Why Trump’s ‘America First’ Strategy Could Literally Make America Sick

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Pulling out of international climate treaties. Disrupting long-standing alliances. Ripping up trade agreements.

Donald Trump has spent his political career promising to do all of these things and, now that he’s back in the White House, he’s already on his way towards accomplishing them. In just the first few days since taking office, he has ordered the U.S. out of the Paris Climate Accords, announced his intention to impose 25% tariffs on Canada and Mexico and continued to make noises about taking back the Panama Canal.

There’s plenty more to come. As Trump sees it, the U.S. is in constant competition with ― and facing constant threats from ― other countries. It’s a nearly Hobbesian worldview in which there’s rarely common good to be found, or mutual benefit to cooperation. It’s what he means when he vows, as he did in Monday’s Inaugural address, that “during every single day of the Trump administration, I will, very simply, put America first.”

Trump is by no means the first American politician to talk or to think this way. But he’s the first to make this posture the official policy of the U.S. government — at least since the end of World War II, when U.S. leaders led the effort to create the agreements and relationships that Trump is trying to tear down.

They did so in part because, after a worldwide economic depression and two horrific world wars, they had come to believe that more cooperation among countries would ultimately make the U.S. richer and safer. Seven decades of progress, prosperity and (relative) peace suggest they were largely right.

That doesn’t mean global connectedness have always worked out to the benefit of Americans, or the rest of the world for that matter. That is why, for example, even defenders of international organizations like the United Nations have called for major reforms ― or why even many promoters of freer trade support initiatives that would protect U.S. workers from low-wage competition.

But Trump has in mind a much more radical shift. And maybe no single Trump decision better illustrates his intentions than his order pulling the U.S. out of the World Health Organization ― a move that, public health experts told me this week, is fraught with danger.

They don’t simply worry that withdrawing from WHO could undermine a vital international agency. They also fear that it will endanger Americans, making the nation more vulnerable to deadly diseases and new pandemics. And they make a compelling case.

What The WHO Does, How It Came To Be

WHO is a United Nations sub-agency charged with promoting better health around the world. It dates to 1948, although its conceptual origins go back to the 19th century, when increases in global shipping created concerns about the spread of disease from dockworkers and locals to mariners, who would then take illnesses with them to other ports.

“Preventing and controlling outbreaks is not just about the health of communities but also about economics and national security,” Preeti Malani, an infectious disease professor at the University of Michigan, told me.

The concern led to a series of agreements including the 1892 International Sanitary Convention and 1926 International Maritime Sanitary Convention. These agreements set early, rudimentary standards for how to report outbreaks and when to impose quarantines.

The establishment of WHO accelerated and strengthened these efforts — by, among other things, creating systems for global sharing of disease data, launching worldwide vaccination campaigns and coordinating responses to outbreaks. WHO played an essential role in the eradication of smallpox, by most accounts, and in the near-eradication of polio.

That kind of work is still going on today, as is the response to sudden health threats. Just a few months ago, WHO coordinated what now looks like a successful effort to contain and then wipe out an outbreak of Marburg virus in Rwanda. It’s an awful disease that leads to bleeding, severe vomiting, neurological issues and eventually a painful death. But in the end there were just 66 reported illnesses and 15 fatalities, and within three months the lack of new cases allowed local officials to declare the outbreak over.

“We found out about it quickly, and that was the way the warning system is supposed to work, and precautions were taken,” says Jennifer Kates, senior vice president and director of global health and HIV policy for the nonpartisan research organization KFF. “These are not things that the average American is going to always feel, but that’s partially because the system is designed to try to contain outbreaks when they happen.”

Back in 2014, WHO wasn’t as successful at stopping an outbreak of Ebola, a closely related virus, that started in the western part of Africa before spreading to Europe and the U.S. Both at the time and later, experts faulted WHO for not raising alarms about the appearance of the disease earlier. But it was still WHO that coordinated the subsequent international response, whose success at preventing the virus from killing many more people won widespread acclaim.

“WHO emergency teams were on the ground, they were isolating cases, they were providing health care,” Lawrence Gostin, professor of global health law at Georgetown University, told me. “They did the contact tracing and eventually stopped the pandemic in its tracks.”

Of course, it’s WHO’s role in COVID-19 that has generated most of the controversy recently ― and, relatedly, has drawn Trump’s ire. From the earliest weeks of the pandemic, back in 2020, a variety of researchers and officials have blamed WHO for not putting more pressure on China to disclose information about the disease’s origins and initial spread.

Trump, famously looking for people and institutions to blame, picked up on these criticisms and actually initiated the withdrawal process, which under U.S. law takes one year. President Joe Biden reversed that order upon taking office, but now Trump has reinstated it, citing “the organization’s mishandling of the COVID-19 pandemic that arose out of Wuhan, China” as a reason.

Trump has also complained that WHO membership costs so much money. The U.S. is the organization’s single biggest funder, with its roughly $1.3 billion in contributions over the 2022-23 period accounting for about 16% of the total WHO budget.

During a Monday evening press conference, as he signed executive orders, Trump said “WHO ripped us off.” Among those orders was the one restarting the yearlong withdrawal process, which means the U.S. is now on track to leave the organization in January 2026.

The WHO Without The U.S.

Even defenders of WHO say it has serious flaws, starting with the kind of excessive deference to strong member nations that WHO showed to China over COVID-19. Other problems include the bureaucratic inefficiency endemic to large international organizations, as well as a financial burden on the U.S. that even some committed globalists think other economically advanced countries could do more to share.

“I think it’s really important to recognize that the challenges that the Trump administration is trying to address are real,” Judd Walson, a professor of international health at the Johns Hopkins Bloomberg School of Public Health, told me.

And while an effort to address some of those issues has been underway, in the form of a new worldwide pandemic treaty the Biden administration was negotiating, it has already drawn objections from many on the political right. According to these critics, the emerging treaty is either too weak (because it would still allow a country like China to get away with withholding information) or too strong (because it would require the U.S. to comply with new demands for information) or both.

But Trump isn’t looking to alter the terms of that treaty, or propose some other way of improving WHO. He’s talking about withdrawing altogether. And while his executive order calls on his national security staff to find other ways of addressing global health, few public health experts think that’s realistic.

“The U.S. has probably more technical expertise than any other nation in the world on health, it has the largest economy, and so in many ways it really can operate on its own more than any other country,” said Kates. “However, it can’t do everything on its own.”

Gostin was even more forceful: “President Trump is living in Fantasyland. You can’t replace the singular global health organization that’s been the center of global health for more than 75 years. And if he thinks we can ― that we are stronger by going it alone ― he’s badly mistaken. It’s very clear our domestic capabilities can’t replace a worldwide network of surveillance and response.”

A simple, practical way U.S. withdrawal could hamper future outbreak responses is by making communication more difficult. One of WHO’s most important functions is creating standards and expectations for the precise kinds of data member nations should provide, and then creating mechanisms for sharing it in real time.

In theory, Walson said, nations could still provide and share information on their own. In reality, he said, it’s not going to happen seamlessly or quickly if the channels for communication don’t exist already: “There are technical challenges, like who exactly in these other countries is going to provide the data … who do they approach in the U.S. about it.”

But probably the biggest single worry among these experts is that without U.S. leadership and money, the organization would simply not be able to do as much. It’s even possible U.S. withdrawal would set off a chain reaction in which other powerful countries start pulling back as well ― until, eventually, WHO is a shell of its former itself, with nothing similar replacing it.

“If that happens … then the whole goal of having global cooperation at times of crisis in particular really gets affected,” said Kates. “You can see that playing out ― now there’s no global cooperation, we’re all in it for ourselves. And then that’s like a dystopian movie.”

As an example of what that dystopia might look like, Walson imagined another outbreak of Ebola or Marburg in a small West African country without the resources to identify, track or contain the virus on its own. The first reports of fever would come in, but they’d struggle to figure out whether it was just another normally circulating disease like malaria or something worse ― and, once they understood the threat, it would take them time to mount a response.

It could be devastating for the country and, as past outbreaks have shown, potentially devastating for the rest of the world too. “People are moving, leaving their country to go work in a neighboring country,” Walson said. “They’re going into airports where they’re in contact with business travelers, who then fly into a European country and meet their American counterpart at a meeting in Davos or in London.”

“Infections spread quickly, so our inability to know that there’s a potential threat, to assess the threat and to help respond and contain that threat, will have immediate and direct consequences for our security,” Walson said.

What The WHO Means To The U.S.

One way WHO could weather a U.S. withdrawal would be to lean more on other powerful nations, although doing so would likely empower China ― the very nation Trump sees as America’s chief adversary ― and leave the U.S. with even less influence over global health policies.

“The thing that makes us weaker is just to take all our marbles and go home, because whenever there is a vital public health decision around the world to be made, the U.S. will be on the outside looking in,” Gostin said.

And while the longstanding U.S. support for WHO may seem to critics like a naïve attempt at creating a utopian global community, Walson says, it’s actually a recognition that the world is full of suspicious and hostile powers ― and that, when it comes to health, mutual survival depends on getting past that.

“We are viewed as a major and important actor in the global health space ― and that trust and belief that we do it not only for ourselves, but that we do it for the community as a whole, has consequences,” Walson said. “There is a level of willingness to engage that allows us to work with countries that otherwise we would not be able to work with effectively, because of that level of trust.”

This is obviously not the perspective of Trump, whose views on the world as a competition for dominance sounds a lot like some of the prevailing sentiments of the 19th century. As Walson noted, those worries about maritime trade spreading disease came from the colonial powers because they were the ones dispatching the ships.

Leaders of those nations embraced international cooperation over health largely out of self-interest: They didn’t want to bring illness back home. Later the same impulse helped lead to the creation of other international organizations and agreements, covering everything from trade to security.

Now those arrangements are in Trump’s crosshairs, and many will not survive. But ”infectious pathogens don’t stop at borders,” as Malani put it. Trump may succeed in pulling the U.S. out of global health organizations. That doesn’t mean the crises they’re meant to address will stop.