now, we must stay focused and determined, working collectively over the next four years to support progressive stances in multilateral forums that seek to protect and promote the health of people and planet.</p><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-other" id="fn-1"><p id="p-14">Competing interests: none declared.</p></li><li class="fn-other" id="fn-2"><p id="p-15">Provenance and peer review: not commissioned, not externally peer reviewed.</p></li></ul></div><div class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list"><li><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1 in text" id="ref-1">↵</a><div class="cit ref-cit ref-web" id="cit-387.nov21_21.q2607.1"><div class="cit-metadata unstructured">Project 2025. Presidential Transition Project. 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