From inhibiting clinical trials and the development of new treatments, to the management of infectious diseases globally, and attacks on academic freedom, the Trump Administration is proving a disaster for health across multiple fronts.
In her column below Dr Lesley Russell also reports on the abolition of NHS England, the COVID toll and the spread of other infectious diseases, and a call to ‘give Medicare teeth’, as well as sharing news of a musical gift from the Sydney Opera House.
The quotable?
When we start to see a decrease in vaccination rates, measles outbreaks are the first thing you see, and often what follows are the other vaccine-preventable diseases.”
Lesley Russell writes:
This is the last edition of The Health Wrap from our Colorado office (for a while at least). We’ve had a wonderful time skiing and snowshoeing, catching up with family and friends and with a little work too.
But there has been far too much time and mental energy consumed with what has been happening in Washington DC. It seems that every hour there is a shocking new Trump initiative, and it can be consuming.
That said, I do not believe we can ignore what is happening. Already we are seeing consequences for Australia – research funds under threat, tariffs on Australian products, actions proposed against the Pharmaceutical Benefits Scheme, and likely problems for those who seek research positions at United States universities and colleges.
Even worse, and thus more demanding of our outrage and actions, are the Australian politicians who would emulate Trump ideologies and attempt to impose them on us.
I commend to you an essay in Nature by bioethicist Arthur Caplan headed ‘Don’t wait out four hard years: speak truth to power’.
He writes: “More scholars must push back.
“The idea that scientists can keep doing what they know must be done to incorporate DEI [diversity, equity and inclusion] into their work while adjusting terms to fit the demands of bigoted autocrats bent on hobbling science is to whistle loudly past a graveyard of avoidable error, continued financial cuts and censorship.
“That diversity matters to science is a truth — albeit one that has only recently begun to be accepted and applied.”
The world reacts to Trump 2.0
The 13 March 2025 issue of the BMJ has a series of articles about the international impact of Trump’s policies and how scientists and clinicians should resist and respond.
The editorial that accompanies these articles, written by the BMJ international editor, outlines how Trump 2.0 and the global export of his “deadly” policies is undermining equality, with an especially devastating impact on women.
Interestingly, among a series of calls for action, this editorial enjoins the case that the next Secretary-General of the United Nations should be a woman who can bring new approaches and fresh leadership.
The list of countries and initiatives that will suffer (or indeed are already suffering) as a consequence of the elimination of USAID funding and support continues to grow.
The Trump/Musk efforts totally fail to recognise the amazing work and extended benefits that USAID work has delivered.
Africa is particularly hard hit. New York Times columnist Nicholas Kristoff has helped document much of this.
In what appears to be Trump acting on Musk’s behalf, there has been a campaign of animus directed against South Africa.
An Executive Order issued by Trump in February accused South Africa of egregious actions and race-based discrimination against Afrikaners.
“It is the policy of the United States that, as long as South Africa continues these unjust and immoral practices that harm our Nation…the United States shall not provide aid or assistance to South Africa,” it stated.
There are fears for what the withdrawal of aid and research grants will mean for programs tackling HIV/AIDS and tuberculosis.
The US Supreme Court has declined to halt a lower court order that required the Trump administration to unfreeze nearly US$2 billion in foreign-aid funding. This should have cleared the way to pay groups that have done work for the State Department and USAID, but to date the Trump Administration has failed to do this.
We can expect that there will be more court cases around this issue (and so many others) but these will take a long time to deliver a decision. We can now be certain that the Trump Administration will ignore legal advice and rulings, and by then the damage will have been done, likely irreparably.
The Trump Administration appears indifferent to the global nature of disease research and to the painstaking process by which treatments are developed.
Just one example of the long-term impact of these actions: an article in MedPage Today asks “Who will volunteer for clinical trials now?”.
“About half of the clinical trials run in cooperation with US companies are conducted in foreign countries. With potentially unreliable funding, research sponsors may be wary of even starting a trial overseas,” says the article.
“As they watch current investments in studies swirl the drain, along with the expensive but now-worthless partial data generated from these interrupted investigations, they may well decide that the enormous costs of mounting trials are not worth undertaking if they cannot count on promised funding.
“Add in job cuts at drug oversight agencies like FDA [Food and Drug Administration], and physicians are likely looking at research pipelines with fewer new agents, and patients who are leery of testing them.”
Big challenges alongside small vindictive acts
It’s increasingly amazing to me that every day I learn about some nasty, vindictive act from the Trump Administration. I wonder how they find the time for the small mayhems alongside the big atrocities.
Here are just a few examples, each more egregious than the one before it.
A mural of Dr Anthony Fauci, together with an inspiring quote, that hung in the halls of the National Institutes of Health has been removed, leaving an empty patch of wall.
The Department of Health and Human Services has removed a declaration from the former US Surgeon General, Dr Vivek Murthy, declaring gun violence as a public health crisis on the grounds that this was in line with Trump’s Executive Order to “protect Second Amendment rights”.
There are now far too many examples of the erasure of Indigenous, Black, Hispanic, and female veterans from US military history.
This looks like an attempt to elevate white men as the sole actors in military history.
But it also erases the times in the life of the nation when Americans of all backgrounds came together to fight a common enemy. The US military, under orders from President Truman, led the way in racial integration.
As I’m writing this, a message comes into my email box advising that the Trump Administration is considering ending federal funding for domestic HIV prevention programs.
This will have “catastrophic consequences” experts say and will undo decades of progress in combating the epidemic. More on this decision is here.
There are reports that scientists, administrators, and other employees at the NIH are “reeling, afraid, and confused” as the agency faces significant workforce cuts and leadership remains silent about how the cuts will be made.
Ultimately, the NIH is expected to shed between 3,400 and 5,000 positions from a workforce of 20,000.
Universities across the United States have been reeling as they face what the Trump Administration is requiring of them if they are to continue to receive federal funds for education, research and other activities.
Columbia University, under fire for allowing pro-Palestinian protests, is confronting huge cuts to its funding (some US$400 million, of which about $250 million is NIH funds), along with demands that extraordinary control is ceded to the federal government.
Federal officials told the university it must immediately place its Middle Eastern, South Asian, and African Studies Department under “academic receivership for a minimum of five years”.
Whatever you think about the University’s response to antisemitism, slashing research funding can hardly be the appropriate response.
An article in The New York Times looks at the research affected. Some of it affects other universities that partner with Columbia on research initiatives.
For example, it appears that funding for an ongoing 30-year, nationwide study tracking patients with prediabetes and diabetes – a project managed by Columbia – has been cancelled.
Columbia is the first university to face such aggressive intervention from the Trump Administration, but many others have been put on notice they’re next if they defy the President’s orders on issues around pro-Palestinian activism, diversity programs or transgender women in sports.
International university, medical and research staff are also at risk, as highlighted by the case of a Brown University doctor (a recognised transplant surgeon), a citizen of Lebanon holding a valid visa, who was detained last week upon her arrival at a Boston airport after a visit to Lebanon and then deported, despite a judge’s order to halt her deportation.
Brown University has now advised all international staff and students to reconsider travel home or elsewhere overseas.
There are much worse deportation issues going on as the Trump Administration has invoked the 18th century, wartime Alien Enemies Act to remove Venezuelan gang members.
The Administration has openly defied court orders on this. The issue – which presages a constitutional crisis – is clearly headed for the US Supreme Court.
What is happening to the National Health Service?
With so much attention on the United States (mea culpa), you might have missed what British Prime Minister Sir Keir Starmer was doing to the way the National Health Service (NHS) in England is run.
His government has announced the abolition of NHS England, phased over two years, and the merging of functions and staff into the Department for Health and Social Care (DHSC).
The rationale was announced as reducing duplication and saving hundreds of millions of pounds.
In an article in The Conversation, Dr Peter Sivey does a good job of explaining what this means. Reading between the lines, I would say it’s all about savings, addressing duplicative functions, and bringing the functions of NHS England directly under ministerial control.
Much of this is presented as a response to the Darzi report, delivered to the Starmer Government in September last year.
The government media release announcing this was headed “World’s largest quango scrapped under reforms to put patients first. Changes to NHS England will reduce bureaucracy, make savings and empower NHS staff to deliver better care for patients.”
The Economist described it as “DOGE comes to England’s health service”.
The commentaries and analyses I have read acknowledge that reforms are needed but are also sceptical about the outcome and worried about the loss of expertise.
It will be several years before the outcomes are realised.
More on vaccines, infectious diseases and pandemics
This past week we have been reminded that it is five years since the COVID-19 pandemic shut down the world.
Now those scary days seem long past, but COVID-19 remains – still evolving and still finding new ways to evade our immune systems.
A recent study published in PLOS Medicine reveals that COVID-19 has cut millions of healthy life years across Europe (and presumably Australia).
The study found that between 2020 and 2022, 16.8 million person-years of life were lost across the 18 European countries studied, Of these, 11.6–13.2 million years were due to registered COVID-19 deaths, while 3.6–5.3 million were linked to non-COVID excess deaths attributed to healthcare disruptions or unintended consequences of containment measures.
Countries with lower vaccination rates and weaker economies saw the highest life-year losses, demonstrating the importance of public health preparedness.
That’s one lesson for Australia: the other is from a new report by the Australian Human Rights Commission that finds that Federal, State and Territory governments did not adequately consider or protect people’s human rights when implementing pandemic response measures.
In the previous edition of The Health Wrap I wrote about the looming threats from infectious diseases. Forgive if I expand upon that in this edition as the situation seems even more threatening.
As measles spreads across the United States (cases have now been reported in 15 states) there are also reports that measles cases in Europe doubled in 2024 to a more than 25-year-high.
Children under five accounted for more than 40 percent of the reported cases and this is attributed to a slump in vaccination rates after the COVID-19 pandemic (could we also blame Trump and mis/dis-information?).
Public health experts are worried about what other vaccine-preventable diseases will emerge.
“When we start to see a decrease in vaccination rates, measles outbreaks are the first thing you see, and often what follows are the other vaccine-preventable diseases,” said one paediatric infectious disease expert.
Take time to read Dr Craig Spencer’s article “The Diseases are Coming” in The Atlantic (it’s also available without signing in here).
And two studies to highlight why research funding and international cooperation in this area is so important.
Infectious diseases are so quickly and easily spread with international travel. Researchers at Northeastern University in Boston say regularly testing wastewater from airplanes at a handful of airports around the globe could help prevent the next pandemic.
Almost every pandemic over the last century has come from a virus that’s spilled over into humans from animals.
A team of ecologists, infectious disease scientists and policy experts have distilled their collective observations into three recommendations to prevent spillovers and halt epidemics and pandemics before they even start (this approach to animal/human health is called One Health).
A particular focus is on bats and the viruses they carry, with research underway in India, Brazil, and countries in Asia and West Africa. (I wonder how much of this research has been funded by now-cancelled grants from the United States?)
As new diseases emerge, new vaccines and medicines will be needed. As Trump, HHS Secretary Kennedy and Musk look to shutdown America’s research pipeline and training, there is an urgent need for others countries to step up to this effort.
Vaccines and medicines made using mRNA technologies will be especially important. But mRNA vaccines are apparently a specific part of Kennedy’s attack on vaccines.
The Acting NIH Director sent an email instructing the NIH that “any grants, contracts, or collaborations involving mRNA vaccines be reported up the chain to [Kennedy’s] office and the White House.”
Of course, we might expect that Kennedy et al might feel differently about mRNA vaccines in the future if they or a family member needs treatment for pancreatic cancer – early studies with mRNA vaccines in the United States and Europe are showing great success.
I wrote about Australia’s vibrant but uncoordinated efforts around mRNA vaccine research, development and manufacture recently for Inside Story magazine.
In case you missed it
Some short summaries of interesting and topical papers and announcements.
Deterioration of children’s eyesight
A recent article in The Australian Weekend Magazine reported on the sudden rise of short-sightedness worldwide, particularly among children and how experts are struggling to explain this “myopia epidemic”.
Sight (and hearing) are not issues regularly focused on in Medicare – despite the profound importance of these senses to our health and wellbeing, to ageing well, working and communicating effectively, and self-esteem.
When it comes to the increase in children’s myopia, there are two factors of particular concern. One is that children are not spending nearly as much time in daylight as they need to for appropriate eyeball growth.
The other factor is that children are spending too long engaged in “near-work”, especially where this involves tablet and phone screens.
Although the modern IT world is not solely to blame: Israeli research shows that ultra-Orthodox boys have a higher prevalence of myopia (82.2 percent) than secular boys (29.7 percent) due to their reading and study habits.
Dental care as an election issue
The Albanese Government is undoubtedly making a health pitch for the upcoming election – more bulk billing, more urgent care clinics, initiatives in women’s health, reductions in PBS co-payments.
However, the only mention of dental is the acknowledgement from Health Minister Mark Butler who keeps responding: “I can’t say to people that in the short term there’s going to be any change to dental, but I do recognise in the longer term there’s a lot of ambition for dental to be covered by Medicare.”
The Australian Dental Association has called for a federally-funded program that would give seniors a means-tested program to access free dental care. This call for a budget and/or election commitment to improve affordable access to dental services is accompanied by the usual stories of dental pain and disability suffered by so many Australians.
This approach, which reflects a recommendation from the 2021 Royal Commission into Aged Care Quality and Safety, seems both valuable and affordable, especially if seniors can be persuaded to use it for prevention services, before their dental problems require major, expensive interventions.
Effectively implemented, it’s also likely to be cost-effective.
In 2022-23 nearly 22,771 Australians aged over 65 were hospitalised with potentially preventable dental issues. (Note: this figure from AIHW website; reported as 16,000 by ABC News, also citing AIHW).
Medical costs website in the news
The Medical Costs Finder website was set up by the Morrison Government in 2019 to help patients find and understand the “typical” costs for private health procedures and avoid surprises when getting billed.
Most people who use it would not say it was helpful and it rarely helps avoid billing shocks.
It is hamstrung by its voluntary opt-in system. To date only 70 doctors provided their fee information to the site (there are around 11,000 specialists who are eligible to upload their fees).
Health Minister Butler has announced a review of the Medical Costs Finder and – ahead of this review – the provision in the Budget of an additional $ 7 million. Is this throwing good money after bad?
Butler says that the additional funding will be used to pay for the “technical capability” to analyse annual Medicare, hospital and insurer data for every common medical service and display the average fee for each specific doctor alongside the national average for that service.
I don’t know enough to understands if this will work. (Read more commentary on this in the latest edition of The Zap).
Bad news on low back pain
Up to 90 percent of Australian adults will experience low back pain at some point and it is the leading contributor to disability globally.
In most diagnosed cases, the pain is considered “nonspecific,” meaning it doesn’t have a clear cause. That’s also partly what makes it so hard to treat.
In a study just published in BMJ Evidence-Based Medicine, researchers reviewed 301 randomised trials that compared 56 non-invasive treatments for low back pain.
They found only one treatment – the use of nonsteroidal anti-inflammatory drugs (NSAIDS) – was effective at reducing short-term, or acute, low back pain.
Five other treatments had enough good evidence to be considered somewhat effective at reducing chronic low back pain.
These were exercise; spinal manipulation from a chiropractor; taping the lower back; antidepressants; and the application of a cream that creates a warming sensation. But these benefits were small.
Indigenous health news
The Albanese Government has announced the provision of over $11 million for 26 projects to help strengthen Indigenous language education in primary schools in more than 40 communities.
This is part of the First Nations Languages Education Program and part of Closing the Gap.
Enthusiastic community responses were reported in the National Indigenous Times.
This is a good news story, as much about health and wellbeing as about education and culture.
The best of Croakey
Bookmark this link to follow Croakey’s coverage of health matters in the lead-up to the federal election.
The good news story
I loved this story about how new technology installed in the Sydney Opera House means people with poor hearing can really enjoy the music and other live performances.
The Sydney Morning Herald: ‘Marian has been unable to enjoy live music for decades. New technology just changed that’.
Croakey thanks and acknowledges Dr Lesley Russell for providing this column as a probono service to our readers. Follow her on Twitter at @LRussellWolpe. Russell is Adjunct Associate Professor at the Leeder Centre for Health Policy, Economics and Data, University of Sydney.
Previous editions of The Health Wrap can be read here.
