Health ministers are bracing themselves for a major onslaught on global efforts to tackle the threat of new pandemics by US President-elect, Donald Trump.
Trump is expected to pull the US from negotiations on a global pandemic treaty and withdraw his country from the World Health Organization (WHO). Other moves to reform US health agencies will also likely have a damaging impact on healthcare worldwide.
Is WHO really ‘corrupt’?
In his first term as President, Trump took steps to end US membership of WHO from July 2021. However, he lost the 2020 election before he could implement them.
He has not changed his view of the ‘corrupt’ WHO, which he accused of protecting China against criticisms that COVID-19 started there. Ironically, China could take over leadership of the global healthcare agenda in the face of America’s retreat, perhaps plugging the black hole in WHO’s budget left by the US withdrawal.
WHO leads global health efforts, coordinating the response of its 194 member states to health challenges from infectious diseases such as COVID-19 or non-communicable ones. It is particularly important in supporting low-income countries.
Pandemic treaty at risk
The proposed global pandemic treaty, already delayed as countries argue over its scope, has long been in Trump’s sights. He has stated that the proposed accord will hurt America’s interests primarily because it would be required to transfer “huge” supplies of drugs to other countries during a future pandemic.
Even if other countries continue the talks without US involvement, there is little likelihood that Trump and the Republican-controlled US Senate will ratify any treaty that emerges, rendering it effectively toothless without US participation.
In truth, other countries have also voiced concern over the treaty, and in the UK the Labour government is coming under pressure from Nigel Farage, the Reform UK Party leader, who has set up Action on World Health to kill off the pandemic treaty and reform or replace WHO.
When Trump moved to withdraw the US from WHO, the organisation’s Director-General, Dr Tedros Adhanom Ghebreyesus, accused him of “playing with fire”. This time, he has scaled down the rhetoric, adopting a more conciliatory tone and stressing the “vital partnership” between the US and the WHO in tackling global health issues.
But Trump could swing his wrecking ball even further.
UN refugee agencies, the United Nations High Commission for Refugees (UNHCR) and the United Nations Relief and Works Agency (UNWRA) will likely see their budgets reduced, hampering their work at a time when governments are struggling to handle the global refugee crisis. Another casualty is expected to be United Nations Population Fund (UNFPA).
Drastic reforms promised
Trump and his Health Secretary, Robert Kennedy Jr, intend to drastically reform US domestic health policies. This overhaul will affect the Centre for Disease Control (CDC), the Food and Drug Administration (FDA) and the National Health Institute – and potentially the global health agenda.
The President-elect aims to cut domestic drug prices, and the FDA could lower the bar on the time taken to authorise new drugs. That would have a knock-on effect on other initiatives such as Project Orbis, a US-led global collaboration to promote faster authorisation and access to cancer drugs.
There are concerns that trade deals will require countries to open up their markets to more US healthcare companies – perhaps accelerating the privatisation of health systems.
However, Trump’s return to the White House may not be all bad news.
Some experts believe that overseas development assistance has been wasteful and unrelated to new challenges. Non-communicable diseases like cancer, obesity and mental health are not on the global health agenda.
Another Trump presidency could, they argue, lead to a major realignment of global health priorities.
