Four Key Areas Where ‘Anti-Globalist’ Trump Threatens Global Health
Health Systems 08/11/2024 •

US President-elect Donald Trump railed against “globalists” during his election campaign, and his victory will have serious ramifications for global health – particularly for action against climate change, scientific institutions and regulatory bodies, United Nations agencies and sexual and reproductive health.

1. Climate denial

“We will drill, baby, drill,” Trump told the Republican National Convention in July, describing the Biden administration’s “Green New Deal” aimed at reducing greenhouse gases as a “scam”. 

During his presidency, he persistently favoured industry over the environment, removing around 100 regulations relating to air pollution, water, vehicle emissions, toxic chemicals and wildlife protection, according to the New York Times.

For example, within weeks of assuming office in January 2017, Trump expedited the controversial Dakota Access Pipeline to transport crude oil through farms and pristine indigenous land. Oil and gas billionaire Kelcy Warren, whose company, Energy Transfer, was responsible for the pipeline, was the fifth-largest individual contributor to Trump’s latest election campaign with a $5.8 million donation, according to Forbes.

He also allowed oil and gas development in the Arctic National Wildlife Refuge in Alaska, one of the last remaining wilderness areas in the US, reauthorised use of an agricultural pesticide, sulfoxaflor, known to kill bees and lifted protections for endangered species.

He appointed industry-friendly people to run the Environmental Protection Agency (EPA) and reduced its budget, which drove these measures. However, this time, he might dismantle the agency almost entirely, giving states latitude to decide on environmental issues, according to threats made on the campaign trail.

In 2017, Trump announced his intention to pull the US out of the Paris Agreement – the commitment to confine global warming to 1.5°C – saying that it undermined the US economy, hamstrung its ability to open new oil and coal fields, and put the US “at a permanent disadvantage to the other countries of the world”.

Trump campaign national press secretary Karoline Leavitt told Politico that he will do the same thing in his second presidency.

Why it matters

This year is “virtually certain” to be the warmest year on record, with the average global temperature rise being 1.55°C above the pre-industrial era, according to a report from the European Union’s Earth observation programme, Copernicus. Record-breaking heat is driving global extreme weather from hurricanes and floods to drought and fires, threatening the lives and livelihoods of virtually everyone.

Trump’s win could lead to an additional four billion tonnes of US emissions by 2030 in comparison with current president Joe Biden’s plans, according to Carbon Brief , based on an aggregation of modelling by various US research groups. This is equal to the total emissions form the European Union and Japan combined, and would cause global climate damages worth more than $900bn, based on the latest US government valuations.

Reaction

“The nation and world can expect the incoming Trump administration to take a wrecking ball to global climate diplomacy,” said Rachel Cleetus, policy director at the Union of Concerned Scientists, told The Guardian.

Environmental justice organisation Greenpeace called on supporters to “resist attempts to roll back environmental and climate protections” and “lean into the intersections between climate justice and democracy protection, given the increasing attacks on freedoms of speech, assembly, and association.”

2. Undermining scientific and regulatory institutions

The US Centers for Disease Control and Prevention

Trump promoted several quack cures during the COVID-19 pandemic and has apparently promised the world’s leading vaccine skeptic, Robert F Kennedy Jnr, a position at the White House. 

Kennedy, who has no health qualifications, abandoned his presidential bid in favour of Trump. Trump has said he wants Kennedy to “go wild on health”. That is easy for Kennedy, whose  wild ideas including the rejection of most childhood vaccinations and that water fluoridation  causes brain disease.

It is unclear what position Kennedy will get, but Trump is almost certain to reform  and reduce the power of the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH).

The CDC leads disease outbreak investigations, publishing public health recommendations and supporting the work of state and local health departments, which is where around two-thirds of its budget goes.

 The FDA sets regulatory policy, and decides on the authorisation of new medicines and medical devices. The NIH funds medical research.

Kennedy has described public health agencies as “sock puppets for the industries they are supposed to regulate.”

He wants to rein in Big Pharma, including by banning TV advertisements for drugs – tricky for Republicans who received significantly more pharma election donations than Democrats. 

Kennedy has also proposed that half the NIH’s budget should be for “preventive, alternative and holistic approaches to health.”

He also mused on X that “FDA’s war on public health is about to end. This includes its aggressive suppression of psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals and anything else that advances human health and can’t be patented by Pharma.” 

Why it matters

 If citizens don’t believe in science or public health institutions, they are unlikely to follow their advice, which could slow recovery form disease and turn outbreaks into epidemics.

A Pew Research Center poll in late 2023 found that there has been a 16% drop in Americans’ view that science has a mostly positive effect on society, with only 57% supporting this view.

Decisions taken by the CDC and FDA are considered as the global “gold standard”, and are particularly important for countries that lack the resources to map disease responses and authorise medical products for themselves.

Reaction

“Among the most destructive impacts of a second Trump administration would be to foment distrust in health, medicine and science, ranging from vaccines to water fluoridation,” Professor Lawrence Gostin, the O’Neill Chair in Global Health Law at Georgetown University, warned on X.

“Censoring public health agencies, cherry picking the data, and pumping out false information would cost lives.”

However, Gostin also noted that “Trump has no power to ban vaccines or water fluoridation. The states have public health power, not the president. And we have robust institutions that will hold.”

Meanwhile, former CDC head Dr Tom Frieden described the body as “the cornerstone of public health in the United States and a global resource—weakening CDC would endanger American lives.”

3. Defunding UN agencies

The WHO plays an essential role in assisting poor countries – in this case, assisting Zimbabwe to respond to a cholera outbreak.

Trump’s first administration froze the US contributions to the World Health Organization (WHO) in the middle of the COVID-19 pandemic, accusing it of being controlled by China.

Trump also cut US funding to the United Nations Population Fund (UNFPA), effectively shrinking the budget of the global sexual and reproductive health agency by around 7% – erroneously accusing the agency of supporting population control programs in China that include coercive abortion.

Trump also withdrew the US from the UN Human Rights Council, and UNESCO, the UN’s cultural agency.

This is likely to be repeated in Trump 2, 

Why it matters

The WHO leads global health efforts, coordinating and guiding its 194 member states on how best to respond to all health challenges – from infectious diseases such as COVID-19 to non-communicable diseases. It is particularly important in supporting low-income countries.

UNFPA provides maternal and reproductive health services throughout the world – excluding abortions. Its role is particularly in humanitarian settings where governments are unable to provide these services.

The loss of the US contribution to the WHO will weaken the global body’s ability to assist countries to react to health challenges. Likewise, the UNFPA will have to scale back its operations, which will impact on women in the poorest, conflict-ridden nations.

The US also contributes 22% to the UN’s core budget and 27% of the peacekeeping budget. 

Reaction

After Trump withdrew the US in April 2020, WHO Director-General Dr Tedros Adhanom Ghebreyesus accused Trump of “playing with fire” by politicising COVID-19, which would result in “many more body bags”.

However, a circumspect Tedros reacted to Trump’s re-election this week by saying: “The partnership between WHO and America is vital, and has significantly improved the health of both Americans and people across the globe. We look forward to working with your administration for global health security.”

Meanwhile, UNFPA has warned that women will “lose lifesaving services in some of the world’s most devastating crises” in places like Afghanistan, Sudan and Ukraine,” according to Reuters.

4. Sexual and reproductive health

A US protest against abortion restrictions.

Sexual and reproductive health (SRH) services are in the firing line, with Trump likely to support the expansion of domestic abortion bans, while entrenching opposition to abortion as a key pillar of US foreign aid. 

Despite the Trump victory, millions of people in seven US states voted to enshrine the right to abortion in their state constitutions, approving amendments in seven of 10 states where measures were on the ballot.

However, the Trump administration is expected to try to end access to medication  abortion,used in 63% of US abortions, including by prosecuting people who ship and transport abortion pills and supplies.  

Trump appointed anti-abortion judges to the Supreme Court who overturned the right to abortion, known as Roe v Wade. Seventeen US states have banned abortion since Roe v Wade was overturned, and many doctors are unsure of when it is legal to assist women to terminate pregnancies – even when they are obviously in distress. 

“In vast swaths of the US South and Midwest, patients are forced to cross multiple state lines to get [abortion] care, but many lack the means to do so,” according to the Center for Reproductive Rights (CRR).

“Obstetricians are fleeing states where abortion is banned because they cannot properly care for their patients, including those experiencing severe pregnancy complications. Obstetricians and medical school residents don’t want to work in these states, creating maternal health deserts.” 

One of Trump’s first presidential actions in 2017 was to prohibit foreign NGOs from receiving US government funding for health if they “provided, promoted, or discussed” abortion – known as the Expanded Global Gag Rule (GGR). 

Many family planning organisations lost their funding and women lost access to contraception in some of the continent’s poorest countries such as Madagascar and Ethiopia – ironically contributing to more unplanned pregnancies.

While legal abortion is out of the reach of most African women and girls, 19 African countries have eased access since 1994 – mostly in an attempt to reduce the maternal deaths caused by unsafe abortions.

But US groups have campaigned against this easing in Africa, led most recently by former Trump administration officials Valerie Huber, and Alma Golden.

Huber was the architect of an anti-abortion pact, the Geneva Consensus Declaration (GCD), adopted in the dying weeks of Trump’s rule in October 2020 with the support of an array of global human-rights polecats such as Iraq, Uganda, Belarus and Sudan.

The GCD also promotes “the natural family” – primarly aimed at removing any recognition of the existence of  LGBTQ people.

While Biden withdrew the US from the GCD, Trump has promised to rejoin it  “to reject the globalist claim of an international right to abortion.”

Project 2025, the controversial conservative blueprint for a Trump victory written primarily by his former officials, proposes that all US aid including humanitarian assistance, should be conditional on the rejection of abortion.

“Proposed measures for USAID [US Agency for International Development] include a significant restructuring, and reduction of budget, the removal of diversity, equity, and inclusion programs, and dismantling of the apparatus that supports gender equality and LGBTQ+ rights,” notes researcher Malayah Harper in an analysis of Project 2025.

In 2023, Republican congressional lobbying even put the brakes on the US President’s Emergency Plan for AIDS Relief (PEPFAR), claiming – incorrectly – that some grant recipients were promoting abortion. As a result of the right-wing lobby, PEPFAR projects now receive yearly budgets instead of five-year funding

Why it matters

Abortion bans have never stopped women and girls from trying to end unwanted pregnancies. It has simply driven them to unsafe providers whose methods often maim and even kill them.

Approximately 6.2 million women and girls had abortions in Sub-Saharan Africa in 2019, and the region has the highest rate of unplanned pregnancies and abortion-related deaths in the world – 185 maternal deaths per 100,000 abortions, according to  Guttmacher.

Reaction

Nancy Northup, CEO of the Center for Reproductive Rights (CRR), said that Trump’s re-election means “anti-rights extremists will soon be back in charge of the White House and the US Senate, wielding power to the detriment of vulnerable populations and seeking to undermine decades of progress on gender equality, a lynchpin of which is the ability of individuals to make decisions about their reproductive lives and have access to reproductive health care.”

Northup, whose organisation uses the law to advance reproductive rights, said the CRR “will scrutinize every action of the White House and federal agencies, amass the factual and legal record to counter agency actions, and work to stop harmful policies from going into effect.

“If they do, we will take them to court. We will vehemently fight any effort to pass a national abortion ban, to stop the provision of medication abortion by mail, to block women from crossing state lines to get care, to dismantle UN protections for reproductive rights and progress made at the national level in countries around the world, and more.”

Saoyo Tabitha Griffith, a Kenyan high court lawyer and women’s rights activist, warned that “African women and LGBTQ people must anticipate that Trump’s return will re-ignite an ideological war with real and physical consequences on their bodies”.

“Issues such as contraceptives, surrogacy, single parenting, safe abortion, HPV vaccines and sexual orientation are all going to be contested, not through science and data but by conspiracies and misinformation,” she added.

Image Credits: Mika Baumeister/ Unsplash, Clay Kaufmann/ Unsplash, Center for Reproductive Rights.

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