US President Donald Trump has been in office just a over two weeks now, and he has already passed multiple executive orders and made announcements that would have profound impact on global and domestic health policies, healthcare institutions and humanitarian aid organisations. Many of these roll back key health care and global health policies established during the Biden administration, signalling a dramatic shift in US health policy and foreign aid priorities.

Here is a comprehensive look at the various moves made by Trump and what it would mean for public health.

Rolling back directives strengthening Medicaid, Affordable Care Act

Through a series of executive orders, on his very first day in office, President Trump revoked Biden-era directives including that aimed at strengthening Medicaid, and the Affordable Care Act (ACA), while also implementing new policies that could significantly impact access to healthcare and foreign assistance programs worldwide.

While the executive order does not immediately change existing laws or regulations, it sets the stage for future policy changes that could weaken Medicaid and the ACA.

Critics argue that this move could lead to reduced coverage, higher costs, and fewer protections for individuals with pre-existing conditions. Supporters, however, contend that the action is a necessary step toward reducing federal overreach and promoting market-based healthcare solutions.

Rolling back directives on global health safety

President Trump revoked the National Security Council Directorate on Global Health Security and Biodefense, which was passed by Joe Biden under Executive Order no 13987 in 2021 when the world was reeling under the impacts of the COVID pandemic. The Biden-era order was called "Organising and Mobilising the United States Government To Provide a Unified and Effective Response To Combat COVID-19 and To Provide United States Leadership on Global Health and Security."

Trump's move effectively dismantles much of the infrastructure put in place to coordinate the US response to COVID-19 and future pandemics. The revocation raises concerns about the nation’s preparedness for future health crises, particularly as global health threats continue to evolve.

Withdrawal from the Paris Agreement

The president also announced moving away from Paris Agreement. Clare Nullis, spokesperson of the UN World Meteorological Organisation (WMO) said that there is need for all countries to respect the accord. She said given that 2024 “was the hottest year on record”, at about 1.55°C above the pre-industrial era the accord must be respected. “It is the defining challenge of our time,” she insisted.

In the wake of the recent devastating and deadly massive wildfires that ripped through Los Angeles, the WMO spokesperson also noted that the US had suffered the bulk of global economic losses from weather, climate and water-related hazards.

“It has sustained 403 weather and climate disasters since 1980 where overall damages/costs reached or exceeded $1 billion. The total cost of these 403 events exceeds $2.915 trillion, according to US figures,” Nullis said.

Withdrawal from WHO

In a related action, President Trump issued an order to withdraw the United States from the World Health Organisation (WHO), citing the organisation’s mishandling of the COVID-19 pandemic and its failure to implement necessary reforms. The order also criticised the WHO for its perceived lack of independence from political influence, particularly from China, and highlighted what the administration called “unfairly onerous” financial contributions from the US compared to other member states.

This decision positioned the USA as the only nation, apart from Liechtenstein, to be a United Nations (UN) member but not part of the World Health Organisation (WHO).

According to the experts, in 2023, Nigeria received $40 million in funding from the USA via the WHO.  Nearly half of the funding, 48.42%, was used to prevent the spread of infectious diseases and manage public health risks, significantly enhancing Nigeria’s capacity for outbreak preparedness and response. This supported efforts to combat diseases such as cholera, Lassa fever and COVID-19.

Another 21.06% was allocated to rapid emergency responses, enabling timely interventions during crises like natural disasters or disease outbreaks. Besides, 19.6% of the funding supported Nigeria’s polio eradication efforts, including partnerships with the Global Polio Eradication Initiative, which played a key role in helping the country achieve polio-free status in recent years.

Pause on all US foreign assistance

In another sweeping move, President Trump issued an executive order calling for a 90-day pause on all U.S. foreign assistance programs to assess their alignment with American values and interests. The order criticises the “foreign aid industry and bureaucracy” for promoting policies that the administration claims are “antithetical to American values” and destabilising to global peace.

The pause affects nearly all global health programs funded through foreign aid appropriations, including initiatives to combat HIV/AIDS, malaria, and tuberculosis.

“90-day pause in United States foreign development assistance for assessment of programmatic efficiencies and consistency with United States foreign policy.  All department and agency heads with responsibility for United States foreign development assistance programs shall immediately pause new obligations and disbursements of development assistance funds to foreign countries and implementing non-governmental organisations, international organisations, and contractors pending reviews of such programs for programmatic efficiency and consistency with United States foreign policy, to be conducted within 90 days of this order.  The Office of Management and Budget (OMB) shall enforce this pause through its apportionment authority,” the order reads.

Sex to be an 'immutable binary biological classification'

President Trump also signed an executive order defining sex as an “immutable binary biological classification” and directing federal agencies to remove recognition of gender identity. The order states that “it is the policy of the United States to recognize two sexes, male and female” and calls for the enforcement of laws that align with this definition.

This policy shift could have significant implications for global health programs that serve LGBTQ+ communities, including PEPFAR and other initiatives aimed at reducing health disparities.  The state department travel website already dropped 'LGBTQ' language for 'LGB.'

Alone in Nigeria PEPFAR had invested more than $6 billion in HIV/AIDS response. PEPFAR Nigeria is the third-largest programme globally and has touched over 2 million Nigerian men, women and children who are on ART treatment for free, a regimen which used to cost as much as $350. Beyond the financing, PEPFAR has laid a logistical and infrastructural framework which allows free testing, counselling, pharmaceutical warehousing and policy development towards the “95-95-95” goal of 2030.

Also read: Ex-WHO Advisor: Trump Right on US, China's Influence Debated