How Will Trump’s Govt Impact Health Policy Abroad?

It’s been 2 weeks since election day, and US President-Elect Donald Trump’s transition team is nominating candidates for crucial cabinet and White House positions, including the role of secretary of the Department of Health and Human Services. 

Health policy experts in Europe told Medscape Medical News that the Trump administration’s healthcare agenda could have far-reaching impacts on healthcare systems and policies abroad. 

US health policies influence global health security, and Europe could face uncertainty as it responds to shifts in US priorities, particularly regarding pharmaceutical regulations, vaccine policies, and public health initiatives.

How much Europe will be affected will largely depend on who is appointed to manage the $2 trillion US health budget and which policy priorities Trump chooses to emphasize. 

Internal Tensions Won’t Help

“Much depends on whether Robert F. Kennedy [Jr] really gets a major role in the administration,” said Martin McKee, PhD, professor of European public health and research director of the European Observatory on Health Systems and Policies at the London School of Hygiene and Tropical Medicine, United Kingdom. 

In a speech on October 27, Trump said he was going to let Kennedy “go wild” on health, food, and medicines. On November 15, it was announced that Kennedy had indeed been nominated to head the Department of Health and Human Services.

Kennedy is a prominent critic of vaccines and has also expressed opposition to water fluoridation. With Trump signaling his support, said Scott Greer, PhD, professor of health management and policy and global public health at the University of Michigan, Kennedy seems poised to influence key health agencies, including the Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA), where he may be given significant autonomy. 

But Kennedy’s skepticism toward mainstream public health practices like vaccines conflicts with the interests of influential sectors such as big pharma and agribusiness — industries crucial to Trump’s political base, said Greer. Although Trump’s rhetoric suggests a shared distrust of government agencies such as the FDA, the National Institutes of Health, and the CDC, Kennedy’s more radical views could create friction within the administration, particularly as they clash with the priorities of major donors, he added.

At the same time, the structure of the US government is highly fragmented, Greer explained. Although the president holds substantial power, enacting meaningful change requires navigating a complex web of interests and competing factions. 

This makes it difficult to predict which healthcare policies will take priority or how they will ultimately affect global health. 

This is further complicated by Trump’s leadership style, which thrives on dominance and media attention, said McKee. This distinctive approach could exacerbate conflicts with figures like Kennedy, potentially hindering efforts to implement coherent health policies. 

Donald Trump’s administration will be a “tricky place” to work in, Greer said.

A Dislike for Multilateralism

Trump’s disdain for multilateralism has been a hallmark of his foreign policy approach, and this sentiment is likely to shape his stance on global health during his second term. 

During his first term, Trump withdrew the US from several key international agreements and organizations, including the Paris Climate Agreement and the World Health Organization (WHO). His preference for bilateral agreements over multilateral cooperation reflects his “America First” philosophy, which prioritizes US interests and sovereignty, often at the expense of broader global collaboration. But given the many challenges Trump is set to face, including a civil service in disarray, McKee said it remains to be seen whether Trump will again deprioritize multilateralism.

If he does, this isolationist approach has significant implications for global health. The US has long been the largest financial contributor to global health initiatives. “The support that the US gives to global health compared to many other countries is far off the charts,” said Lisa Goerlitz, head of the German Foundation for World Population’s office in Brussels, Belgium.

US support has been critical for multilateral organizations such as the WHO, the United Nations Population Fund, and the President’s Emergency Plan for AIDS Relief, which address health crises including infectious diseases, maternal health, and family planning. A reduction in US funding or a full withdrawal from these organizations would create a vacuum in global health efforts that Europe may struggle to fill. 

“The main European donors, Germany and the UK, both face their own problems; the former political, the latter economic. It is difficult to say whether they would fill that gap,” said McKee.

The US also plays a central role in setting international health standards, coordinating pandemic responses, and facilitating global drug approvals — FDA approvals are taken into consideration in drug reviews worldwide. A US withdrawal from the WHO would weaken these efforts, making it more difficult to respond effectively to health emergencies that require global coordinated actions, explained Goerlitz.

Tariffs, Pharma, and Drug Shortages

Trump’s commitment to tariffs that aim to assert US economic interests could have wide-ranging effects on the pharmaceutical industry and global drug supply chains. 

Tariffs could intensify a shift toward localized or “near-shore” supply chains in Europe. This move would enhance resilience against global disruptions but also sacrifice efficiency and increase costs. For European consumers, this could translate into drug shortages and higher drug prices, a significant drawback at a time when affordability is critical, Greer said.

The impact on US pharmaceutical companies may be equally complex: Tariffs on raw materials and manufacturing inputs from Europe and Asia could drive up production costs, leading to drug shortages and price hikes in the US.

European Integration

Greer said Europe has repeatedly and effectively taken an integration approach to address recent major financial, refugee, and pandemic challenges, in addition to its response to the crisis in Ukraine. “Each time, they have chosen more Europe,” he said. 

He sees the second Trump administration as another “existential crisis for Europe” that may require further integration as a solution. “Europe needs to get its act together in the next couple of years,” said Greer, as the potential damage to healthcare policy by a Trump-led US could be significant. 

Goerlitz added that a united Europe will be crucial for sustaining a pro-science, multilateral approach, particularly in global health. “I do hope a bit of a countermovement could unite Europe, because we cannot afford any backlash.” 

McKee, Greer, and Goerlitz report no relevant financial relationships.

Manuela Callari is a freelance science journalist specializing in human and planetary health. Her words have been published in The Medical Republic, Rare Disease Advisor, The Guardian, MIT Technology Review, and others.