New medicines, access to treatments, infectious disease monitoring, and more are on the table.
US President-elect Donald Trump has pledged to put America first in his second term – but his domestic health agenda could impact those beyond his own country.
Public health became an unlikely hot topic in the waning days of the US election, with Trump saying he would let Robert F Kennedy Jr – a prominent vaccine sceptic, environmental lawyer, member of the Kennedy political dynasty, and presidential hopeful turned Trump ally – “go wild” on federal health agencies in a bid to “make America healthy again”.
Trump is notoriously unpredictable, so it’s not clear exactly how far the duo will go, but in a post-election interview with NPR, Kennedy offered some clues.
He said Trump has given him three mandates: to rid regulatory agencies like the Food and Drug Administration (FDA) of “corruption and conflicts,” to “return the agencies to the gold standard empirically based, evidence-based science and medicine,” and to “end the chronic disease epidemic” with results in two years.
We don’t yet know whether Kennedy will become the de facto US health czar – or how long he’ll stay in Trump’s good graces – but regardless of his role, the incoming administration appears poised to curb the authority of US health and scientific agencies.
Trump’s other “America first” priorities will also deeply affect the health sector.
Some proposals, like ending the practice of adding fluoride to water, would predominantly affect Americans, but other changes could ripple across Europe. Here’s how.
Access to medicines
Trump has proposed a 10 per cent universal tariff on all imports into the US, which could affect global trade for medicines and the raw materials used for drugs as Europe is already grappling with shortages.
The US is the European Union’s main trading partner for drugs and other medicinal products, with the US accounting for 33 per cent of all EU exports and 39 per cent of imports in 2023.
“When you’ve got a system of medical supply chains which is already teetering, then to add these things in just creates more complications,” Dr Martin McKee, a professor of European public health at the London School of Hygiene and Tropical Medicine and former president of the European Public Health Association (EUPHA), told Euronews Health.
Even so, McKee cautioned that Trump’s campaign priorities may not translate to concrete policies once he is in office.
New drug and vaccine development
Trump has suggested he wants to trim the US National Institutes of Health, which invests most of its $47.7 billion (€44.1 billion) annual budget in medical research.
For example, the agency and other government grants poured $31.9 billion (€29.5 billion) into developing the mRNA COVID-19 vaccines used around the world.
“NIH is a major producer of evidence as a global public good, so cuts to NIH and disruptions there will have an impact on the world,” McKee said.
Even before the election, the European pharmaceutical sector had been pushing for more clinical trials and drug development to happen in the EU, warning that Europe is falling behind US and Chinese competition. If the US cuts go through, it could expedite that process.
Medicine regulation
Kennedy has said he wants to eliminate the “revolving door” between the FDA and the drug industry, and that the agency should not receive payments from companies that have medicines and vaccines awaiting regulatory approval.
Trump has also signalled that he could purge the FDA and other agencies. In the final months of his first term, Trump recategorised an estimated 50,000 federal workers, making it easier to fire them and hire political allies.
While President Joe Biden rolled the measure back, Trump is expected to do something similar when he retakes the White House.
Lawrence Gostin, a global health law professor at Georgetown University in the US, said the FDA is considered the global “gold standard” for determining whether medicines and vaccines are safe and effective – but that with such uncertainty swirling around the agency, its status could be in jeopardy.
“The European Medicines Agency might supplant the FDA as the gold standard if the FDA goes off track and is politically poisoned,” Gostin told Euronews Health.
Infectious disease outbreaks
Government programmes to monitor infectious diseases could also take a hit if the US Centers for Disease Control and Prevention (CDC) and other health agencies are weakened.
The CDC, for example, has been monitoring the spread of H5N1 bird flu and mpox, which both pose threats to global health. European agencies are keeping their own tabs on these threats and could be forced to do more if the US reduces its own efforts.
“To be effective and prepared for the next pandemic, which will certainly come, you need measuring stations all over the globe that collaborate very closely, and certainly the US is an important player,” Dr Ferry Breedveld, president of the Federation of European Academies of Medicine and a professor of internal medicine in Leiden University in the Netherlands, told Euronews Health.
Notably, though, CDC reform could come in a lot of forms. For example, Trump-era FDA chief Dr Scott Gottlieb recently suggested that some of the CDC’s core functions could be moved to other agencies, allowing the CDC to laser-focus on infectious diseases.
Vaccine scepticism
US policies that lead to increased vaccine scepticism may rub off in certain parts of Europe.
For example, US states look to the CDC and FDA when making decisions about which routine childhood vaccinations to require for kids to enrol in school, targeting illnesses like measles and polio.
But Trump has said he will revoke federal money from states that mandate vaccines.
Meanwhile, Kennedy – who has advanced the debunked idea that vaccines cause autism – has said that while “we’re not going to take vaccines away from anybody,” he wants additional research on vaccine safety to help people make informed decisions about whether to immunise their children.
Public health experts are concerned his rhetoric could raise unfounded fears over routine vaccines.
Americans are already less likely to vaccinate their children today than they were just a few years ago, in line with a decline in immunisation coverage across the globe. If that rate continues to fall, more US children could get sick with preventable illnesses.
Yet while Trump and Kennedy’s current plans could have serious implications in the US and around the globe, for now, there are still more questions than answers, McKee said.
“There are all sorts of uncertainties here,” he said.
