In his first month back in the White House, U.S. President Donald Trump has taken steps that are likely to dramatically alter the landscape for global health programs around the world. In addition to ordering the U.S. to withdraw from the World Health Organization and ending U.S. participation in global agreements to address climate change and prevent future pandemics, the incoming administration signed several executive orders that have frozen most U.S. foreign aid and disallowed funding of programs that acknowledge transgender and non-binary identities. While some exceptions have been made for life-saving aid, the long-term implications for U.S.-funded global health programs such as the President’s Emergency Plan for AIDS Relief (PEPFAR), which funds HIV medications for millions of people around the world, remain unclear.
Duke Global Health Institute experts have been active in the media, sharing insights on how the administration’s actions are likely to impact public and global health in the U.S.and in countries where U.S. funding is key to preventing diseases such as HIV, tuberculosis and malaria. Here are a few of their insights from stories that have appeared in the media over the past few weeks. We will update this page with additional comments as they appear.
U.S. withdrawal from the WHO
“U.S. withdrawal may also empower authoritarian member states in the organization, like Russia and China. Public health decisions in Russia and China are “much more politically controlled, and that’s a danger to everybody. None of us wants to live in a world where Russia has a larger voice in global health governance.”
-DGHI Director Chris Beyrer, M.D., in The New York Times on Jan. 29
“A hotter world raises the risk of a spillover of pathogens from animals to humans and can push mosquitos carrying diseases like dengue and Zika into areas that previously didn’t worry about the viruses. We are in an era where there is an increased number of cross-species transmissions and outbreaks, largely due to habitat destruction and climate change.”
-Beyrer in The Mercury News on Jan. 28
The impact of freezing foreign aid
“There’s a distinction between reviewing a program, asking questions about a program, and completely freezing its lifesaving mission. What’s transpired over the last [few days] is something completely different, which is chaos, confusion and potential reversal of one of America’s greatest accomplishments.”
-Jirair Ratevosian, DrPh, Hock Fellow at DGHI and former senior advisor to PEPFAR, in The Hill on Jan. 31
“The federal freezes are catastrophic, reckless, unconscionable, and wholefully unneighborly. For those of you who profess faith in Jesus, this is not grace or loving thy neighbor or mercy or anything like Jesus. It is selfishness and power-grabbing.”
-Emily Smith, Ph.D., an assistant professor in emergency medicine and research professor of global health, as shared on her Facebook page, “Friendly Neighbor Epidemiologist,” Jan. 28
“From Tanzania to Ukraine, I’ve heard from colleagues forced to comply with directives that carry deadly consequences. According to an analysis by amfAR, some 220,000 people – including women and children – present daily to PEPFAR programs to receive HIV medications, which are lifesaving and must be taken consistently to ensure viral suppression. Now, many are being turned away.”
-Ratevosian in Health Policy Watch on Jan. 28
“This really is a major concern, but it’s not just PEPFAR, the President’s Malaria Initiative has been put on pause, the contribution to the Global Fund to fight TB (tuberculosis), AIDS and malaria; [the] pandemic preparedness fund with bird flu going on right now, the Marburg outbreak in East Africa, mPox in central Africa.. Pausing humanitarian assistance and these kinds of programs in our world is incredibly dangerous. Infectious diseases don’t take a pause… HIV doesn’t pause, hunger doesn’t pause.”
-Beyrer in DW News on Jan. 26
“People could stop going to work, and clinics could get shut down, presumably, if there’s no one there to turn the lights on. If you’re halting existing programs, that’s playing with fire as it relates to the HIV program: You stop HIV treatment that leads to drug resistance, and drug resistance elsewhere impacts drug resistance in the United States.”
-Ratevosian in Science on Jan. 24
On the nomination of Robert F. Kennedy, Jr., to lead the Department of Health and Human Services
“What’s remarkably different this time is the man Trump wants to put in charge has signaled his intent to shake things up in ways that are very concerning. [Kennedy’s] anti-science, anti-public health agenda is deeply worrying… Taken together, all of these actions will have a crushing impact on America’s health research.”
-Gavin Yamey, M.D., director of the Center for Policy Impact in Global Health, in The BMJ on Jan. 30
Gender identity and NIH research
On his first day in office, Trump issued an executive order dictating all government programs must define only two sexes and ordering that programs that acknowledge transgender or non-binary identities no longer be funded. The National Institutes of Health currently funds an estimated 1,600 research and training projects that mention gender.
“There is … very real concern,” about the fate of such studies… “particularly among younger investigators [who] want to launch careers in this area.”
-Beyrer in Science on Jan. 24
