Opinion: The Trump effect on global health and development in 2025

The most significant trend that will affect global health and development in 2025 is the election of Donald J. Trump as president of the United States. A recent Science article forecasts “more mortality, more illness,” alongside potential U.S. withdrawal from the World Health Organization, cuts to USAID and the Global Fund to fight Aids, Tuberculosis and Malaria, halting of U.N. Population Fund funding, reimposition of the “global gag rule,” and targeting the U.S. President’s Emergency Plan for AIDS Relief over abortion. The nomination of Robert F. Kennedy Jr. has brought a new level of concern from commentators who identified his “three most dangerous ideas” — anti-vaxxer views, the benefits of raw milk, and anti-pharmaceutical conspiracy theories. However, one could also forecast opportunities. A core theme of this Trump administration, as signalled by his Cabinet choices, is disruption. There are potential reform paths aligned with conservative principles that could benefit global health, which I outline below. One thing is for sure: U.S. global health and development will look vastly different because of Trump’s upcoming presidency. Change is coming. If organizations don’t appreciate that and get ahead of it, they could end up underneath it. Enhancing U.S. national security National security is the quintessential reason for the U.S. to belong to WHO. Pandemics start anywhere but affect everywhere. Microbes cannot be countered bilaterally. Effective pandemic preparedness and response requires global cooperation. The updated International Health Regulations — which have been agreed by all Member States — and the Pandemic Agreement, which is still being negotiated, provide opportunities to learn the hard lessons of COVID-19 to improve global health security. More than any other function of WHO, mechanisms to prepare for, prevent, and respond to pandemics strengthen U.S. national security. As the chair of the ongoing pandemic agreement negotiations said recently, “At the heart of the negotiations is recognition that collaboration among countries will ensure the world will not be left vulnerable in the face of future pandemics, while each and every country will maintain their sovereignty and control over national health decision-making.” I hope that in 2025, the incoming U.S. administration will continue to engage to build a greater sense of comfort that the pandemic agreement does not undermine national sovereignty while it will enhance U.S. national security. Indeed, the unresolved negotiations present an opportunity for Trump to get the deal done. Focusing on results The only true justification for investment in global health is results. Even before the U.S. election, development assistance in health was falling and the donors faced a replenishment traffic jam. Global Fund and GAVI, the Vaccine Alliance have always been good at highlighting their results, but this is easier to do for vertical programs, which are disease-specific or intervention-specific initiatives. The multilateral U.N. system historically has been less good at doing so. I have proposed an approach for delivering on the SDGs called GSD, or Get Shit Done, which prioritizes governing for results, scaling innovation, and using data to target delivery. Improving the governance of multilateral agencies to focus on results costs nothing and improves value for money. WHO has come a long way under Dr. Tedros’ leadership: He has laid the foundation for a more results-based WHO during his term, with more to be done. The lessons are also relevant for a more results-based U.N. overall. One thing to watch will be the upcoming nominations/elections of heads of agencies such as the U.N. Development Program in 2025 and the U.N. itself in 2026, and the extent to which candidates emphasize results — not only in word but also with a credible plan on how to improve them. Within WHO, the thing to watch will be whether its program budget for 2026-27, which will come to the Executive Board and World Health Assembly in 2025, incorporates or improves upon the outputs of WHO’s own Investment Case — signalling that WHO plans to deliver what it promised while raising funds. These are moments when the U.S. — and all countries — can push for greater results. If Trump were to lead the transformation of the U.N. system into a genuinely results-oriented and impact driven-organization, that would be a massive and historical contribution. Scaling innovation In 2020, Trump launched Operation Warp Speed, which led to the development of COVID-19 vaccines, saving 20 million lives just in their first year of use. Now, a priority of the incoming administration is chronic disease — with a focus on healthy food. Our preliminary estimate is that 943,000 lives could be saved each year through widespread global access to GLP-1 drugs for obesity and diabetes — such as Ozempic, Mounjaro, Wegovy, and Zepbound — which is in the same order of magnitude as antiretrovirals for HIV or even childhood vaccines. Although Robert F. Kennedy Jr. has voiced skepticism regarding these drugs, Dr. Oz, nominee to lead the Centers for Medicare and Medicaid Services, has voiced support. The number of potential lives saved will, I hope, prove too large to ignore. Innovation goes beyond just products like vaccines, drugs, diagnostics, and devices, to service delivery models, such as the Friendship Bench for mental health. This approach trains lay counselors to deliver mental health services. A 2022 grant from USAID aimed to extend the approach to 1.5 million patients in Zimbabwe over the next five years. With service delivery, a key strategy will be scaling innovations that already reach 1 million people to benefit 100 million. Such innovations save and improve lives without “big pharma” or “big food” — a path that the incoming U.S. administration might find appealing. Mobilizing innovative finance During Trump’s first term, he launched the U.S. International Development Finance Corporation, which “partners with the private sector to finance solutions to the most critical challenges facing the developing world today.” Historically, development finance has supported funds such as the Global Health Investment Fund, which has shown success in social and financial returns. But traditionally, these are one-offs. The opportunity is to build a sustainable ecosystem — connecting diverse sources of capital in a capital stack. The Health Impact Investment Platform, a partnership between WHO, the European Investment Bank, and other regional development banks, provides a promising foundation for such an approach. Innovative finance partnerships can also help to improve WHO and the U.N. since these investments bring heightened accountability for results. With the return of President Trump, I expect innovative finance to continue to grow in 2025. Fostering self-reliance Results, innovation, and innovative finance lead to greater self-reliance — which is the mirror image of Trump’s “America First” philosophy. Self-reliance is the only truly sustainable form of sustainable development. Calls for self-reliance are not new, and the global health community is already embracing “localization.” However, greater self-reliance requires ongoing support and excellent national health leadership. National health leaders such as Muhammad Pate of Nigeria represent shining examples of this shift, and I expect this movement to continue to expand in 2025 and beyond. Addressing geopolitics Trump’s administration will no doubt seek to balance China’s influence in international organizations. His nomination of Elise Stefanik as U.S. Ambassador to the U.N. also signals that they will prioritize fighting antisemitism. Accordingly, in 2025, multilateral institutions could continue to demonstrate their neutrality. For example, WHO has repeatedly called on China for greater transparency in sharing data on COVID-19 origins. It can continue to do so. Similarly, antisemitism has unfortunately been increasing, especially since Oct. 7, 2023, and the U.N. system could certainly do more to fight it. For example, in August 2024 the International Federation of Medical Student Associations, or IFMSA, suspended the Federation of Israeli Medical Students. To do so, IFMSA had to suspend their own bylaw requiring an investigation, applying a double standard not used for any other country’s medical student organization. Although IFMSA has recently announced a review of membership procedures, they have not reversed their decision. The U.N., WHO, and World Medical Association — all in official relations with IFMSA — should suspend their relationships with IFMSA until it reverses this decision. In January 2025, IFMSA’s official relations with WHO are up for routine review at the WHO executive board. In 2025, I expect to see a greater emphasis on examples like these and hopefully more vigorous actions by U.N. agencies to demonstrate their neutrality and fight discrimination, consistent with their own founding principles and charters. Conclusion As baseball champion Yogi Berra said: “It’s tough to make predictions, especially about the future.” And President-elect Trump seems to value being unpredictable! Avoiding and opposing the worst excesses of disruption — especially for women’s and children’s health — will be crucial. The absence of Day One notice to leave WHO in January 2025 and reauthorization of PEPFAR in March 2025 would be early positive signs. At the same time, certain paths to reform, closely aligned with conservative principles, could improve global health and development. I predict and hope that in 2025 these paths will gain prominence.