Dean M. Harris, J.D.
June 2, 2025

Dean M. Harris, J.D., Associate Professor (Retired), Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA, Dean_Harris unc.edu.

As soon as Donald Trump began his second term as US President, he started taking steps that will cause serious harm to global public health. On the day of his inauguration for a second term, Trump took action to withdraw the US from the World Health Organization (WHO). This is not merely a symbolic gesture, because the US was one of the biggest sources of funding for WHO. Trump’s action will reduce global cooperation, and could also reduce monitoring and security of smallpox labs in the US and Russia. In addition, Trump stopped US participation in negotiations for the WHO Pandemic Agreement.

On January 24, 2025, which was 4 days after his second inauguration, Trump reinstated the Mexico City Policy, which is also known as the “Global Gag Rule.” That policy has the effect of reducing access to reproductive health services in global health programs. The policy was announced in 1984 at a conference in Mexico City by former President Ronald Reagan, who was a member of the Republican Party. That policy was routinely renewed by other Republican presidents including Donald Trump, and was routinely revoked by Democratic presidents including Joe Biden.

The Mexico City Policy does not simply prohibit US funds to perform abortion. In fact, another US law already prohibited using US funds to perform abortion, with very few exceptions. The Mexico City Policy goes much further, by generally prohibiting foreign non-governmental organizations (NGOs) that receive US government money from using money from any other source to perform, refer, provide public information, or advocate for abortion. That is the reason it is called the “Global Gag Rule.”

Before Trump’s first term as president, the policy only applied to a relatively small amount of family planning funds from the State Department and the US Agency for International Development (USAID), which totaled about $575 million. However, during his first term in office, Trump renewed and greatly expanded the policy. Trump’s expanded policy applied to more types of funding from more US government agencies, and was estimated to apply to almost $10 billion. For example, Trump’s 2017 Mexico City Policy included about $6 billion in funding for HIV/AIDS. Trump’s Mexico City Policy was revoked by President Biden in 2021, but Trump reinstated his policy on January 24, 2025. Although the policy specifically refers to abortion, it also has the effect of reducing access to other health care services outside the US. As Skuster et al explained, “[T]he US government’s attempts to limit abortion care through the gag rule also limit access to other essential sexual and reproductive health services.”

In addition, Trump has drastically cut US government funding for global health programs, such as programs funded by USAID. The US government had been a major donor of humanitarian aid in the past, including 2024 contributions for global health of about $12 billion. In January of 2025, the second Trump administration tried to effectively end USAID by stopping most funding activities, laying off most employees, and moving remaining functions to the US State Department. Over the next 10 years, experts predict that those drastic cuts in foreign aid will cause hundreds of thousands to die from HIV/AIDS, malaria, and other diseases.

Apparently, Donald Trump is opposed to providing money or resources to other people - especially to people in other countries - because he sees the world as a “zero-sum game.” He seems to believe that anything which is given to help another person hurts him in an equal amount. He has difficulty imagining a “win-win” situation, in which both sides could benefit.  Trump takes a transactional approach to relationships. He does not really value global cooperation or alliances, and he prefers to show off his power and dominance by acting, or appearing to act, entirely on his own. Trump’s approach is contrary to the basic principles of global public health. As explained by Dr. Thomas R. Frieden, a former director of the US Centers for Disease Control and Prevention (CDC), “Health is not a zero-sum game …. When one country is healthy, it helps not only them, but their neighbors and the world.”

In historical context, USAID and the modern system of foreign aid were parts of the Cold War “battle for hearts and minds” between the US and the USSR. Former US President John F. Kennedy created USAID in 1961, which was the year in which the Berlin Wall was built.

The USSR had tried to spread communism by building big projects, such as the Aswan Dam in Egypt. The US approach included efforts to influence “hearts and minds” by providing food and health care to people in foreign countries from the American people.

During Trump’s second term in office, top USAID officials warned Trump’s team about the effects of ending US funding. Over the next 10 years, it was predicted that ending USAID funding would cause as many as 166,000 deaths from malaria, 200,000 children would suffer paralysis from polio, new tuberculosis cases would increase by 30%, and 1 million children would not be treated for severe malnutrition. Despite those warnings, the Trump administration cancelled 83% of USAID programs, including 5,200 contracts.

The Trump administration claimed that it had a “waiver” exemption process to preserve funding for lifesaving projects. In reality, that waiver process was neither realistic nor effective. Even if a request for a waiver was approved, the health project might not be able to operate because the Trump administration had also cut off access to the system for payment.

On May 21, 2025, Marco Rubio, the US Secretary of State testified to a committee of Congress that “no one has died” as a result of the cuts to USAID funding, but heartbreaking reports of dead children clearly show that Rubio was wrong. In addition to those tragic reports about individual patients, Professor Brooke Nichols of Boston University and her colleagues have been working on modeling and estimating the human cost of the cuts to USAID funding. Those experts have made their results available on an Impact Counter, which can be accessed for free online.  As of June 1, 2025, their Impact Counter showed the estimated deaths caused by discontinuation of funding to be 99,718 adults and 208,076 children.

As in most research, Professor Nichols freely acknowledged the limitations of the data which she used in her research, and she explained why those limitations do not change her basic conclusions. For example, it is likely that some health programs are still operating with other funding or with volunteer workers, in which case the death toll would be somewhat less than estimated. It is also likely that some deaths and some causes of death were not counted in the research, in which case the death toll would be somewhat more than estimated. Thus, the death toll from discontinuation of funding could be somewhat less or more than Nichols and her colleagues have estimated, but the basic conclusion is still reasonable. As Nichols explained, "We can argue about the specifics and the size of the error bars, but we're not talking about dozens of people [dying] …. We're talking about tens of thousands of people."