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Revitalizing Global Health Policy In The Post-Trump Era

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It is evident throughout former President Donald Trump’s four-year term, that he compelled the United States to choose isolationist policies to put “America First.” In office, the Trump administration criticized the North American Trade Organization, limited migrants and refugees, withdrew from the Paris Climate Agreement, and threatened to cripple funding to the World Health Organization (WHO) during a pandemic. By scaling back on the United States’ commitments around the world, we have not only abdicated our leadership role on the international stage but also alienated our allies and cultivated a reputation as an unreliable partner. Although these policies range from undermining multilateral institutions to escalating the trajectory of climate change, each of these decisions are also inextricably linked to health both within and outside of the United States.

For example, despite a robust military and one of the largest defense budgets in the world, it is impossible to ignore the fact that these reflections of power and diplomatic priorities did not correlate with an effective pandemic response in the United States. This non-military threat demonstrates that global health and cooperation is a core component of national security in an increasingly interconnected world. A consistent and cohesive internationalist approach in global health is not just a means to achieve geopolitical gain as per the whim of each new administration but a necessary long-term strategic investment in national security. It is time the White House leadership prioritized global health system strengthening deployment to support public health worldwide, especially for vulnerable in low- and middle-income countries (LMICs).

As the 46th president of the United States, Joe Biden needs to create a concrete action plan to commit to global health security, as it relates to pandemic preparedness and response as well as climate change, by partnering with other countries to facilitate equitable health care and resilient health systems. We stand at the cusp of an opportunity to revitalize a more inclusive, decolonized, accountable global health policy that also satisfies a global health security agenda. It is not enough for President Biden to revert to a pre-Trump era global health strategy and aid. We propose the following actions to match the globalist rhetoric:

Repair Our Relationship With The World Health Organization

First, while the Biden-Harris campaign did publish a COVID-19 plan and timeline, this needs to be framed within a larger, more progressive global health agenda for the United States to re-establish itself as an equitable leader and reliable partner. To realize President Biden’s plan to “…mobilize an international response that assists vulnerable nations in detecting, treating, and minimizing the spread of COVID-19,” we must repair our fractured relationship with the WHO.

The US has collaborated with the WHO, one of the most influential stakeholders in global health, to facilitate projects such as the Polio Eradication Initiative, which reduced polio worldwide by 99 percent. Additionally, the US government and the WHO have worked together effectively during all previous recent pandemics including the Avian flu, Zika virus, and Swine flu. Now, the US needs to support the $6.7 billion United Nations COVID-19 Humanitarian Response Plan. We need to pledge support to synchronize efforts across country leaders, nonprofit organizations, financial institutions, epidemiology centers, and other stakeholders to provide aid to vulnerable communities. Not only does this plan cover COVID-19–related funding but also provides support for other services such as mental health care and food supplies disrupted by the pandemic.

Decolonize Our Global Health Strategy

Second, we need to practice a decolonized global health strategy, which means we must “confront present structural agential sources of social injustices, asymmetrical power structures, patriarchal ideologies, logics of capitalist exploitation, resilient imperial/colonial reason, and racist articulations and practices.”

Reviving multilateralism in global health as far as how the US develops relationships with other countries, what aid is required, and how funds are generated needs to occur through a decolonized lens. This will require the US to more directly involve LMICs, which is inherently a human rights–based approach. We must shed the remnants of colonial power dynamics with deliberate respect for LMICs and support of local knowledge. To be truly multilateral in our approach, we need to step away from the mindset of US exceptionalism, which takes ownership and autonomy away from local governments and leaders. The more equitable approach is to allow the recipient countries to steer the global health agenda based on their individual health system needs rather than engaging in vertical funding dictated by the donor. This leads to ownership and accountability by the recipient country that mutually strengthens global health security. We see examples of the dismantling of these neo-colonial hierarchies with empowerment of local public health and research infrastructure such as the Bangladesh-headquartered organization, Building Resources Across Communities, collaborations such as the Kampala Initiative, and advocacy for the “People’s Vaccine” campaign.

Increase Access To High-Quality Health Care

Third, we need to focus on strengthening health systems and increasing access to high-quality health care. Instead of siloed development assistance for specific diseases, our priority should be to build resilient health care infrastructure. As per the Bellagio Forum for High-Quality Systems, high-quality health systems are those “that consistently deliver services that improve or maintain health, are trusted by people, and can adapt to changing needs and health shocks.” To accomplish this, we need to invest health financing into access to essential primary and surgical care, enhance clinical education and competency assessments, collect data to inform health care service delivery models, provide robust outcome measures and metrics for accountability, and incentivize value-based health care. Such health care infrastructure would strengthen global health security as it allows for agile local response to emerging infectious disease outbreaks and noncommunicable disease burden, while also decreasing the mortality attributable to poor-quality health systems in LMICs.

With a new president in the White House and the dissemination of life-saving vaccines finally coming to fruition, as a country and a global presence, we have the ability to make a full pivot to support intentional multilateralism in global health. These upcoming breakthroughs and power handoffs are an opportunity to not just revert to a pre-Trump era global health paradigm but to catalyze change to accommodate the ever-evolving global health development and policy arena.

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