75 million people voted for Trump, with the economy and cost of living the primary concern for many on polling day. Health issues did not decide the election. But in the lead-up to the 2026 mid-terms, voters of all political backgrounds should ask themselves whether their access to care, health costs, and the health of the country as a whole improve during Trump’s second presidency. Media reports already say that Congress is unlikely to renew Biden-era health insurance subsidies in March, resulting in 4 million people losing their coverage. Many ordinary citizens will be steeling themselves to organise, advocate, and protest on issues related to health and human rights, not least further restrictions on reproductive rights. The increasingly threatening and ambiguous laws around reproductive and obstetric care are making practising medicine in the USA a risky business. Many health-care workers will need both moral and legal support.
The global health community must now face the prospect of weakened or withdrawn US leadership. Both Gavi and The Global Fund to Fight AIDS, Tuberculosis and Malaria are undergoing replenishments in the next 12 months, and the USA has historically been a leading donor to both. WHO is also in the midst of an investment round and must fear that Trump will once again sever ties, as he did during the COVID-19 pandemic. Climate change experts have already voiced alarm over Trump’s election as COP29 gets underway in Azerbaijan. Multilateralism is stronger for the USA’s involvement, and every effort must be made to make clear the need for global cooperation to address global issues. But the international community has to consider alternatives and will wonder about the reliability of the USA as a partner for long-term agreements—other countries are now under pressure for even greater commitment and collaboration. Ed Miliband, UK Secretary of State for Energy Security, has already promised that the UK will “step up and lead” at COP29.
This is a time for more science, not less, and for the value of science to be defended and promoted. For scientific institutions and the career scientists who staff them—particularly those working with and within the Trump administration—the priority is to continue their work. To generate evidence. To correct misinformation. To create accountability. And to engage. Federal agency scientists working with the incoming administration have been described as a key guardrail against the worst politicisation of science. COVID-19 showed that respected and capable scientists can exert valuable influence in even the most trying political environments by taking an open and non-partisan approach. No doubt many will be called on to do so again over the next 4 years. It will be no easy task, requiring a clear-eyed sense of pragmatism, a steadfast belief in the value of scientific principles, and a good deal of courage.