U.S. shuns global health scene, but we can’t be healthy in unhealthy world

The first obligation of any government is to keep its people safe. This is generally interpreted as support for the military and police, yet, even in times of war, more people die from preventable diseases than from conflict.

National safety cannot be guaranteed without robust systems providing health security and capacity. The COVID-19 pandemic, in which the U.S. fared worse than many comparable countries, and the 2014-2016 Ebola epidemic in West Africa — which could have had much greater impact in the U.S. absent the control efforts overseas — illustrate how lack of preparedness makes us all vulnerable.

While domestic health issues deserve attention, they won’t be solved in isolation. Microbes do not need passports. Dangerous respiratory viruses still circulate globally.

Meanwhile, antimicrobial-resistant tuberculosis and gonorrhea, reemerging tropical diseases such as malaria, dengue and chikungunya — driven in part by climate change — are becoming less contained by geography. Noninfectious health threats spread globally through supply chains for medicines, tobacco, alcohol, illicit drugs, foods and other substances. Ideas, cultures and lifestyles are shared around the world and influence health.

Protecting national health requires protecting global health, and no country can go it alone.

U.S. progress on global health is becoming undone under Trump

In the worlds of military defense and intelligence, extensive collaboration occurs between allies. Information is shared with partner countries in timely fashion, allowing prevention or containment of hostile actions.

The same is necessary for addressing emerging, or reemerging, health challenges. Global health security requires robust health systems in all countries, including laboratory infrastructure, disease surveillance and a trained health workforce.

The U.S. has supported tremendous progress in this realm. In addition to saving millions of lives, the President’s Emergency Plan for AIDS Relief has fortified health systems that could have otherwise collapsed under threats like Ebola. U.S.-sponsored global health security efforts have expanded that progress.

In collaboration with the World Health Organization, the U.S. had, until now, supported critical global laboratory and surveillance networks and prevention and control efforts. And we had a seat at the table, early access to critical information and privileged ability to influence health actions around the globe.

That progress is being undone.

In January, President Trump declared intent to withdraw the U.S. from WHO, the only agency with convening authority across all countries relating to matters of health. This organization that represents all nations of the world but must respect national sovereignty faces inevitable challenges.

Still, walking away from WHO rather than investing in strengthening it will substantially reduce American access to health intelligence and influence.

Cuts to NIH, CDC and FDA have real-world impact on Americans

In 2024 the U.S. spent approximately $12 billion on global health aid, mostly toward HIV/AIDS, tuberculosis, malaria and maternal and child health. This spending is dwarfed by U.S. defense and Medicare budgets, but the impact is enormous.

Yet, the current administration is slashing global as well as national health spending. The United States Agency for International Development has been dismantled.

Credit: United States Mission Geneva

Dr. Kevin DeCock, former director of the HIV program at WHO and founding director of the Center for Global Health at the CDC. (Courtesy of United States Mission Geneva)

Funding and staffing for the country’s major health agencies, such as the Centers for Disease Control and Prevention , the National Institutes of Health and the Food and Drug Administration — all world famous and globally impactful — have been substantially curtailed, and research around many diseases that disable and kill Americans has been withdrawn.

These cuts will inevitably make the country weaker in terms of preparedness and response capacity for health threats both current and future, known and unknown.

But protecting our own health is only one reason for supporting global health.

We also do it because we care. Because when people suffer and lose their lives anywhere, it diminishes us here.

And finally, we do it because we have a lot to learn from other countries, especially low- and middle-income countries where poverty is a great stimulus to the kind of innovation that can help us increase efficiency and cut waste.

Right now many of our partner countries feel betrayed, and trust garnered over many years has been lost. If we act quickly to restore our ability to contribute to global health, we can rebuild that trust and save lives, both there and here.