Trump’s Earthquake and its Aftershocks: How the Implosion of the Global Health System Increases Inequality, Weakens Global Governance and Threatens Us All

The return of Donald Trump to the U.S. presidency represents a major disruption for an already fragile system of international health cooperation. Even before his re-election, donor fatigue, a weakened 2030 Sustainable Development Agenda, and overlapping crises —from pandemics and climate disasters to conflicts and economic instability— were straining global health systems. Now, Trump’s return threatens to further destabilize this delicate landscape.

Historically, the U.S. has been the largest contributor to global health, supporting multilateral organizations, research, and emergency response. The second Trump administration is withdrawing these critical resources, forcing global health institutions to reassess strategies, partnerships, and governance. Simultaneously, European donors are also reducing development aid, worsening the funding crisis.

The past decades have seen extraordinary global health achievements —from eradicating smallpox and reducing polio by over 99%, to expanding HIV treatment and rapidly deploying COVID-19 vaccines. These milestones show what coordinated global action can accomplish. However, such progress is now at risk. Trump’s “America First” approach prioritizes domestic interests over international collaboration, undermining long-term investments in global health security while consistently attacking and jeopardizing science and research. This narrow vision ignores the reality that health threats transcend borders.

In this shifting geopolitical environment, this analysis, written by Sydney Jennings, Claudia García-Vaz, Elizabeth Diago-Navarro and Gonzalo Fanjul, explores the consequences a second Trump term —marked by repeated attacks on science and international cooperation— is having on an increasingly constrained global aid ecosystem, and outlines what can be done to mitigate the damage. Key recommendations aim for a strategic rethinking of global health financing, governance, research and innovation. As traditional leadership and funding models shift, new actors and alliances must emerge to ensure resilience and equality. The response must not be limited to a mere exercise in reconstruction, but rather a reconsideration of some of the foundations on which we have worked until now.

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