If Donald Trump returns to the White House in 2024, experts warn that global health priorities could face significant disruption, with Europe facing a tough decision about how much to step in to fill the void left by a US retreat from international health leadership. While Trump’s previous term offers some insights into what to expect, the global health landscape in 2024 is far more complex, with issues like emerging diseases, reproductive rights, and climate change likely to be at the forefront.
Trump’s Impact on Global Health: A Backward Step?
Trump’s first term in office set a precedent for his approach to global health: a retreat from international partnerships and health organizations. His administration pulled the US out of the World Health Organization (WHO) and declined to join the COVAX vaccine-sharing initiative, which was a major global effort to ensure equitable access to COVID-19 vaccines. As a result, Europe, particularly Germany, stepped in to fill the funding gaps. Germany, for instance, boosted its WHO contributions from $359 million (€321.9 million) to more than $1.26 billion (€1.1 billion), briefly becoming the organization’s largest donor.
However, experts suggest that Europe may be less able to repeat this support if Trump wins a second term, particularly with the financial strain from post-pandemic recovery and rising geopolitical tensions.
“What we saw with Germany during COVID was remarkable, but it was largely a response to an exceptional crisis,” said Suerie Moon, co-director of the Global Health Centre in Geneva. “Under current budget constraints and with Europe’s shifting political mood, it’s not clear that European countries would step up in the same way again.”
What Could Trump Do Differently in a Second Term?
In a second term, Trump is expected to continue his “America First” approach, which could undermine global health cooperation. He may further weaken international agreements, such as the global pandemic treaty that is currently under negotiation. These talks, which resumed this week, are aimed at creating a comprehensive framework for future global health emergencies. Given Trump’s history of undermining international agreements, he may push to block any efforts to establish binding commitments on pandemic preparedness or health equity.
On reproductive health, Trump’s legacy could again come into play. Under his previous administration, the so-called Mexico City Policy, which bars foreign NGOs from receiving US funding if they provide or promote abortion services, was significantly expanded. If Trump returns to power, it is likely he would extend these restrictions even further. This would have major repercussions for sexual and reproductive health programs globally, especially in low- and middle-income countries that rely on US funding.
Lisa Goerlitz, the head of the Brussels office for Deutsche Stiftung Weltbevoelkerung (a German advocacy group focused on sexual and reproductive health), emphasized the challenge Europe faces in filling the gap. The US allocated $9.4 billion (€8.4 billion) in 2022 alone to global sexual and reproductive health programs—far more than Europe contributes. “When the US pulls back, Europe simply cannot balance that massive funding gap,” Goerlitz noted.
But money is just one part of the puzzle. A Trump administration would also test Europe’s political will to lead on global health. There is already growing skepticism within EU member states about further integration on global health issues, and some may be reluctant to take on a larger leadership role.
Will Europe Step Up?
Despite these challenges, Europe has made strides in shaping global health in recent years. European Commission President Ursula von der Leyen has been a strong advocate for the EU’s Global Health Strategy, which was adopted in the wake of the COVID-19 pandemic. This strategy emphasizes the EU’s support for health systems in low-income countries, particularly in Africa. However, the EU’s political focus is shifting, and recent budget decisions show a reallocation of funds. For example, €1 billion earmarked for health crises was redirected to support Ukraine’s war efforts.
Dr. Muhammad Jawad Noon, a physician affiliated with Harvard University, noted that the EU is facing internal tensions on how closely countries want to align with EU-wide initiatives. “The European Commission is trying to position Europe as a leader in global health, but some member states are reluctant to take that on, preferring to keep their sovereignty,” he said.
Kamala Harris’s Approach to Global Health
In contrast, Kamala Harris, if elected president, would likely follow the health policies of her running mate, Joe Biden, focusing on strengthening global health partnerships and funding for programs like sexual and reproductive health. Under Biden, funding for sexual health initiatives increased, and it is expected that Harris would maintain this support.
However, challenges would remain, especially with ongoing debates about funding for HIV/AIDS programs. The Biden administration recently proposed cuts to the “President’s Emergency Plan for AIDS Relief” (PEPFAR), which has saved millions of lives in Africa over the past two decades. Such decisions highlight the ways in which domestic politics—particularly partisan divides—can have far-reaching consequences for global health.
The Future of Global Health: Shifting Priorities
No matter who wins the election, both the US and Europe are expected to shift their focus in global health. Pandemic preparedness, antimicrobial resistance (AMR), and other health challenges that transcend national borders will likely become a more central part of both regions’ strategies. Suerie Moon points out that “both Europe and the US will prioritize health issues that can be presented as essential to their own populations’ security—issues like pandemic preparedness and antimicrobial resistance. These are more politically appealing to domestic audiences than traditional development aid for lower-income countries.”
This approach would mark a shift away from global health as a primarily altruistic endeavor and move toward a more self-interested model, in which both Europe and the US focus on health issues that directly affect their populations. However, this new focus on self-interest could undermine efforts to address health inequalities globally.
Conclusion: Europe Faces Tough Choices
A second Trump term could lead to a further withdrawal from global health leadership by the US, leaving Europe to fill the gap. However, Europe’s political and financial capacity to do so remains uncertain, especially with rising domestic challenges and growing skepticism about deeper integration on global health issues. Meanwhile, a Harris administration would likely continue Biden’s approach, which includes strong support for global health programs but may face challenges in securing consistent funding and addressing the growing political divisions at home.
In either case, the global health landscape will likely see significant shifts in priorities, with Europe and the US focusing more on domestic health security issues. How this dynamic will play out in practice remains to be seen, but one thing is clear: the next US president will have a profound impact on the direction of global health for years to come.