02/06/2025
News from Johns Hopkins Center for Health Security:
Trump administration moves to overhaul federal health agencies, global health influence, with potential harms to health security
The Trump administration’s recent moves to withdraw from WHO, restrict federal health agencies’ communication, and freeze all foreign aid, including that for health and humanitarian programs, represent a seismic shift in US policy with far-reaching healthand security consequences. There are many facets and factors to all these developments, but here we try to summarize some main points.
WHO withdrawal
On his first day in office, President Trump signed an executive order to initiate a process to withdraw the US from WHO and halted funding. This week, Argentina announced its intention to exit WHO, mirroring Trump’s move. WHO leadership and member states, as well as members of Congress, have urged the US to reconsider its position.
Impact:
· A US withdrawal would create a leadership vacuum in global health governance, potentially opening the door for China to expand its influence in the arena.
· As the largest donor in both assessed and voluntary contributions, the US withdrawal could reduce WHO's budget, particularly beginning in 2026. The US was set to provide US$900 million in total funding for 2024-2025, but it has yet to pay its full fees for that period.
· The US withdrawal will weaken international cooperation on pandemic preparedness and response, threaten the availability of technical guidance and data on emerging health threats, and exacerbate health inequities worldwide.
· Notably, the withdrawal will weaken the US’s potential to respond to infectious disease threats, such as Ebola and mpox, both domestically and abroad at a time when ongoing outbreaks necessitate protective measures.
What to watch:
· Other countries could potentially follow suit in leaving WHO. Officials in Hungary and Russia already have signaled favor of their nations’ withdrawal.
· Without US support and funding, and the potential for other nations’ withdrawal, WHO could become destabilized and lose its ability to function effectively. Already, the International Pandemic Preparedness Secretariat (IPPS) says the world is unprepared for the next global pandemic.
· China or another country could take on greater influence in global health governance.
Foreign aid freeze and dismantling of USAID
Also on his first day in office, President Trump signed a different executive order that calls for a 90-day pause in new foreign assistance obligations and disbursements pending review of all foreign aid programs. A notice sent on January 24 went further, calling for a freeze on all existing foreign assistance and stop-work orders for nearly all existing programs supported by these funds, including global health efforts such as PEPFAR.
Impact:
· Though a limited waiver was issued a week later, allowing “life-saving” services to restart, many remain paralyzed due to confusion over which programs fall under the waiver and subsequent staff cuts.
· Over the weekend, Elon Musk, a “special government employee” of President Trump’s, indicated on his social media platform that USAID—the world’s largest provider of humanitarian assistance—would be dismantled. The independent agency’s website went dark, social media accounts disappeared, and its more than 10,000 employees were locked out of their email accounts. The USAID website now displays a message stating that most employees will be placed on administrative leave on February 7 and all overseas staff will be repatriated within 30 days, with few exceptions.
What to watch:
· Secretary of State Marco Rubio is now in charge of whatever is left of USAID. A group of 37 US senators sent a letter to him this week asking about the legality of the stop-work orders, furloughs, and overall efforts to seemingly eliminate the agency, which they said disregard laws and harm US national security.
· The Congressional Research Service published an explainer of whether the Trump administration has the authority to abolish or restructure the agency, and what happens to USAID’s resources if such actions are undertaken. The document leaves open the possibility for Congress to initiate oversight activities.
· Many observers—even those who feel USAID needs reform—said that dismantling the organization will severely wound US soft power, opening the door to China, Russia, or others to fill that void. In fact, authoritarian governments worldwide appeared to delight in President Trump’s dismantlement of the foreign aid agency, which many hardline leaders view as a threat.
· With the shutdown of programs that deliver medicines, treatment, food, and other humanitarian assistance, analysts predict many thousands, even millions, of lives will be harmed or lost. One report estimated that more than 8,000 women and girls will die from complications during pregnancy and childbirth over the course of a 90-day freeze.
· The cessation of PEPFAR services alone threatens the lives of more than 20 million people worldwide, including 500,000 children; risks reversing decades of progress made against HIV; and could spur the emergence of drug-resistant HIV strains.
CDC data disappearance and communication ban
Two other executive orders signed on January 20 set in motion the removal of thousands of web pages and datasets from government websites, particularly affecting health agencies such as CDC and NIH and topics including gender, vaccines, and climate change. The information is being reviewed and either altered or removed permanently to comply with the executive orders by deleting any mention of gender, DEI, and accessibility. Additionally, CDC staff were ordered to halt all communication with WHO and to withdraw any research papers submitted to journals. These moves havesignificant implications for public health, including the loss of technical guidance for clinicians and parents and diminished ability to respond to health threats, such as bird flu. Some communications from federal health agencies are now allowed, but many remained blocked.
The bottom line
While it is normal for new presidential administrations to make changes and shifts to operations, Trump's recent actions risk creating rifts in global health leadership and disease surveillance, potentially leaving the US vulnerable to health threats. In addition to possibly weakening health security in the US, the long-term consequences could extend beyond public health, affecting diplomatic relationships, economic stability, and national security.
