IN ITS FIRST MONTH, the new Trump administration has shocked the world with a daily stream of actions and plans that fundamentally alter US national values and our role in the world. The results will be catastrophic for global food insecurity, treatments for HIV, TB, and malaria, US leadership in research and science, and all aspects of global health and human rights. With these actions, half a century of commitment to humanitarian aid and global health affecting millions of children and adults around the world has been abandoned. The actions include executive orders and agency directives that are summarised in Table I, and program terminations in Table II. At this fragile moment in US and world history, we cannot look away. It is essential to review these actions and take stock of their potential impact on science, global health, and human rights.
The extraordinary actions include a challenge to the birthright citizenship that is a constitutional right in the US, a purge of language and a freeze on all funding that supports efforts to address diversity, equity, inclusion and accessibility (‘DEIA’), an assault on the rights and the very existence of transgender individuals, and a ban on language and programs that support gender diversity and non-binary individuals in the US and around the world.
The new directives deploy mass deportation with expanded governmental powers for search and seizure, freeze budgets and fire federal employees in agencies and programs that provide humanitarian aid, development, disease surveillance and scientific research. These agencies include but are not limited to the US Agency for International Development (‘USAID’), the National Academies of Science, Engineering and Medicine, NASA, the National Science Foundation, the National Forestry Service, the National Institutes of Health (‘NIH’), the Food and Drug Administration (‘FDA’) and the Centers for Disease Control (‘CDC’). The Trump administration’s choices for new scientific leadership at NIH, CDC, FDA and the Department of Health and Human Services (‘HHS’)have been widely criticized for being unqualified, and openly hostile to many accepted public health care standards like childhood vaccines and global health diplomacy, exemplified through the magnificent program for global HIV – the President Emergency Program for AIDS Relief (‘PEPFAR’).
Though the justifications for these actions have been scant, a few clear rationales have emerged in the Project 2025 report from the Heritage Foundation and in public comments over the past month. The first priority is to secure the border and deport anyone who lacks legal status to be in the US. To fulfill an election promise to shrink the federal workforce and remove fraud, waste, and corruption, President Trump created DOGE, the Department of Government Efficiency, to be assisted by Elon Musk and a team of inexperienced software engineers. Musk has been charged with cutting waste and unnecessary spending across all government agencies. As one example of the limited explanations, the dismantling of USAID was justified in a few sentences that claimed that USAID was corrupt, evil, and run by ‘radical lunatics’.
Another explicit objective is to eliminate ‘woke’ culture and language, rejected for being unnecessary and offensively promoting radical left pro-LGBTQ+ agenda. In a claimed effort to eliminate unneeded bureaucracy, key independent federal agencies and individuals that provide government oversight and consumer protections have been eliminated, as with the Federal Consumer Protection Bureau.The Inspector Generals from multiple agencies have been fired. The rationale for the actions against transgender individuals and gender diversity is contained in the title of the EO: ‘Defending women from gender ideology extremism and restoring biological truth to the federal government’. The speed and aggressiveness with which these actions have been taken have neither been justified nor even acknowledged, other than an attempt to follow the silicon start-up company credo to ‘move fast and break things.’ A common feature is the widespread and casual use of lies and misinformation to support these actions that have been implemented in an astonishingly arbitrary, capricious, and cruel fashion without regard to any minimal standards of decency and respect for human dignity.
My intention in this series of articles is to review these actions and the known and potential outcomes of these actions on science, health, and human rights in the US and the world.
The assault on the NIH, CDC, FDA, and government-led science and health
The assault on science and health has taken three forms: personnel and leadership changes, funding freezes, and a purge of language and programs related to DEI and gender diversity.
By targeting recent hires and personnel on probation due to recent job changes, the administration has fired staff with the least legal job protections. The estimated job losses are 1,200 personnel at NIH, 700 at FDA, and 750 at CDC to date, with an estimated 10 percent of the workforce at CDC or 1,300 firings in total planned. The CDC layoffs threaten our ability to identify and respond to new outbreaks in the US and abroad, and compromise our national ability to monitor trends in communicable diseases. Personnel at these agencies were told that they were “not fit for continued employment”, that their “ability, knowledge and skills do not fit the agency’s needs” and their “performance has not been adequate”, in spite of high scores on recent performance reviews, and in violation of their contracts and standard human relations practices in the federal workplace. The action to cut NIH, CDC, and FDA personnel was characterized as “cutting off our hands to spite our face.” The job losses are potentially devastating for agencies already understaffed due to recent cuts in the past five years. In several states, including North Carolina, Alabama, Missouri, and Pennsylvania, academic medical centers are among the largest employers in the state, and the economic consequences of the layoffs may be devastating.
Scientists at other agencies were also affected. A high percentage of workers in the Interior Department layoffs were forestry workers needed to strengthen the growing need for firefighters, as evidenced by the recent fires in Los Angeles. A lawsuit brought by a coalition of firefighters succeeded in blocking the firings and budget freeze at the Interior Department, while a final judgement is pending.
The NIH oversees $47 billion in annual research funding. In 2023, $35 billion was spent on 50,000 competitive grants involving 300,000 researchers at 2,500 universities, medical schools, and other research facilities. Of this $26 billion was paid for direct research costs and $9 billion in indirect costs that support labs, equipment, and essential non-research positions. H. Holden Thorp, the Editor of Science, described the indirect costs as indispensable to the research, covering jobs, health insurance, and other critical costs. Importantly, each $1 dollar spent on research generates $2 dollars in additional economic activity in the region, and so these cuts will have a ripple effect across local economies.
On February 7 all NIH grant reviews were suspended indefinitely, impacting all aspects of science, including wildfires and climate change, cancer, children’s health, aging and traumatic brain injury. According to Harold Varmus, former NIH director, the proposed budget cuts and lowering of indirect cost payments will compromise scientific progress in innumerable ways like disrupting research, restricting publications, limiting scientific meetings, and undermining the established pathways at CDC and NIH for grant making and promotion of promising young scientists. Added to this are the limits on immigration that create major disincentives for visiting scientists and students. It represents a biomedical research crisis.
In an unusual joint statement, eight former officials at CDC, NIH and FDA denounced the cuts that threatened current efforts to curb the US opioid epidemic, control an outbreak of Marburg virus in Tanzania, and improve rural health care in the US, among other projects. These former health leaders noted that “these (fired) individuals deserve a debt of gratitude, not a pink slip.” The newly approved leader of the HSS, Robert F Kennedy Jr, has openly challenged vaccine efficacy, and on February 18, announced that HHS will scrutinize the childhood vaccine schedule and the use of psychiatric medications in the US. These public declarations of vaccine uncertainty and re-evaluation fly in the face of decades of research on the remarkable efficacy and safety of vaccines.
The willingness of the current administration to create chaos and undermine science was seen in the sudden freeze on all NIH grants and programs, an action that halted thousands of ongoing research projects and left tens of thousands of scientists and their research infrastructures in an uncertain limbo. On February 5, Judge John C. McConnell declared the spending freeze to be illegal and ordered it to be rescinded. In a second judgment, he declared that the administration was noncompliant with the first ruling, setting up a confrontation and a possible constitutional crisis in the US. It is astonishing to write that this administration is openly contemplating disregarding these judicial orders, one of several potential outcomes that would precipitate a constitutional crisis in the US.
Three other counterintuitive assaults on science will compromise global health: the withdrawal from WHO, the closure of the US Office of Pandemic Preparedness, and the withdrawal of the US from the Paris Climate Accords.
Each of these actions severely limits the capacity for the United States to effectively deal with known and unknown futures challenges that require a collaborative international scientific response.
Note: The second part of this series will delve into the systematic assault on reproductive justice, gender and DEIA in the US under Trump