Today marks the inauguration of Donald J. Trump as the 45th President of the United States. After a long, tumultuous and often divisive campaign, Mr. Trump won the majority of the votes in the Electoral College, despite gaining less than the majority of the popular votes. At the beginning of this transition, a large proportion of the US population, including researchers and scientists are wondering what his election and the new government will bring. Here, we consider the same question for emerging and re-emerging infectious diseases and their impact and control around the world.
The United States is, and has been for more than a century, one the biggest contributors of research and aid for global health. Specifically, the federal government has had an important role in combating emerging infectious diseases. The President’s Malaria Initiative has been the driving force behind the dramatic reductions in malaria morbidity and mortality throughout sub-Saharan Africa in the last 20 years, contributing to the lowest rate of under-5 mortality in the region in recorded history. The Center for Disease Control, in collaboration with WHO, has been at the forefront of fighting emerging infectious diseases globally, exemplified by their critical response, supported by the US Armed Forces, in the mitigation and eventual containment of the Ebola outbreak in West Africa in 2015. In addition, funding from the federal government through the National Institutes of Health led to groundbreaking and momentous discoveries, such as the vaccines against Ebola and malaria last year.
Many wonder how the new administration might change this critical role of the United States, and the federal government in particular, in global health. Based on the rhetoric that Mr. Trump has demonstrated on the campaign trail, one might suggest that we can expect a reduction in it, at least temporarily.
Many of the arguments put forward by Mr. Trump suggest that as President, he will focus on issues that are important in the United States internally, and will reduce the focus on international affairs. Such shift in emphasis typically is reflected in suggested budget allocations to Congress, which would indicate that there will be less funding dedicated to service and research on emerging infectious diseases that are important outside of the United States. Outbreaks of diseases in other countries might be seen as distractions that do not require the focus of the federal government. This could change once such outbreaks are imported into the United States and garner significant media attention, such as that happened with Ebola in 2014.
What might such reductions in focus and funding mean for emerging infectious diseases, their impact and their control worldwide?
There is definitely a potential for disruption of services to vulnerable populations which hitherto received aid and medical support using funds from the federal government. Research on diseases that are not considered priority in the US, such as most neglected tropical diseases, might not get funded, or fall behind, and drugs and vaccines being developed to treat and prevent them might get shelved. Distant areas of the world, and the emerging infectious diseases lurking there, might get forgotten and ignored, until a new pathogen, such as Zika virus, emerges from there. These reductions might put the whole world at greater risk to epidemics that only get noticed when widespread. Most importantly, the new President and his administration could further disrupts the precarious economic and political balances of our world, with potentially catastrophic consequences.
However, one might argue that the above picture is unnecessarily grim, biased and lacks a long-term perspective. Historically, there has never been a time when there was so much support for healing people and combating emerging infectious diseases. The scientific advances of the last century, ranging from drugs to vaccines and vector-control innovations (such as genetically modified mosquitoes and Wolbachia) reduced human death and suffering due to infectious diseases to levels never before seen. Through the Millenium Development Goals and the Sustainable Development Goals, poverty and child mortality was substantially reduced, maternal health has improved, and hundreds of millions have been treated for HIV, malaria, TB and other diseases. Despite all the suffering in the world, we live in a time with the least suffering across the globe in history.
Barring extreme events (e.g. such as a World War), the incoming new administration is unlikely to reverse this progress altogether, perhaps just put a dent in it. The scientific and public health community will adapt to these new conditions, just like they adapted before to unfavorable conditions. Looking back at history again, scientific research has progressed under and despite far more challenging times, such as during World War II, and in economic crises.
In addition, while the United States and the federal government has a very important role to play, there are many other key players in global health; Institutions, such as the WHO, as well as other countries (e.g. the UK, France, Brazil, India) will keep committed to these goals. Physicians, clinicians, researchers and scientists, who dedicated their life to helping patients and solving problems of infectious diseases will not cease and abandon their values and goals; they will keep working for their patients and the public. Will they have a more difficult time finding support and funding in this new era? Yes, possibly. However, finding funding has never been easy, and the community will adapt. Private funding sources, such as the Bill and Melinda Gates Foundation, will continue to support their work, even more so if there is clearly a funding gap left by the federal government.
Importantly, there will be a continued need for their work (“a fierce urgency of now”), as the risk of emerging infectious diseases will not diminish. Neither pathogens, nor vectors do not care who is in charge of the federal government, and will continue to infect people, especially those already in vulnerable conditions. We, the scientific community, owe them to not give up, and keep working for them.
The transition to a new era, especially now, with a President whose trademark is unpredictability, brings with itself a tremendous amount of uncertainty. We can’t reasonably predict the decisions that the new President and federal government will make in the next 4 years, and the potential consequences of those decisions. While some of these can further exacerbate existing problems driving the emergence and re-emergence of infectious diseases, some of them might actually help. A major focus of the campaign of President Trump was to target the concerns of working class, especially rural, white Americans. Effective steps to lift them out of poverty and improve their quality of life will also protect them against infectious diseases.
Unfortunately, we cannot hope that this will be the norm. What we lack in hope, we will have to make up by re-doubling our determination, especially in the US, to our core values as scientists and physicians, to uphold the basic human right to health, regardless of the conditions under which we work. I believe the words of Martin Luther King Jr. apply to here in terms of health inequality as well: “the arc of the moral universe is long, but it bends toward justice”. However long it may be, let’s bend it all together!