For decades, the United States has wielded considerable power in determining the direction of global health policies and programs, and President Donald Trump has issued three executive orders on the first day of office it could signal the end of that era, health policy experts say.

Trump order to: remove from the World Health Organization means the U.S. likely won't be at the table in February when the WHO's executive board meets next. ​on how to share critical data, treatments and vaccines during international emergencies. If the US is absent, it will cede power to others.

“It's just stupid,” said Kenneth Bernard, a visiting fellow at Stanford University's Hoover Institution who served as a top biodefense official during the George W. Bush administration. , he said, “which is clearly not in America's best interest.”

Executive orders withdrawal from WTO and re-evaluates America approach to international assistance citing the WHO's “mishandling of the COVID-19 pandemic” and saying that US aid serves to “destabilize world peace.” In the process, they reiterate the priorities that have been established Project 2025“Leadership mandate”, a conservative policy project From the Heritage Foundation.

The 922-page report said the U.S. “should be ready” to withdraw from the WTO, citing its “blatant failure” and recommended a review of the State Department's international aid for pursuing a divisive political and cultural agenda abroad that promotes abortion, climate extremism, gender radicalism and perceived interventions against systemic racism,” the report said.

As one of the world's largest funders of global health, through both international and national agencies such as the WHO and the US Agency for International Development, America's retreat could curtail efforts to provide life-saving health care and fight deadly outbreaks, especially at low levels. income countries without the means to do so alone.

“Not only does this make Americans less safe, it also makes citizens of other nations less safe,” said Tom Bolicki, director of global health at the Council on Foreign Relations.

“The United States cannot insulate itself from transnational health threats,” he added, referring to policies that block travelers from countries with disease outbreaks evidence around travel bans shows that they provide a false sense of security and distract nations from the actions they need to take domestically to ensure their own security.”

Less than 1%

Technically, countries cannot withdraw from the WTO after a year of formal notification, but Trump's executive order refers to its termination notice starting in 2020. If Congress or the public pushes backthe administration can claim that more than a year has passed.

Trump has suspended WHO funding in 2020, a measure that does not require congressional approval. US investment in the agency has dropped to a minimum $163 million During the first year of COVID, lagging behind Germany and the Gates Foundation, former President Joe Biden restored US membership and payments. In 2023, the country gave WTO $481 million.

As for 2024, Suery Moon, co-director of the Center for Global Health at the Geneva Graduate Institute, said the Biden administration has paid: I owe two years An early issue for 2024-25, which will cover a portion of this year's payments.

The executive order cited “unfairly burdensome payments” as a percentage of their gross domestic product, meaning the United States, the world's richest nation, paid more overall than others. countries.

Funding for the WHO is about 4% of America's budget for global healthwhich in turn accounts for less than 0.1% of US federal spending each year. At about $3.4 billion, WHO's entire budget is roughly one-third that of the Centers for Disease Control and Prevention, which received $9.3 billion in core funding in 2023.

It WHO measures support programs to prevent and treat polio, tuberculosis, malaria, measles, and other diseases, especially in countries struggling to provide domestic health care.The organization also responds to health emergencies in conflict zones, including those where the U.S. government is not operating in parts of Gaza, Sudan, and the Democratic Republic of the Congo, among others.

In January 2020, WHO warned the world about the danger COVID: the outbreak sounding its loudest alarm; Over the next two years, it reviewed diagnostic tests and potential cures for COVID, regularly updated the public and advised countries on steps to keep citizens safe.

Experts cited the agency's missteps, however many analyzes show that domestic issues are the reason the US has the world's highest death rate from COVID. “All countries received the WHO alert of a public health emergency of international concern,” Bolicki said. Taiwan and others responded aggressively to it, but the US did not.”

“It's a red herring”

However, Trump's executive order accuses the WHO of “mishandling” the pandemic and “failing to adopt urgently needed reforms.” In fact, the WTO has made some changes through bureaucratic processes that involve the input of countries that belong to it.Last year, for example, the organization adopted several changes to its regulations on health emergencies.These include provisions for transparent reporting and coordinated funding.

“If the Trump administration tried to push some reforms for a year and then they were disappointed, I might find the reform line credible,” Moon said. “But to me, that's a red herring.”

“I don't buy the explanations,” Bernard said. “It's not about money,” he added. “There is no justification for leaving the WTO that makes sense, including our problems with China.”

Trump has accused the WHO of complicity in China's failure to openly investigate the origins of COVID, which he refers to in the executive order as “improper political influence.”

“The World Health Organization has shamefully covered the Chinese Communist Party's tracks at every turn,” Trump said. video published on social media in 2023.

Many times the WTO has called for transparency From China. The agency has no legal authority to force China or any other country to do what it says, which also belies Trump's warnings that the pandemic agreement being negotiated at the WTO impinges on American sovereignty can better cooperate in the next pandemic.

Trump's executive order calls on the US to “cease negotiations” on the pandemic agreement. This means the pharmaceutical industry could lose one of its staunchest advocates as the debate moves forward.

So far, the United States and the European Union have sided with lobbying in the negotiations pharmaceutical industry to protect strict patent rights on drugs and vaccines opposing efforts from middle-income countries in Asia, Africa, and Latin America to include licensing agreements that would allow more companies to produce drugs and vaccines when supplies are running low during a crisis.A the study was published in Nature Medicine it was estimated that more than a million lives would be saved if COVID vaccines were available globally by 2021.

“When the U.S. is gone, for better or for worse, there will be less pressure on certain positions,” Moon said.

“This is a moment of geopolitical shift because the US is making itself less relevant,” said Ayoade Alakija, president of the African Union Vaccine Delivery Alliance.Alakija said countries with developing economies in Asia and Africa could now contribute more money to the WTO, to change policies and set agendas that were previously opposed by the US and European countries fighting the war in Ukraine, “Power is changing hands.” said Alakija. “Maybe it will give us a fairer and more just world in the long run.”

Feedback from the project 2025

However, the WHO is unlikely to fully recoup its losses anytime soon, Moon said, with funds typically accounting for about 15% of its budget executive order which freezes international aid for 90 days, a lack of money could prevent many people from receiving life-saving treatment for HIV, malaria and other diseases.

Another loss is the scientific collaboration that takes place at the WHO and the 70 or so centers it hosts at US institutions such as Columbia University and Johns Hopkins University.Through these networks, scientists share findings despite political animosity between countries :

A: the third executive order directs the secretary of state to ensure the department's programs are “consistent with America First foreign policy.” It follows an order to freeze international aid “to be consistent with United States foreign policy.” That order says U.S. aid has served to “destabilize world peace; promoting ideas in foreign countries that are directly opposed to harmonious and stable relations”.

These and executive orders on climate policy follow policy agendas expressed by Project 2025. Although Trump and his new administration have departed from the Heritage Foundation's playbook, CBS News reviewed employment history of 38 key authors and found that at least 28 of them worked in the first Trump administration.

He was one of its main architects Russell Wuthwho served as director of the Office of Management and Budget in Trump's first term and is running for it again. Many of Project 2025's investors are from the America First Legal Fund, a group led by Trump adviser Stephen Miller that has filed complaints against “woke corporations.”

Project 2025 recommends cutting international aid to programs and organizations focused on climate change and reproductive health, and redirecting resources to “strengthening the foundations of free markets,” lowering taxes and deregulating businesses as a path to economic stability.

Several experts said the executive orders appear to be about ideological rather than strategic posturing.

The White House did not respond to questions about its executive orders on global health. “We're referring you to the White House.”

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