Will Trump Administration’s Funding Pauses, Withdrawal from WHO Hamper Public Health?
This is the second in a series looking at the intersection of government and public health. In this segment, Contagion Editor-in-Chief Jason Gallagher, FCCP, FIDP, FIDSA, BCPS, discusses the WHO pullout, and the pauses on federal communication and research grants.
On January 20, the Trump Administration issued an executive order announcing its withdrawal from the World Health Organization (WHO).
The order stated it was, “due to the organization’s mishandling of the COVID-19 pandemic that arose out of Wuhan, China, and other global health crises, its failure to adopt urgently needed reforms, and its inability to demonstrate independence from the inappropriate political influence of WHO member states. In addition, the WHO continues to demand unfairly onerous payments from the United States, far out of proportion with other countries’ assessed payments. China, with a population of 1.4 billion, has 300 percent of the population of the United States, yet contributes nearly 90 percent less to the WHO."1
“I think we're going to find out more about what it means going forward,” said Jason Gallagher, FCCP, FIDP, FIDSA, BCPS, clinical professor at Temple University School of Pharmacy and clinical pharmacy specialist in Infectious Diseases at Temple University Hospital, of the WHO withdrawal. “I think as much as anything else, it's a signal that is concerning for the degree to which the United States wants to engage in the rest of the world, and related to public health.”
“Through membership in the WHO the US gets influence on health policy around the world. And I don't think that's the kind of thing you want to give up. Within the more tangible benefits, WHO is doing epidemiology work and detection of outbreaks. That seems to be where some of the disagreement with them has been at least from a gut opinion perspective.”
And while it was believed to be a gradual withdrawal with WHO, within a week, a memo came from the Centers for Disease Control and Prevention’s (CDC), Deputy Director for Global Health John Nkengasong, PhD, which was written to senior leaders at the agency telling employees that work with the WHO must immediately stop and to “await further guidance.” Congress will need to approve withdrawing from the WHO, and the country has to provide a 1-year notice.2
Read more: Now is Not the Time for Funding Pauses, Cutting Ties With Health Organizations
A Gag on Federal Communications
Within the administration’s flurry of executive orders, there was a pause put on federal communications. This included not publishing the CDC’s Morbidity and Mortality Weekly Report (MMWR) last Thursday. It is a significant public health publication. This pause on not publishing this report was the first time in decades. This report has been publishing since the 1950s.
“This is a premier health publication that everybody reads…multiple times a year you take a peek at that one because people are talking about something that has been described in MMWR,” Gallagher said. It's used for other publications as well; recommendations, guidelines, and so forth that can go in other places, but it really has been a stalwart of US public health and our information network about health for decades."
MMWR was not published yesterday—marking 2 weeks in a row—and it remains to be seen, if and when, this will come back.
Research Grants Pause
In a January 27 memo sent by Matthew Vaeth, acting director, Office of Management and Budget (OMB), to the heads of executive departments and agencies, a pause was placed on all funding, including research grants.
The memo stated, “to the extent permissible under applicable law, federal agencies must temporarily pause all activities related to obligation or disbursement of all federal financial assistance, and other relevant agency activities that may be implicated by the executive orders, including, but not limited to, financial assistance for foreign aid, nongovernmental organizations, DEI, woke gender ideology, and the green new deal.”3
The memo also stated this was a temporary pause and gives the administration time to review agency programs and “determine the best uses of the funding for those programs consistent with the law and the President’s priorities.”3
Later, the OMB rescinded the memo, but the White House press secretary said other freezes tied to executive orders issued by Trump remained in effect. This has led to more confusion, uncertainty, and delays including research.3
“Money not going into research funds means money not going into clinical trials, which are not going into discovering therapies that are ultimately going into patients. And with the sort of wide pauses and suspension of some of the work of our federal health agencies in NIH, CDC, and FDA—that's what I think of more than anything else,” Gallagher said. He notes a large portion of the university funding for research comes from those aforementioned government agencies.
Much remains to be seen how this will all play out. The hearings for Robert F. Kennedy Jr for the Health and Human Services Secretary position were this week and a vote for his confirmation has not taken place yet. If he does become secretary, this could also have long term effects on public health policy including vaccines.
“I think most pauses will be lifted at some point, and what comes off on the other side of that is something we don't know. It could be stipulations, and what can be researched,” Gallagher said.
