Garrett on Global Health – Trump: Two Weeks

Council on Foreign Relations -by Laurie Garret

Since his January 20 inauguration, President Donald J. Trump has issued a dizzying array of statements, executive orders, and memorandums, several of which have bearing on international affairs, foreign policy, and the soft power agenda of the United States government.

President Trump’s obsession with the size of his inaugural crowds versus those of his predecessors, the ongoing attacks on the media, and debate about “alternative facts” should not distract from the sweeping series of executive orders (EOs) issued from the Oval Office, coupled with reorganizations of the National Security Council (NSC) and State Department. Slate writer Fred Kaplan characterizes the state of the foreign affairs agency as “mass confusion,” making it impossible for the State Department to take significant diplomatic actions. A dense fog of social media and White House statements often serves to obscure from view the vital events unfolding. And from outside the government, speculation and paranoia have often reigned, both in the United States and overseas. But I will try to sort fact and fiction.

While politically appointed positions are always vacated during administration transitions, new presidents usually try to avoid wholesale resignations until replacements have been identified. This has not been the case with the Trump administration, particularly in the State Department. The majority of high-level positions there—both political and foreign service personnel—have been emptied over the last ten days.  As of February 2, thirty-five of the forty-three top positions in the State Department were empty.

Shortly after taking office, President Trump started releasing a torrent of executive orders and national security presidential memoranda (NSPMs). Combined with rumored actions made public by Trump’s tweets or offhand comments from White House officials and Capitol Hill allies, the executive orders have left most federal agencies and the American public confused and anxious. Even prior to these actions the Bulletin of Atomic Scientists to advance its nuclear risk clock closer to midnight.

NSPM 1 calls for a massive overhaul and expansion of the U.S. Armed Forces. Among the most urgent elements of NSPM 1 is a thirty-day deadline for delivery of a state-of-readiness report from all branches of the military, addressing a broad range of potential threats to the United States and its interests.

NSPM 2 drastically restructures the National Security Council, giving White House political strategist Steve Bannon a seat on the principals committee (PC) of the NSC, the first such allocation to an Oval Office strategist in history.

Traditionally, the lead advisor on the PC is the chair of the Joint Chiefs of Staff, who has been removed from permanent seating in the newly envisioned NSC in favor of Bannon’s prominence. Susan Rice, who led national security in the Obama White House, called the reshuffling “stone cold crazy.”

NSPM 3 demands that the NSC, within thirty days, supply the president with a “plan to defeat the Islamic State of Iraq and Syria.” It also calls for “a detailed strategy to robustly fund the plan” and for “recommended changes to any United States rules of engagement,” such as use of torture.

The three NSPMs are part of a pile of eighteen presidential actions taken (in the order listed below) by President Trump between January 20 and 31

  1. “minimizing the economic burden” of the Affordable Care Act (ACA)
  2. freezing all regulations
  3. reinstating the Mexico City abortion policy (also known as the global gag rule)
  4. scrapping the Trans-Pacific Partnership 
  5. freezing hires for the federal workforce 
  6. advancing the Dakota Access Pipeline
  7. advancing the Keystone XL Pipeline
  8. expediting environmental reviews on infrastructure projects
  9. promoting pipelines “produced in the United States”
  10. reviewing domestic manufacturing regulation 
  11. increasing border security measures 
  12. eliminating “catch-and-release” strategies
  13. pursuing undocumented immigrants
  14. reevaluating visa and refugee programs
  15. strengthening the military (NSPM 1)
  16. reorganizing the National Security Council (NSPM 2)
  17. implementing a lobbying ban
  18. calling for a plan to defeat the self-declared Islamic State (NSPM 3)
  19. reducing regulations

Because Trump’s party controls both the House and the Senate, and will likely approve the president’s Supreme Court nomination, the presidential actions are expected to be backed by legislation. In other words, each of these presidential actions, and several leaked in draft form, is likely, with minor changes, to become the law of the land, barring successful legal challenge. Thirteen suits have been filed against the White House related to the immigration EO.

A bit of perspective is warranted: Barack Obama signed more executive orders in his first two weeks in office than Trump has, spawning as much flabbergasted outrage among the American right wing in 2009 as Trump is now triggering among the country’s left. In at least one case, Obama issued an EO reversing a George W. Bush policy; Trump has flipped that policy back. As Quartz shows, executing a flurry of EOs during the first few days in office is normal in the United States, as it offers a new president an opportunity to show muscle and please his base.

The national security restructuring laid out in the NSPMs is the clear exception: no president in modern history has instigated such sweeping changes in such a short time, sparking so much confusion and distress within the executive branch. For health practitioners, the most immediate concern is expansion of the use of torture under NSPM 3, which during the George W. Bush presidency included requiring physicians to keep subjects alive during days of physical and mental abuse.

The Affordable Care Act

Signed just hours after Trump took the oath of office, the first EO targets the Affordable Care Act by ordering the executive branch to slow or ignore its implementation, pending a Republican vote in the House and Senate to repeal it entirely. Some see the EO’s impact on global health as largely symbolic: passage of the ACA greatly enhanced worldwide enthusiasm and optimism about universal health care (UHC) and the United Nations’ Sustainable Development Goal number three, health for all. Elimination of the ACA could dampen spirits in pursuit of UHC but will not directly impair the campaign. An article in the Lancet, on the other hand, says repeal of the ACA will have more than a symbolic affect outside the United States because, “[Trump’s] stated intention to put ‘America first’ [is] creating anxiety and uncertainty about America’s domestic health policies and its global leadership role in areas such as security and development.”

Some Republican leaders are getting nervous about repeal of the ACA, as surveys show more than 60 percent of Americans are opposed both to elimination and to significant reform of the ACA. A survey of U.S. physicians finds even stauncher opposition to ACA repeal.

Only 15 percent of primary care physicians favor repeal of the ACA, and even among those who voted for Trump, repeal is backed by just 38 percent.

As I noted in a previous Garrett on Global Health, President Trump, House Speaker Paul D. Ryan (R-WI), and the administration’s nominee to head Health and Human Services (HHS), Tom Price, all favor getting government out of the business of health care. Though there is no consensus yet among Republican leaders regarding a replacement for the ACA, the federal government will likely kick the task down to the states. Through some mix of income tax credits and Medicaid and Medicare payouts, each state would then decide how to create its own health system. Price favors a marketplace approach for basic health care, putting families in the position of shopping for care in an openly capitalist system of medicine. Ryan has his eyes set on slashing both Medicaid and Medicare, using the anti-ACA EO as a jumping-off point to a wider restricting of the U.S. health-care system.

In the late 1990s, after effective combination therapy for HIV was developed, the federal Ryan White Act was meant to underwrite the costs of keeping HIV-positive Americans alive and able to be productive members of society. But payments were passed through states, each of which set its own rules regarding patient qualification for subsidized care. In some states, such as California and New York, Ryan White funds could be used to assist in drug payments for fully employed homeowners. But in the majority of cases in southern and midwestern states, recipients of support had to spend down their assets and be living below the federal poverty line to obtain life-sparing medicines. I recall meeting with HIV patients in West Virginia in 1999 who were required by the state to qualify for Medicaid in order to receive subsidized medicines; in that state a person could not own a home, car, or assets exceeding $10,000 in value and qualify for Medicaid. If the ACA is replaced with a state-by-state hodgepodge of standards and payouts, average life expectancies and medical procedural survival rates regionally will likely vary even more dramatically across the United States than they already do. (Hawaiians enjoy an average life expectancy of 81.3 years, but West Virginians and Alabamans see only 75.4 years.)

Freeze on Hiring

The presidential memorandum on hiring will harm global health and development, food, and disaster relief programs, as it freezes all new hires throughout the federal government. Employees of the National Park Service (NPS) characterized the freeze as “a nightmare scenario for the National Park Service and Bureau of Land Management,” which already are overburdened with staff shortages. At least 358 higher-level positions are vacant at the Department of Energy (DOE), which, among other things, manages the nation’s nuclear arsenal and oversees its national laboratories. The Food and Drug Administration (FDA) will be less able to ensure public safety through surveillance and testing of products entering the United States, and approval of new drugs will be slowed by the hiring freeze. The freeze will slow overseas development programs, already understaffed. The U.S. Department of Food and Agriculture (USDA) will be unable to fill empty positions in inspection of meat, fish, produce, and dairy products, slowing importation and market distribution. Similar concerns have been raised about agencies all over the government.

In addition to freezing hiring, the presidential memo puts all grants and contracts on ice for the Environmental Protection Agency (EPA). Academic researchers working on EPA studies, construction companies building Superfund clean-up projects, and groups hired to teach families how to purify lead out of Detroit water all depend on the EPA’s flow of money. Therefore, these projects and contracts are frozen.

The Trump freeze is far more sweeping than any historical measure aimed at cutting government spending through limited hiring. As such, it will likely be whittled down or slashed altogether by lawyers, but that could take months. In the meantime, federal workers’ unions say hiring freezes will increase burdens for existing staff and therefore violate labor agreements.

Meanwhile, crucial health and science positions, including high-level political appointments, remain unfilled.


Under Trump’s EO aimed at limiting regulation, any federal agency that hopes to impose one new regulation must first eliminate two. Among other things, this could make it impossible to implement the new Twenty-First Century Cures Act intended to speed up new drug approvals and push research and development faster from lab bench to pharmaceutical manufacturing—all steps that will require passage of perhaps one thousand regulations spread out over the National Institutes of Health (NIH), FDA, and HHS.

The real target of the administration’s effort to deregulate is the EPA and, in particular, the Clean Air Act. Since the agency’s creation by Richard Nixon in 1970, The EPA’s enforcement of protections for endangered species, clean air, and water have often put regulators in direct confrontation with land developers, chemical manufacturers, and extraction industries (mining, gas, and fossil fuels), all of which have lobbied hard for decades to remove statutes that limit their activities.

Treaties and International Agreements

One way or another—either based on bills passed by Congress or on presidential action—U.S. financial support for global public goods and systems of global governance is threatened. It would be extremely unwise and naive to ignore the signals from Capitol Hill and the Oval Office that the United Nations and most major treaties and trade agreements are standing on quicksand. Among the first pieces of paper signed by President Trump was an order ending all Trans-Pacific Partnership (TPP) Asian trade agreements and negotiations, thus killing the TPP not only for the United States but for all of Asia.

Trump then signed a piece of paper that starts a process aimed at dissolving the North American Free Trade Agreement (NAFTA). Another executive order calls for immediate action to build a wall across the U.S.-Mexico border that could cost well over $25 billion to erect and an additional $2 to $3 billion a year to maintain and patrol.

Two draft executive orders obtained by the New York Times would radically reduce support of the United Nations and treaties. The “Auditing and Reducing U.S. Funding of International Organizations” order would possibly cut U.S. support for UN agencies across the board by 40 percent and kick off an auditing process aimed at unearthing corruption or mismanagement of funds within the system, permitting still more cutting. Agencies (including potentially the World Health Organization) that are found to violate any of a long list of standards of management and behavior outlined in the draft executive order would U.S. financial support, effective immediately. The second, “Moratorium on New Multilateral Treaties,” would forbid the State Department from participating in any new treaty talks, on any issue, and start a process toward revoking treaties signed by the Obama administration, including the COP21 Paris climate agreement.

What seemed a done deal early last week—slashing U.S. support for the UN system, perhaps even ordering the headquarters removed from New York City—hit a snag for the White House when its new ambassador to the United Nations, Nikki Haley, pushed back. Previously, in her Senate confirmation hearing, Haley had said, “I want to bring back faith in the UN. I want to show that we can be a strong voice at the UN. I want to show that we can make progress and have action at the UN.”

But Haley also said, “for those that don’t have our back, we’re taking names; we will make points to respond to that accordingly. Our goal with the administration is to show value at the UN and the way that we’ll show value is to show our strength, show our voice, have the backs of our allies, and make sure that our allies have our back, as well.”

A White House spokesman told reporters on January 27, “While no executive orders on these subjects are expected at this time, this president and his administration intend to be watchful stewards of the American people’s interests and of the American taxpayer’s dollars.”

The U.S. government foots 22 percent of the overall UN budget and 28 percent of the cost of peacekeeping operations. In one draft EO, Trump ordered creation of a high-level commission to investigate the United Nations, advising on reasons to reduce support. That is roughly consistent with Republican bills floating in Congress. Natalie Samarasinghe, executive director of the United Nations Association-UK, told Devex that implementation of the draft EO would, “at worst, seriously undermine the UN’s lifesaving work . . . by forcing its already dangerously underfunded agencies to scale back humanitarian assistance, including programs that successive U.S. administrations—and the American public—have traditionally supported. At best, this is just bluster, albeit a very worrying bluster that ignores the value of the UN to the United States, and the potential for the organization to play a greater role, particularly in the peace and security arena, if the Trump administration does indeed plan to put ‘America first’ and be less active globally.”

The Council on Foreign Relations’ Stewart Patrick and the Center for Global Development’s Charles Kenny offer excellent reasons why U.S. national security interests and humanitarian programs would both be harmed by reductions in UN commitments.

In the Pipeline

Reportedly in the pipeline are EOs that would allow denial of rights to gays, lesbians, and transgender (LGBT) individuals on grounds of religious freedom to refuse; target the way tech giants such as Apple, Microsoft, and Amazon recruit their employees, especially from overseas; and expand the use of the Guantanamo detention facility and use of torture on suspected foreign terrorists. That last one—expanding use of torture and so-called secret black sites for interrogation—apparently was not approved by Secretary of Defense James Mattis and Central Intelligence Agency Chief Mike Pompeo, both of whom are asking the president to reconsider. There was also a snag in the release of that EO; leaked draft referred to the “atrocities of September 11, 2011.” On Tuesday, the White House signaled that “for now,” the Obama administration protections of LGBT rights will remain in place, but indicated a review of the policy will ensue sometime later this year.

Global Gag Order

It is believed that Vice President Mike Pence played a crucial role in creating an executive order reinstating the Ronald Reagan–era Mexico City policy, also known as the global gag rule, prohibiting U.S. federal employees from discussing family planning or birth control overseas. The Trump-Pence version of the Mexico City policy was the president’s third executive order, and this global gag rule goes considerably further than both the initial 1984 order and its version reimposed by the Bush administration.

As I outlined on last week, those original rules led to a net increase in abortion rates, especially in sub-Saharan African nations, due to loss of funding for nongovernmental groups that promoted contraception, and had a stifling impact on HIV/AIDS prevention programs and condom distribution.

The Trump global gag rule is broader in that it not only prohibits distribution of federal funds to foreign entities that provide abortion services (even when no U.S. dollars are used directly for abortions), but it also stipulates that money cannot go to a group that works with an abortion-providing group.

Moreover, no U.S. agency can collaborate on the ground with a local group or international nongovernmental organization that either provides information about abortions or funds the actual procedure. This could mean that if the U.S. Agency for International Development (USAID) responds to a category 5 hurricane disaster in Indonesia, USAID staff could not share resources or even participate in meetings with members of the Irish Marie Stopes Foundation in planning emergency services for women and children. While the UN Children’s Fund (UNICEF) does not support abortions, it does believe in spacing pregnancies to avoid both maternal and infant deaths, a family planning policy. The global gag rule could prohibit funding UNICEF because, at some point, it assisted a mothers’ health group that provides abortion information.

Concretely, the global gag rule under the Bush administration had a direct impact on roughly $600 million worth of USAID programs, with ripple effects across millions more health efforts under the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Centers for Disease Control and Prevention (CDC). But the Trump global gag rule affects about $9.4 billion worth of health and development programs, and might, depending on legal challenge and interpretation, even impose limitations on a couple of billion dollars’ worth of humanitarian relief and food assistance efforts.

The reaction from other donor nations and organizations was swift and universally opposed to the global gag rule. The government of the Netherlands announced creation of a fund to support abortion services and family planning wherever U.S. services have withdrawn under the global gag rule. What began as a unilateral $600 million fund quickly got the backing and additional financial commitments from twenty other nations. Canadian Prime Minister Justin Trudeau announced that Ottawa will direct Canada’s foreign aid agencies to increase their support of reproductive health services.

Migrants and Refugees

On Friday, January 27, President Trump signed an executive order severely restricting the entry of immigrants and refugees into the United States, prohibiting entry for those from seven countries, slowing granting visas, and otherwise blocking migrants, especially (or particularly) Muslims. The long and complicated edict sowed confusion across the Department of Homeland Security (DHS) and its various agencies, all of which were required by the EO to implement the policies starting Saturday morning.

By midday on Saturday, Twitter was overwhelmed with reports and rumors of families and individuals detained at New York’s JFK International Airport and other international hubs across the United States. Thousands of protestors and volunteer lawyers descended upon airports, demanding release of the detained, and holding placards welcoming refugees.

Around the world, refugees and would-be migrants who had filled out forms, undergone months of U.S. and UN vetting, and obtained visas to the United States suddenly found their hopes and dreams destroyed.

The momentum of protest against the immigration ban grew nationwide, and by Sunday, tens of thousands of demonstrators filled streets and airports. As word spread of Iraqi translators denied entry despite years of service, at great risk, for U.S. military forces, and crying families from Syria were seen, the anger spread like contagion around the world.

By Monday, January 30, the White House was hearing both reasoned and enraged protests against the refugee and immigration ban from discrete elements within Trump’s party, from legal experts, and from the streets. National Public Radio broadcasted a sobbing American citizen whose Iranian family was barred reentry from overseas travel though they were political refugees who escaped the Ayatollah in the 1970s and had lived in the United States ever since. An Australia-born high school student was denied entry to attend space camp because his parents were born in Iran and fled the Islamist government. Senators and members of Congress took to the floor to describe a litany of such stories. The president of Columbia University estimated seventeen thousand college students were affected by the EO, either having themselves been born in one of the seven named countries or having family members in those nations. Students, scientists, artists, U.S. military translators, retirees, babies—all sorts of individuals—were banned entry or admission to flights under the order. Overall, some ninety thousand people were affected, spread across the nation’s congressional districts.

The tech industry was especially appalled, as many of its top executives and company founders are, themselves, foreign-born, including the chief executive officers of Microsoft and Apple and one of the original developers of Google. The entire industry has arisen in the age of globalization and enabled it, making it possible for people to communicate and collaborate via the internet regardless of where in the world they live. So Google created a $4 million crisis fund to assist travelers affected by the EO, and nearly the entire executive elite of the industry sounded a loud chorus of denunciation of the travel ban. Lurking on the horizon for is another EO, leaked in draft form, targeting H1B visas and other mechanisms used by the tech industry to recruit and retain foreign talent, especially from China and India. The draft EO would affect far more than the seven nations of origin targeted by Trump’s current immigration order, noted in the Bloomberg graphic below in red. The gold-colored nations are excluded from the order, possibly, Bloomberg News notes, because Donald Trump has business interests in these countries from which he has not divested, despite concern that their retention on his part violates the Constitution. The draft EO would affect tech workers from all over the world and could be especially painful for China’s FoxCon and India’s Tata Consultancy Services Ltd., Infosys, and Wipro, major computer and device manufacturers that work with the likes of Apple, Dell, and IBM.

Courtesy of Bloomberg

The selected seven targeted nations have baffled foreign policy experts, as none of them have been the source of terrorist actions inside the United States. Taking note of this discrepancy, more than one hundred of top U.S. national security leaders, both Republican and Democrat, signed a letter denouncing the EO, noting that, “in the middle of the night, just as we were beginning our nation’s commemoration of the Holocaust, dozens of refugees onboard flights to the United States and thousands of visitors were swept up in an order of unprecedented scope, apparently with little to no oversight or input from national security professionals. Simply put, this order will harm our national security.”

This was followed by release of a formal dissent memo, signed by over one thousand State Department employees, drawing on a diplomatic method of group protest inside the agency, dating back to the Vietnam War. It is unprecedented for the mechanism to be invoked in the first month of a new presidency, and the number of signatories is historic.

White House Press Secretary Sean Spicer reacted to the dissent memo, saying of the diplomats, “they should either get with the program or they can go.”

The U.S. medical community also expressed outrage, noting that the U.S. health-care system depends on foreign-born and foreign-trained physicians, nurses, and technicians. And that dependency had been rising: In 2006, 1.5 million foreign workers joined the ranks of U.S. health-care workers, and that figure swelled to 1.8 million annually by 2010, by which time 16 percent of all the U.S. health workforce was foreign-born.

Indeed, second-year internal medicine resident, Dr. Kamal Fadlalla of Brooklyn’s Interfaith Medical Center, was barred reentry to the United States on Saturday after visiting his family in Wad Madani, Sudan. His ban harms medical services in the Park Slope neighborhood, home to U.S. Senator Chuck Schumer (D-NY). “We don’t see a clear pathway to get him back to work serving the patients that he needs to take care of in Brooklyn,” a union representative told Scientific American. “There’s a tremendous amount of uncertainty.”

Roughly 12.5 million people are employed in health-care provision in the United States, and more than thirty recruitment companies scour the world in search of nurses, as U.S. nursing schools cannot provide an adequate army of skilled personnel. Medical schools are also grossly under-producing physicians, so the nation’s health-care system highly depends on foreign recruitment. This is true for both the civilian and military health sectors. The current travel ban will limit recruitment from seven nations, but an expanded order limiting H1B and other professional visa exemptions could lead to shortages in medical personnel all over the United States, both because talented individuals would not be allowed into the country and because the existence of such limitations would hamper recruitment and send the talent to other eager nations such as Canada and Australia.

Echoing the concerns of the tech industry, national security community, State Department employees, and medical recruiters, academics have sounded a similar note: more than eighteen thousand, including fifty Nobel laureates and nearly five hundred members of the National Academies of Sciences, Engineering, and Arts have signed a petition demanding the EO be rescinded. According to an attorney from the Department of Justice, by February 3, some 100,000 visas were revoked under the immigration ban.

Legal experts, including former Acting Attorney General Sally Yates, a career professional at the Department of Justice, have doubted the constitutionality of the EO. Four federal judges separately issued stays of its execution, and Yates instructed her department to decline to enforce the White House order pending further analysis. On January 30, President Trump fired Yates, describing her action as “betrayal.” A group of UN special rapporteurs then concluded that the EO violates international human rights agreements. A draft revision of the immigration EO has leaked, and it could correct some of the most egregious effects of the current version. Stay tuned.

Are Scientists Ready?

Before President Trump took the oath of office, rumors of a purge of climate change experts and their data from government jobs and websites were spreading like wildfire within the scientific community. Professional associations in a range of scientific disciplines urged researchers at such agencies as the EPA and the National Aeronautics and Space Administration (NASA) to start downloading their data to private servers and cloud storage sites, lest they be scrubbed from digital existence by the Trump administration. A frantic downloading effort has been underway ever since.

On January 20, hours after taking the oath of office, Trump ordered a cone of silence across federal agencies, stipulating that government employees could not release any information, or speak with reporters or members of Congress, without White House approval. Agencies like HHS, the EPA, National Oceanographic and Atmospheric Administration, and dozens more ordered their employees—including thousands of scientists—to go dark. All references to climate change were removed from the White House website. EPA research grants were frozen and an internal memo prohibited emailing or blogging information about changes inside the agency.

If there is one personality type that bridles at being told to follow orders and shut up, it is the scientist. As the Obama administration was closing up shop, its DOE leadership issued a set of guidelines aimed specifically at protecting scientists working in DOE’s national laboratory system from all forms of political pressure. The January 11 guidelines, issued in hopes of protecting federal scientists from the Trump administration, state that DOE officials “should not and will not ask scientists to tailor their work to particular conclusions.”

But no similar guidelines were promulgated at other science-heavy agencies, and the international scientific community took note when the White House ordered the EPA to remove scientific papers presenting evidence of climate change from its dense website.

“I think we’re stepping into a phase of history that’s not quite like anything we’ve seen before,” Roland Wall, senior director for environmental initiatives at Philadelphia’s Academy of Natural Sciences, said in a recent public discussion of DataRefuge, the leader of the massive data storage effort. “Certainly nothing I’ve seen in the last sixty days indicates that the administration isn’t going to be exactly what it says it is, which is, in many cases, openly contemptuous of science and scientific knowledge, particularly on subjects like climate change.”

What had been a fairly discreet data download effort escalated dramatically when President Trump lashed out against the NPS over its retweet of side-by-photos showing Obama’s 2009 inauguration’s enormous crowds versus Trump’s modest turnout. The tweet infuriated the president, who called the head of the NPS to demand reappraisal and ordered a clampdown on communication from the agency. From that set of events has risen arguably the most massive mobilization of scientists ever seen in the United States, likely to be visible on April 22 when the March for Science takes place. Using the tools they know best—from social media to crowdsourcing—scientists inside the government and tens of thousands of academic and private sector researchers have swiftly mobilized a staggering array of responses to what they perceive as censorship, gagging, and, via the immigration EO, barring their colleagues and students from entering the country.

Two days after the inauguration, officials at the CDC canceled a long-planned climate change and human health conference, scheduled for mid-February, fueling still more outrage in the scientific community. Former Vice President Al Gore stepped up to the plate, moving the scheduled conference to the Carter Center in Atlanta on February 16, cosponsored with the Harvard School of Public Health and the American Public Health Association. The CDC’s timidity was roundly condemned by scientists who were crunching climate data for 2016 and had concluded it was the warmest year on record as temperatures rapidly approach the Paris Climate Agreement thresholds.

An article in Nature opined that Trump was planning to unravel the entire Obama science legacy. Some scientists have discerned a complex web of antiscience and conspiracy advocates, linked to polluting industries, in Trump’s nominees and appointments. This comes at a time when young scientists are already unhappy, as the nature of the laboratory labor force, academic employment, and likelihood of obtaining federal research grants is transforming in ways that are decidedly difficult for them.

Installation by the street artist, Banksy, at London’s Saatchi Gallery. Picture: Jeff Felten, Pictify.

Just how large the March for Science will be remains to be seen. A geologist from West Carolina University is telling his colleagues not to march and that the protest will further polarize Americans and worsen antiscience sentiments. He may not be alone. Some agencies may have overreacted to memos from the White House, taking steps to stifle their scientists that they are now rolling back. A savvy White House could easily mute protest by sowing confusion over whether or not government data sites will be cleansed or shut down. But an unmistakable momentum is in place, among tech-savvy, smart, young researchers.

In addition, two alleged White House rogue sites have appeared—there is no way to verify their authenticity, but they are fascinating to follow: @RoguePOTUSStaff and @AngryWHStaffer.

Science Does Matter

A long list of recent discoveries and experiments raise regulatory questions, but it is difficult to imagine how the Trump administration will deal with them or if, indeed, it will take any action at all. Just in January, for example, researchers published evidence that 60 percent of all primate species on Earth face extinction (as the GOP in Congress plans to introduce a bill voiding the Endangered Species Act). In Brazil, the mosquito-carried yellow fever virus spread in the Amazon among monkeys and is now claiming human lives outside of Sao Paulo.

The Audubon Society published evidence that 314 North American bird species are on the “brink of extinction.”

Air pollution levels in New Delhi broke records, sparking a mass exodus of professionals and middle class from the Indian capital. Pollution levels in London also broke records.

Two reports were published showing that mcr-1, a plasmid gene that confers full drug resistance against humanity’s last-resort antibiotics class, iswidespread in China. Highly drug-resistant forms of E. coli and Klebsiella were found in hospitals and may have originated in the swine industry, where colistin—the antibiotic targeted by mcr-1—is used as a growth promoter in pigs.

British researchers genetically altered human cells to attack leukemia cells and claimed to have cured two children.

Image courtesy of the Salk Institute for Biological Studies. 

A team at the Salk Institute in La Jolla, California, used CRISPR gene editing to create a chimera creature that contains both human and pig cells. After first creating mouse-rat chimeras, the researchers turned to human-pig gene mixing, which could potentially create sources for organ transplants for people. Though there is debate regarding the capacity of this approach to create an organ-harvesting industry, there is no doubt it opens a giant can of ethics worms. Under NIH guidelines, the Salk team was required to destroy their chimera creatures after a few weeks, rather than allow them to grow and reproduce. Across science, medicine, and bioethics, the chimera work conjures concerns regarding human-made life forms, the moral dilemma of saving human life by creating organ donor life-forms, and religious concerns about the sanctity of life.

Recalling the two-for-one regulations rule handed down from the White House, scientists are at a loss to know how the NIH, HHS, DOE, and FDA will tackle chimera animals, injection of genetically altered anticancer cells into babies, prevention of a nightmare spread of universally drug resistant bacterial pathogens, or the extinction of all nonhuman primates and hundreds of American bird species.

Finally, here is a list of my recent publications:

Gag Me: Trump’s Anti-Abortion Executive Order” on

Post-Ebola Reforms: Ample Analysis, Inadequate Action” in the British Medical Journal.

Donald Trump and the Anti-Vaxxer Conspiracy Theorists” in Foreign Policy.

Laurie Garrett
Senior Fellow for Global Health
Council on Foreign Relations

Um pensamento sobre “Garrett on Global Health – Trump: Two Weeks

Deixe um comentário

Preencha os seus dados abaixo ou clique em um ícone para log in:

Logotipo do

Você está comentando utilizando sua conta Sair /  Alterar )

Foto do Google

Você está comentando utilizando sua conta Google. Sair /  Alterar )

Imagem do Twitter

Você está comentando utilizando sua conta Twitter. Sair /  Alterar )

Foto do Facebook

Você está comentando utilizando sua conta Facebook. Sair /  Alterar )

Conectando a %s