5 Trump-era global health policies a Biden administration might undo

U.S. president-elect Joe Biden and vice president-elect Kamala Harris. Photo by: Andrew Harnik / Reuters

MANILA — When Joe Biden takes over the White House in January, global health is one area where he will likely take a very different approach from his predecessor.

As president, Donald Trump has made a number of controversial policy decisions related to global health, including severing ties with the World Health Organization, expanding the so-called “global gag rule,” and defunding United Nations agencies.

Biden victory will mark a return to 'normality,' development experts say

After years of budget battles, Joe Biden's victory in the U.S. presidential election was a moment of "tremendous relief" for many in the development community. Here's what his presidency may mean for the sector.

Biden and vice president-elect Kamala Harris have said they will “immediately restore” the U.S. government's relationship with WHO as part of a seven-point plan to beat the COVID-19 pandemic. Health advocates hope they will reverse a range of other Trump administration decisions too.

Here are five global health policies where a Biden administration might look to reverse the course of the last four years — and how they might go about it.

1. Global gag rule

The Mexico City policy, often referred to as the global gag rule, prohibits U.S. government funding to foreign nongovernmental organizations engaged in abortion-related activities. It was one of the first decisions taken by Trump when he became president in 2017, but Trump’s version expanded the restrictions from family planning to all U.S. global health assistance. A new proposal aims to further expand the policy again to include U.S. global health contracts.

U.S. presidents decide whether to implement or revoke the policy. Historically, it’s been implemented by Republican presidents and revoked by Democrats. Former President Barack Obama rescinded the policy, and Biden has said he will do the same.

In 2019, the U.S. House of Representatives introduced legislation to permanently repeal the policy, but that failed to secure support from the Republican-dominated Senate.

2. UNFPA funding

The Trump administration has withheld funding for the U.N. Population Fund every year since 2017 by invoking the Kemp-Kasten amendment, which prohibits U.S. funding to any organization or program that supports or participates in coercive abortion or involuntary sterilization. The amendment was in response to concerns over potential UNFPA involvement in China’s population control policies, an allegation that the U.N. agency has repeatedly denied.

The amendment was first enacted in 1985 during Ronald Reagan’s term in office. U.S. presidents determine whether an organization meets the requirements or not, and thus resume or withhold funding for the organization. This means it would fall on Biden to determine whether to restore or withhold funding for UNFPA.

Much like the Mexico City policy, Republican presidents have determined UNFPA ineligible to receive funding under the amendment, while former Presidents Obama and Bill Clinton — both Democrats — restored U.S. funding to UNFPA.

Restoring U.S. funding to UNFPA is part of Biden’s plan to end violence against women.

3. US membership of WHO

How could the US withdraw from WHO?

What's the procedure for withdrawing membership of the WHO? Devex spoke to the health organization's former legal counsel and a U.S. foreign policy expert.

The Trump administration notified the U.N. Secretary-General António Guterres in July of its intention to withdraw from WHO. The decision followed months of criticism from Trump that WHO was too close to China, and that this allowed COVID-19 to spread.

Biden has said he would reverse the decision once elected.

There are no provisions in WHO’s constitution regarding member state withdrawal. The U.S. Congress set its own conditions for how withdrawal could happen when it helped to create and signed onto WHO in 1948.

It established that the U.S. would have to provide a year's notice for the withdrawal and fulfill its outstanding financial obligations to the organization. That means U.S. withdrawal notice from WHO can only take effect in July 2021.

To overturn this, the U.S. will again have to notify the U.N. chief of its intentions, according Gian Luca Burci, former WHO legal counsel and adjunct professor at the Graduate Institute of International and Development Studies of Geneva.


The Trump administration announced it would not join COVAX, the vaccines pillar of the Access to COVID-19 Tools Accelerator, the global framework meant to speed up and ensure equitable distribution of COVID-19 diagnostics, therapeutics, and vaccines.

Opinion: What the US election could mean for global COVID-19 vaccine access

The Center for Global Development's Amanda Glassman discusses why joining and allocating funding to the COVAX initiative is a priority for U.S. national security and global health leadership.

Instead, the Trump administration has focused on securing vaccine deals from a number of COVID-19 vaccine manufacturers for domestic use. The decision puts U.S. global health investments and leadership at stake, experts have argued, and could put the country’s own vaccination goals in jeopardy if any of its prepurchased COVID-19 vaccines fail to deliver.

Part of the Biden-Harris plan to beat COVID-19 is to invest $25 billion in vaccine manufacturing and distribution, and ensure every American gets access to a vaccine, cost-free. But the plan doesn’t mention joining COVAX.

The U.S. can still join COVAX however, if Biden decides to do so.

The initiative is not turning away countries that have missed the deadlines set in joining COVAX, a spokesperson for Gavi told Devex.


PREDICT, a U.S. Agency for International Development-run program whose mandate was to detect viruses with pandemic potential and train scientists in other countries to strengthen their capacities in detecting and responding to pandemic threats, was closed in September 2019.

USAID issued a six-month extension to reinstate the program from April to September 2020 to support countries in detecting COVID-19 cases and investigate the source of the virus causing the disease.

Experts found the decision to end the program unfortunate given the need for early detection work amid a predicted increase in pandemic-level global health security threats like COVID-19.

Biden and Harris said they will relaunch and strengthen PREDICT. It’s unclear how it would operate alongside USAID’s newly launched project, called Strategies to Prevent Spillover or STOP Spillover, a five-year, $100 million project aimed at addressing threats posed by emerging zoonotic diseases that could transmit from animals to humans.

The project will leverage data collected and knowledge gained from the PREDICT project to develop interventions that would reduce risk of animal-to-human transmission of dangerous pathogens, according to a news release.

About the author

  • Jenny Lei Ravelo

    Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.