There was a 20 per cent global increase in cases of measles last year, driven by inadequate immunisation and killing an estimated 107,500 people, the World Health Organisation announced on 14 November. On the same day, President-elect Donald Trump announced his nomination of Robert F. Kennedy, an anti-vaccine activist, as the US secretary of health and human services.
Kennedy, who chaired a leading anti-vaccine group called Children’s Health Defense, visited Samoa in 2019, months after a measles outbreak killed 83 people. He characterised the epidemic as “mild”.
Health experts are in despair and fear the gains in public health made over the last century may be halted or even reversed under a new US administration that includes science sceptics.
Plenty of health professionals would like to see reform of bodies such as the WHO, particularly of its unwieldy structure and sometimes inability to react nimbly to events.
But the Trump administration seemingly aims to go further and target the very principles of multilateral co-operation so vital to tackle global health and other challenges that are also in the US national interest.
Realignment of global health priorities
Looking at the near and bleak future, some experts are calling for pre-emptive action on how to go forward. “In today’s polycrisis world, classic humanitarianism is not the route to solving complex global health problems,” wrote Richard Sullivan of King’s College London.
“Above all, a Trump presidency should be the start of a serious realignment of global health priorities, not just to an attempt to fill in the loss of US funding, but to restructure the world’s approach to health and development,” he said.
The spread of conspiracy theories and the erosion of trust in health bodies by Trump and his nominees could cause more infectious diseases to spike and put everyone in danger, regardless of where they live given that another pandemic is forecast by many public health professionals.
Public health programmes and research will remain under siege while funding for US health bodies and overseas aid is likely to be slashed
While Kennedy and some of Trump’s more unexpected choices may fail to get Senate confirmation, public health programmes and research will remain under siege while funding for US health bodies and overseas aid is likely to be slashed.
“A second Trump presidency could very well be the end of public health as we know it,” wrote Matt Motta, assistant professor of health law, policy and management at Boston University’s School of Public Health.
Vaccine hesitancy
Take the measles vaccine, which has “saved more lives than any other vaccine in the past 50 years,” according to Tedros Adhanom Ghebreyesus, WHO director-general. While Kennedy has said he would not take vaccines away from anyone, he has repeated claims that “autism comes from vaccines,” a theory popularised by Andrew Wakefield, a doctor who was struck off the British medical register and who has since peddled his views on social media.
Wakefield’s 1998 study was later retracted by The Lancet and multiple other studies have shown no link between vaccines and autism. But vaccine hesitancy among parents shows no sign of declining and will likely rise under Trump, who has expressed his own doubts about the MMR vaccine against measles, mumps and rubella.
All US states have vaccine requirements for schoolchildren for diseases including measles and polio but there are exemptions on religious and other grounds. During the campaign, Trump said: “I will not give one penny to any school that has a vaccine mandate or a mask mandate.”
Trump could revive “impoundment” whereby he just refuses to spend money that is allocated by Congress
To circumvent lawmakers, Trump could revive “impoundment” whereby he just refuses to spend money that is allocated by Congress, the Washington Post reported. US agencies under Trump’s sway include the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the National Institutes of Health (NIH), and USAID.
The US is also the largest bilateral donor in the world, giving $63 billion in official assistance last year, according to the Organisation for Economic Co-operation and Development. Global bodies that could see US funding cuts or even a withdrawal are the WHO, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Gavi, the Vaccine Alliance.
Attack against multilateral agencies
Trump said last month that the WHO is “run by China”. In 2020, he halted US funding and threatened to withdraw from the body altogether. If he returns to the attack against multilateral agencies, ironically, it could be China that steps up funding along with influence given the slashing of aid budgets by European and other richer countries.
Global health bodies will find their work further stymied should Trump restore the Mexico City Policy, called the global gag rule by critics
At the G20 meeting in Rio de Janeiro this week, the WHO said it received pledges to cover 53 per cent of the $7.1 billion it needs for the next four years and it has managed to attract other new donors including African countries.
Global health bodies will find their work further stymied should Trump restore the Mexico City Policy, called the global gag rule by critics. Adopted by previous Republican administrations since 1984 under President Ronald Reagan, it blocks US federal funding to organisations that even discuss abortion services. In the past, it has led to cuts in other programmes such as those for HIV and cervical cancer screenings because organisations were so fearful of losing US funding.
Infectious diseases such as mpox, bird flu, dengue and many others are on the rise in a world that has 110 armed conflicts currently raging, according to a tally by the Geneva Academy of International Humanitarian Law and Human Rights.
An editorial in The Lancet called on all scientists to defend and promote their work. “It will be no easy task, requiring a clear-eyed sense of pragmatism, a steadfast belief in the value of scientific principles, and a good deal of courage,” it said.
