Dr Maidah* and Dr Sheraz Ahmad Khan**
The United States presidential election on Tuesday, November 5, 2024, culminated in Donald Trump securing both the popular vote and the Electoral College, reclaiming the presidency with a decisive mandate.
With control of the presidency and both chambers of Congress—a political trifecta—Trump’s authority is firmly established. This unprecedented consolidation of power positions him to significantly influence global politics, including the critical sector of global health.
As cautious optimists, we hope the Trump administration will harness soft power strategies, such as championing global health initiatives, to align with the ethos of Making America Great Again (MAGA).
A renewed U.S. withdrawal from the World Health Organization (WHO), however, would stand in stark contrast to that vision—an outcome we fervently hope to avoid.
The US has been a key contributor to global health initiatives. It donated $1.402 billion to UNICEF’s initiatives in 2023 and was the largest donor to UNAIDS in 2022, with $90.4 million.
The US President’s Emergency Plan for AIDS Relief (PEPFAR) focuses on combating HIV/AIDS by providing life-saving antiretroviral therapy (ART) to over 20 million people.
It consolidated the US position as the leading donor by pledging $6 billion during the Global Fund’s sixth replenishment in 2022.
GAVI, the Vaccine Alliance, and initiatives like COVAX, the Coalition for Epidemic Preparedness Innovations (CEPI), the National Institutes of Health (NIH), and the Centers for Disease Control and Prevention (CDC) collaborate with international agencies to develop vaccines, treatments, and diagnostic tools.
For Trump, stepping away from leadership is not an option. Funding gaps and weakened partnerships could severely impede vaccine distribution and epidemic responses if the U.S. withdraws from global health leadership.
Abandoning this space may not serve U.S. interests either. While other nations might struggle to fill the void, competing powers like the BRICS could eventually bridge the gap over time.
The U.S. has historically supported global health through assessed and voluntary contributions.
These funds have been instrumental in emergency health responses to outbreaks, immunization campaigns, and providing technical assistance to help countries develop health policies and train healthcare workers. The U.S. remains a critical partner in strengthening global health security.
The U.S. initiated its withdrawal from the WHO in 2020 under Trump, but President Joe Biden reversed this decision in early 2021, reinstating membership and funding before the withdrawal could take effect.
As one of the WHO’s largest contributors, the withdrawal risked creating a considerable financial deficit and operational challenges for the organization.
In previous funding crises, such as in 2016, nations like Germany and the United Kingdom (UK) stepped in to provide support. However, the current global landscape makes similar interventions significantly more challenging.
If Trump withdraws from global health leadership, the ability of other countries to bridge the resulting gap remains highly uncertain, particularly in the face of today’s geopolitical and economic pressures.
Scaling back U.S. global health funding, coupled with a potential reduction in support for the Ukraine war, would place the European Union (EU) in a difficult position.
The EU would face the dual challenge of filling two critical voids—global health leadership and military support—while grappling with economic pressures and strained budgets.
Complexity theory offers a valuable framework to understand and tackle these challenges. Global health systems, akin to complex adaptive systems, rely on collaboration, adaptability, and resilience to navigate the interconnected crises of the 21st century.
Addressing these challenges requires leveraging principles of complexity—such as interdependence, decentralization, and system-wide innovation—to craft solutions that engage diverse stakeholders and ensure sustained contributions to global health.
No single entity can fully replace the scale of U.S. contributions to global health. Likewise, no singular foreign policy approach can maintain the U.S.’s global influence.
Global health diplomacy will inevitably intersect with great power politics.
With its geoeconomic influence, China could play a role, but strategic competition between the U.S. and China might limit its effectiveness as a global health leader.
The EU and nations like Germany and France could increase their technical and financial contributions.
However, economic slowdowns in these countries and the ongoing war in Ukraine may constrain their capacity to prioritize global health over security concerns.
Private philanthropies, such as the Gates Foundation, and regional organizations, like the African CDC, could step in. However, their resources and scope are unlikely to match the scale of U.S. funding.
Without robust leadership, decentralization risks fragmenting global health security, potentially leading to broader geopolitical paradigm shifts.
By prioritizing global health solidarity, the U.S. can bolster alliances, mitigate future pandemics, and position itself as an indispensable global health leader.
For Trump in this second term, championing global health could redefine his legacy and strategic leadership that transcends borders, bolstering his global image and promoting MAGA beyond the American borders.
*Dr. Maidah, MBBS, IPFPH, is currently a Research fellow at the Global Health Department at Health Services Academy; Dr. Sheraz Ahmad Khan, PhD, MPH, MBBS, is currently Dean of the Global Health Department at Health Services Academy
*The views expressed in this article are solely those of the authors and do not necessarily reflect the opinions or positions of The Diplomatic Insight. The organisation does not endorse or take responsibility for the content presented.
