In the US, an assault on science, global health and human rights: Part 1 - The challenges confronting government-led science and health

IN ITS FIRST MONTH, the new Trump administration has shocked the world with a daily stream of actions and plans that fundamentally alter US national values and our role in the world. The results will be catastrophic for global food insecurity, treatments for HIV, TB, and malaria, US leadership in research and science, and all aspects of global health and human rights.  With these actions, half a century of commitment to humanitarian aid and global health affecting millions of children and adults around the world has been abandoned.  The actions include executive orders and agency directives that are summarised in Table I, and program terminations in Table II.  At this fragile moment in US and world history, we cannot look away. It is essential to review these actions and take stock of their potential impact on science, global health, and human rights.

The extraordinary actions include a challenge to the birthright citizenship that is a constitutional right in the US, a purge of language and a freeze on all funding that supports efforts to address diversity, equity, inclusion and accessibility (‘DEIA’), an assault on the rights and the very existence of transgender individuals, and a ban on language and programs that support gender diversity and non-binary individuals in the US and around the world. 

The new directives deploy mass deportation with expanded governmental powers for search and seizure, freeze budgets and fire federal employees in agencies and programs that provide humanitarian aid, development, disease surveillance and scientific research. These agencies include but are not limited to the US Agency for International Development (‘USAID’), the National Academies of Science, Engineering and Medicine, NASA, the National Science Foundation, the National Forestry Service, the National Institutes of Health (‘NIH’), the Food and Drug Administration (‘FDA’) and the Centers for Disease Control (‘CDC’). The Trump administration’s choices for new scientific leadership at NIH, CDC, FDA and the Department of Health and Human Services (‘HHS’)have been widely criticized for being unqualified, and openly hostile to many accepted public health care standards like childhood vaccines and global health diplomacy,  exemplified through the magnificent program for global HIV – the President Emergency Program for AIDS Relief (‘PEPFAR’). 

Though the justifications for these actions have been scant, a few clear rationales have emerged in the Project 2025 report from the Heritage Foundation and in public comments over the past month. The first priority is to secure the border and deport anyone who lacks legal status to be in the US. To fulfill an election promise to shrink the federal workforce and remove fraud, waste, and corruption, President Trump created DOGE, the Department of Government Efficiency, to be assisted by Elon Musk and a team of inexperienced software engineers. Musk has been charged with cutting waste and unnecessary spending across all government agencies.  As one example of the limited explanations, the dismantling of USAID was justified in a few sentences that claimed that USAID was corrupt, evil, and run by ‘radical lunatics’. 

Another explicit objective is to eliminate ‘woke’ culture and language, rejected for being unnecessary and offensively promoting radical left pro-LGBTQ+ agenda.  In a claimed effort to eliminate unneeded bureaucracy, key independent federal agencies and individuals that provide government oversight and consumer protections have been eliminated, as with the Federal Consumer Protection Bureau.The Inspector Generals from multiple agencies have been fired. The rationale for the actions against transgender individuals and gender diversity is contained in the title of the EO: ‘Defending women from gender ideology extremism and restoring biological truth to the federal government’. The speed and aggressiveness with which these actions have been taken have neither been justified nor even acknowledged, other than an attempt to follow the silicon  start-up company credo to ‘move fast and break things.’  A common feature is the widespread and casual use of lies and misinformation to support these actions that have been implemented in an astonishingly arbitrary, capricious, and cruel fashion without regard to any minimal standards of decency and respect for human dignity.