A Trump win could reshape global health. Is Europe ready to step up?

Between emerging diseases and pandemic threats, abortion and reproductive health, climate change, and humanitarian aid to war zones, Donald Trump and Kamala Harris have wildly divergent visions for global health, with the outcome in next week’s US presidential election likely to reverberate across Europe and the world.

Trump’s former administration offers a solid clue about his approach to global health. Most notably, he cut funding and started pulling the US out of the World Health Organization (WHO) and opted not to join the COVID-19 vaccine-sharing programme COVAX.

At the time, Germany boosted its funding to the WHO from $359.2 million (€321.9 million) to more than $1.26 billion (€1.1 billion) – briefly becoming its biggest donor – but it’s not clear that would happen again today with budget cuts and a conservative shift across Europe.

“What we saw during COVID with Germany was very important, but may have been exceptional in crisis circumstances, with different leadership,” Suerie Moon, co-director of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva, told Euronews Health.

How Trump 2.0 would affect Europe on health

In a second term, Moon said Trump may seek to undermine negotiations over a global pandemic treaty.

Talks are slated to resume on Monday and while negotiators want to get the agreement finished by the end of the year, it’s already been delayed.

Reproductive health initiatives would also be disrupted. Depending on their political party, US presidents tend to either roll back or reinstate the Mexico City Policy, which bans foreign nongovernmental organisations (NGOs) from offering or advertising abortions as a condition for getting US family planning funding.

Trump significantly expanded the ban and would likely do so again if he goes back to the White House. Last time around, in 2017, a Dutch-led fund raised €260 million for international sexual health groups that lost money as a result of the Trump-era restrictions.

But given the US significantly outspends Europe on global sexual and reproductive rights – it allocated $9.4 billion (€8.4 billion) in 2022 – when the US pulls back it “will never be possible to completely balance out this massive gap,” said Lisa Goerlitz, head of the Brussels office for Deutsche Stiftung Weltbevoelkerung, a German advocacy group focused on sexual and reproductive health and neglected diseases.

Money isn’t the only challenge. A Trump win would test Europeans’ political commitment to global health – and leaders may not have the appetite to take it on.

“The impact on global health of another Trump administration could be worse this time than last time, and Europe might be in a worse place to respond and to step up than it was last time,” Goerlitz said.

Notably, European Commission chief Ursula von der Leyen has been supportive of the EU’s Global Health Strategy, which was adopted in the wake of the COVID-19 pandemic and has positioned the EU as a key supporter of Africa’s push to shore up its own health capabilities.

But earlier this year EU leaders diverted €1 billion that had been set aside for health crises to support Ukraine, and the incoming Commission’s health portfolio is spread across multiple people, suggesting health may not be the political priority it once was.

EU countries are also grappling with debates over how close they want to be to the EU, which could affect their willingness to coordinate more on health issues.

“The European Commission is trying to put Europe as a leader in global health, but then these countries are trying to push away from it,” Dr Muhammad Jawad Noon, a physician affiliated with Harvard University who was previously based in Germany, told Euronews Health. “That’s another tension”.

Kamala Harris presidency could bring its own changes

A Harris administration would likely take a similar approach to global health as President Joe Biden.

Funding for sexual health programmes increased under Biden, for example, and Harris’ team would likely stay involved in pandemic treaty negotiations.

However, support for global HIV/AIDS efforts could be at risk.

This year, the Biden administration said it would slash funding for the US “president’s emergency plan for AIDS relief (Pepfar)”, which is credited with saving 25 million lives in Africa over the past 20 years. The programme was re-authorised for just one additional year after being caught up in a political fight about abortion.

The Pepfar saga underscores how domestic politics impact global health and foreign policy – a dynamic that both the US and Europe will be grappling with over the next few years.

Regardless of who takes the White House, Moon expects both European and US global health priorities to shift away from development aid for lower-income countries and toward addressing shared health challenges, such as pandemic preparedness and antimicrobial resistance (AMR), in an effort to make those issues more appealing to voters at home.

“There’s a likelihood that Europe will prioritise more issues that it can make the case to its own citizens,” Moon said.

“These are issues that we need to handle to protect ourselves, as well as to contribute to health in the rest of the world”.

That means a focus on the “health concerns of Europeans, as well as supporting and protecting the health of people everywhere else in the world. And that’s a very different rationale from what we’ve had dominating global health for the last 20, 30 years,” Moon added.