RSC College Member Matthew Herder and colleagues Roojin Habibi, Fatima Hassan, and Andrew Hill published an analysis in BMJ in late March arguing that the actions of the United States government under President Trump met the threshold of a “public health emergency of international concern” (PHEIC). Normally used in response to an infectious disease outbreak that is spreading across country borders, such as the Ebola epidemic in West Africa during 2014-2016, or the covid-19 pandemic, Herder et al. explain that this legal mechanism is not confined to the “manifestation of disease”; rather, a PHEIC can be declared in relation to any “extraordinary event” that “creates a potential for disease.” And due to a range of decisions since President Trump assumed office in January 2025— withdrawing from the World Health Organization, cutting key global health programs, freezing funding for treatments and services in low- and middle-income countries, and undermining of immunization and pandemic preparedness both domestically and abroad—the risk of a wave of new epidemics of HIV, malaria, tuberculosis and other diseases has been dramatically increased. Herder et al. therefore call upon WHO to determine that these actions constitute a PHEIC in order to mobilize resources and take other steps, such as compulsory licensing of essential medicines, to mitigate the harms caused by the United States’ actions and avert the millions of deaths expected to occur by 2030.
In response to coverage of the BMJ publication by multiple news outlets, including Newsweek, the White House offered an official response, attacking the authors as well as WHO as a “corrupt and incompetent institution.” Herder et al.’s analysis in BMJ and the White House revealing attempt to rebuke it is important on several levels.
First and foremost, in a world so rife with conflict and chaos, wracked by new horrors seemingly almost every day, it is critical not to lose sight of the suffering that many people in low- and middle-income countries have already endured as a result of the actions of the Trump Administration. Multiple studies predict these harms will grow exponentially. But even the temporary freezes of funding that occurred in early 2025 led to shutting down of clinics, HIV testing, and other critical healthcare services, which in many cases have not been restored.
Second, many high-income countries have, owing to the instability of the global economy, significantly reduced their own foreign aid, potentially compounding the harms caused by the United States’ actions. This is short-sighted and increases the risk of future outbreaks. Deeming the US’ actions to be a PHEIC should put other countries on notice and short up their support for a variety of global health programs that serve the world’s most vulnerable.
Finally, the publication in the BMJ and the White House’s response to it, underscores the importance of international cooperation instead of trying to appease the world’s most powerful hegemon. As Herder et al.’s analysis went to press, member states of the World Health Organization’s met in Geneva to negotiate the final details of the Pandemic Treaty. Unable to reach agreement, member states have resolved to meet again in late April in advance of the World Health Assembly a month later. The details are crucial. Without a meaningful “pathogen access and benefit-sharing” mechanism behind the treaty, the inequities observed during covid-19, like so many infectious disease outbreaks that came before, are apt to be repeated. With the Trump Administration apparently set on a course of “divide and conquer,” it’s clear that the phrase that was commonly used by political leaders during the pandemic “no one is safe until everyone is safe” is an understatement. On the contrary, we’re all in danger until we work together. And, whether that means declaring the United States’ actions amount to a PHEIC, or ratifying robust benefit-sharing commitments as part of the Pandemic Treaty, it is now critical for countries to engage in sustained cooperation to reduce global health inequities.
