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Pandemics in the age of Trump

If Donald Trump’s administration maintains its commitments to stoking nationalism, reducing foreign aid, and ignoring or denying science, the United States and the world will be increasingly vulnerable to pandemics.

When these positions are reversed—that is, when foreign aid is increased; when, in times of pandemics, national interests are subservient to global cooperation; and when science and evidence are our guides—great strides have been made in ridding the world of epidemic and pandemic diseases and relieving the suffering felt by millions. History is not a blueprint for future action—history, after all, never offers perfect analogies. However, there is little dispute among historians of medicine and science that the past has taught us a lot about what works and what doesn’t.

When it comes to pandemic disease focusing on nationalist interests is exactly the wrong approach to take. But during the height of the Ebola crisis in 2014, in a series of Tweets, that’s exactly what Donald Trump advocated—he called President Obama “psycho” for not stopping all flights from West Africa. Fomenting fear and taking an isolationist position is reckless and will put many millions at risk. It’s been clear for centuries that taking a nation-centric approach to pandemic disease is fruitless. Take a look at cholera in the nineteenth century. When it first appeared in Europe in the early 1830s, Russia attempted to close its borders—among other measures, soldiers formed a human wall in an attempt to stop cholera from entering the country. While it was surely a show of force, and demonstrated the country’s military might, as a tactic against cholera it was utterly useless. As global travel sped up with advances in rail and steamship technology, it became clear that cholera was a global concern and focusing on it as a national problem would not work. Early on this often meant restricting travel from heavily effected countries—often in xenophobic form.

At the 1872 international sanitary conference called to cooperate on cholera, the Italian delegate said: “We have to stop that cursed traveller who lives in India, everyone knows it, from taking his trips; at least we have to stop its progress as closely as possible to its departure point.” This kind of ethnocentrism was always present in discussions of disease control, and as long as international cooperation focused solely on immigration restrictions, cholera kept coming. But as medical knowledge of cholera and plague (which erupted in pandemic form in the 1890s and 1910s) became more sophisticated, control of pandemic disease increasingly followed more scientific routes. It became less about labeling people ‘unclean’ or ‘naturally prone to illness’ and more about greater efforts at instituting sanitary measures, working on vector control, and increasing disease surveillance. To insure that the next Ebola epidemic does not spread to the United States, to say nothing of West Africa and the rest of the world, the US must commit itself to bolstering health systems in places like Liberia and Sierra Leone. The US will only be safe from pandemic threats once robust health systems exist in the places most likely to be sources of pandemic diseases.

USG/FHI/PEPFAR Stands at the Fair, demonstrating Ghana and United States partnership to fight HIV/AIDS by official photographer of the U.S. Embassy in Ghana. Public domain via Wikimedia Commons.

But controlling pandemic disease cannot be done if drastic cuts in foreign aid and basic scientific research are made. The massive increase in foreign aid directed towards HIV/AIDS by Republican President George W. Bush has arguably done more to combat the pandemic than any other single initiative. When Bush announced the President’s Emergency Plan for AIDS Relief (PEPFAR) on 28 January 2003, during his State of the Union Address, he signaled a strong US commitment to the disease. As Bush said: “AIDS can be prevented….Seldom has history offered a greater opportunity to do so much for so many. . . . [T]o meet a severe and urgent crisis abroad, tonight I propose the Emergency Plan for AIDS Relief—a work of mercy beyond all current international efforts to help the people of Africa. . . . I ask the Congress to commit $15 billion over the next five years…to turn the tide against AIDS.” This unprecedented program has saved many lives. Recently, however, the new administration has wondered: “Is PEPFAR worth the massive investment when there are so many security concerns in Africa? Is PEPFAR becoming a massive, international entitlement program?”

The US now seems poised to relinquish its leadership role. In America First: A Budget Blueprint to Make America Great Again, President Trump wrote that the US must make “deep cuts to foreign aid. It is time to prioritize the security and well-being of Americans, and to ask the rest of the world to step up and pay its fair share.” The potentially good news is that “America First” does say that PEPFAR and the Global Fund won’t be affected by the “deep cuts”—for now. But with the overall foreign aid budget to be cut by just over 30%, other key components in the US’s global health armamentarium, however, are not as lucky. The US Agency for International AID will have its budget slashed. And the Fogarty International Center at the National Institutes of Health—whose mission statement reads: “To protect the health and safety of Americans, Fogarty programs build scientific expertise in developing countries, ensuring there is local capacity to detect and address pandemics at their point of origin; accelerate scientific discovery; and provide national and international health leadership”—will be eliminated. Weakening developing countries’ capacity to respond to burgeoning pandemics will put the US and the world at risk.

It’s impossible to know exactly what the new administration is going to do. What does seem clear is that there is little concern for shoring up the basics of pandemic preparedness: investing in science and insuring that developing countries have adequate resources.

Featured image credit: Syringe, World medicine by qimono. Public Domain via Pixabay.

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