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As all eyes look toward President-elect Donald Trump's inauguration, GHTC examines the policy issues we'll be tracking on in 2017.

January 18, 2017 by Courtney Carson

Donald Trump. Photo: Flickr/Gage SkidmoreDonald Trump. Photo: Flickr/Gage SkidmoreAs eyes turn to the inauguration of President-elect Donald Trump this Friday, we still have only limited insight into the incoming administration’s vision for global health and medical research.

At GHTC we have long championed a strong role for the US government in developing new vaccines, drugs, and diagnostics to address the world’s most pressing diseases and health conditions and have celebrated America’s historic leadership in global health research and development (R&D). We urge the Trump administration and the 115th Congress to continue to prioritize global health and medical research and will be watching the following issues in 2017:

Budgets and funding

One of the first ways the Trump administration can demonstrate commitment to global health, international development, and medical research is through the president’s fiscal year 2018 budget request. Traditionally, the Executive Office of the President uses the first budget of a new administration to articulate priorities and set the stage for the following years. We expect President-elect Trump to release a preliminary budget request in February, with a more detailed budget proposal released by May. These two policy proposals will provide the most comprehensive picture to-date of the Trump administration’s views on global health, development, and medical research, and whether the new president will continue to prioritize these areas of American leadership.

As Congress ultimately sets the budget and appropriates funds, it will also be critical to watch this body. As a check on executive power, Congress has the power to accept, reject, or find middle ground with the president’s proposal. Importantly, while there have been shifts in the makeup of Congress, strong global health and medical research champions remain—and we can look to these members to support continued and robust investments in these areas.

GHTC will be closely following the budget and appropriations process to ensure US leadership in global health and medical research continues to be prioritized. The United States leads the world in investment in global health R&D, so any changes to US funding—positive or negative—can have a significant effect on global health research projects worldwide.

Key nominees

While President-elect Trump has nominated cabinet-level officials, many of those who will assume leadership posts with a more direct role in global health, international development, and medical research have yet to be named. Who Trump picks to lead the US Agency for International Development (USAID), USAID’s Bureau of Global Health, the National Institutes of Health (NIH), and the Centers for Disease Control and Prevention (CDC) will provide insight into the administration’s plans for global health R&D.

Key questions for these future nominees will include how a Trump Administration USAID will advance innovation to further development efforts, how new leadership of NIH will prioritize research that benefits the health of Americans and the global community—including research for both emerging and long-standing disease threats—and how the CDC will continue leadership in critical work to prevent, detect, and respond to emerging health threats around the world, including investments in new technologies.

Commitment to US leadership in global health and international development

President-elect Trump has not yet articulated a policy direction on global health and international development. On the campaign trail, Mr. Trump promisingly expressed support for signature US global health programs like President Bush’s President’s Emergency Plan for AIDS Relief (PEPFAR), and his nominee to lead the State Department, Rex Tillerson, stated in his nomination hearing that PEPFAR is a “remarkable success” and model we should look to in the future.

However, recent reports cite potential skepticism toward health, development, and aid programs. Members of the Trump transmission team have asked “Is PEPFAR worth the massive investment when there are so many security concerns in Africa?” and “Is PEPFAR becoming a massive, international entitlement program?” The team is also cited as questioning US engagement in Africa more broadly, including whether corruption in African governments means US aid to certain countries is “stolen.”

Photo: CDC/James GathanyPhoto: CDC/James GathanyWhile worrisome, our hope is that this line of questioning leads to a better understanding of the value of US investments in regions such as Africa. GHTC will continue to champion the United States’ history of leadership in global health and development, as well as highlight the dramatic number of lives saved and other returns to economic growth and national security from US investment in global health and development.

Prioritization of global health security

Recent outbreaks of Ebola and Zika have demonstrated that America is not immune to diseases and health conditions that have traditionally only threatened other geographies. Global health is American health, and recent efforts to strengthen health security and infrastructure around the world through initiatives such as the Global Health Security Agenda, are beginning to show impact.

Given the increasing threat of diseases with potential to impact American health, it is likely that global health security could rise to the top of the Trump Administration’s global health agenda. In order to address this urgent need, Mr. Trump will need to support robust and expanded activities to prevent, detect, and respond to emerging diseases that threaten American and global health. This must include establishing dedicated funding for both emergency response to threats as they occur and ongoing investments to strengthen health systems and bolster capacity to prevent, detect, and respond to emerging diseases, including investments in the development of new technologies.

Engagement with key multilateral bodies

Multilateral partnerships are essential to global health policy that works for the United States. In an interconnected world, we can’t stop the spread of new, emerging diseases or eradicate long-standing heath challenges like polio without countries working together in partnership. Strong participation in bodies like the United Nations (UN), the World Health Organization (WHO), and the Global Fund to Fight AIDS, Tuberculosis and Malaria is key to advancing American leadership, as well as to ensuring that those organizations function as effectively as possible. While the Trump administration has offered general statements implying more inward-facing policy, several of his nominees to defense and diplomatic positions have stressed the value of strong international and multilateral engagement as a “force multiplier” for the United States

GHTC will also be monitoring efforts in Congress to restrict funds to the UN. Political tensions around passage of a UN Security Council Resolution on Israeli settlements have prompted several US legislators to introduce bills and resolutions to defund the UN, with some proposing a fifty percent reduction in funding to all UN agencies—including WHO, the UN Development Programme, and other specialized agencies. While these measures do not currently have bipartisan support, any cuts to the UN and UN agencies would have significant effects on global health programming and achieving global goals for health and development.

GHTC is committed to maintaining a strong, coordinated voice to champion policy that advances US leadership in global health R&D in 2017 and beyond. Global health, development, and medical research are historic areas of bipartisan agreement, and we look forward to maintaining this legacy and driving progress in the years ahead.

About the author

Courtney CarsonGHTC

Courtney Carson is a policy and advocacy officer at GHTC, who leads GHTC's US advocacy portfolio.