Donald Trump must be loving the shutdown. Free to roam the White House grounds with barely a soul in sight. Fewer germs to be spread around. For Trump does not like germs; he doesn’t even like health workers who protect people from the spread of germs (“KEEP THEM OUT OF HERE”), and he wants to cut the budget of key agencies that monitor and control germs around the world.
He certainly does not want to be working with other states and “s***hole countries” to manage and respond to global health security threats.
His inauguration as the 45th president of the US two years ago was therefore understandably met with alarm across the global health community. How would he respond to a pandemic? What would happen to Obamacare? Would he cut the budget of the Centre for Disease Control? The apparent gung-ho attitude during this latest US government shutdown only adds to the feeling of insecurity, and the sense that this is a confounding new reality.
Fundamentally, people working in global health could not understand how, when presented with facts and evidence, an electorate would vote for someone who did not believe in facts and evidence. No one trusted him to keep up US contributions to global health funding, diplomacy and leadership.
In part, such fears were well founded. One of the first things Trump did in office was to reinstate the Mexico City policy – aka the global gag rule – that would prevent any US federal funding or partners working with the US government from supporting abortion services, advocacy or advice, even if the activities themselves were funded by other sources.
This is a significant blow to efforts on reproductive rights – the gag has historically not reduced the number of abortions, it has just increased the number of unsafe abortions.
However, it is worth remembering that the global gag rule is not just a Trump issue. As Sara Davies and I argue in a recently published paper, reproductive rights have long been a political football. The norm in the international community has not been the provision of reproductive rights, but the curtailment. Trump is just adhering to this norm.
Given the concern and threat to what could have been, global health has thus far gotten off lightly under the Trump administration. The president’s Emergency Plan for HIV/Aids Relief (Pepfar) – a vital intervention that has changed the game and prolonged millions of lives for people living with HIV/Aids around the world – was reauthorised in November 2018.
This prompted a major sigh of relief for the international HIV/Aids community.
Trump has said nothing on the Ebola outbreak in the Democratic Republic of Congo. Trump has said nothing on the sexual harassment scandal in the Joint United Nations Programme on HIV and Aids. In public at least, he does not care about global health.
But this should not detract from the more worrying aspect of his presidency and its implications for global health. Anti-expert, anti-gender, anti-human rights, and increasingly isolationist tendencies run contrary to many of the founding ideas of global health governance.
Expert critique of Trump only fuels his core support base. The more global health experts use evidence to criticise his policies; the more they are framed as an out of touch elite. The more they use studies to show the efficacy of vaccination, the more they are framed as controlling everyday people.
This is the real tricky dilemma of the Trump presidency for the global health community: the tools we use to secure the health of the world no longer work with more and more of the world’s politicians.
This year will see the global health community face increasing resistance from politicians and a public that has lost trust in experts, fact, and evidence. When Trump can show the kind of intransigence on display during this tough few weeks for US public workers, it is clear that we will need new tools and political savvy to manage this new, and post-expert, world.
Sophie Harman is professor of International Politics at Queen Mary University of London
This opinion piece is drawn from a longer article with Sara E Davies ‘President Donald Trump as global health’s displacement activity’, published in the Review of International Studies
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