Trump 2.0: PH stays optimistic amid worries on aid, health care

DONALD TRUMP composite image from Inquirer file and AP file photos

(First of two parts)

MANILA, Philippines—As Donald Trump prepares for his return to the US presidency, experts are taking a close look at the ripple effects his second term could have on the Philippine health care system which has benefited significantly from US assistance.

Following last week’s US presidential elections, many cautioned that Trump’s victory over Vice President Kamala Harris could send global shockwaves, sparking concerns among international allies about a resurgence of his nationalist “America First” policies.

One of the most talked about and weighed-in possible impacts of Trump’s

second term by experts, political figures, and lawmakers alike was on immigration.

Trump has made it clear that he would reinstate stricter border policies, resume construction of the US-Mexico border wall, and implement tougher regulations on asylum and refugee admissions.

This approach mirrors his previous administration’s policies, which sharply limited both legal and illegal immigration while prioritizing strict vetting and enforcement measures.

READ: How Trump’s mass deportation plan will impact undocumented Filipinos

However, the potential effects of Trump’s victory go beyond immigration, bilateral partnerships, and economic impacts. Attention is also turning to the US’s global health aid efforts, which include substantial investments and initiatives benefiting numerous countries, such as the Philippines.

Additionally, concerns are mounting over the potential changes to US health care policies under Trump, especially after hints of appointing a longtime anti-vaccine activist and conspiracy theorist as his health czar.

US aid cuts?

Reports of potential drastic cuts to US foreign aid surfaced just days after Trump’s victory. Observers have pointed out that these cuts could significantly impact critical global health programs, including those supporting health systems worldwide.

A report by Al Jazeera noted that potential cuts could target the approximately $8 billion in annual US aid to Africa, which supports crucial programs like PEPFAR (the US President’s Emergency Plan for AIDS Relief), vaccine distribution, HIV/AIDS treatment initiatives, and reproductive health services.

Christopher Isike, a professor of African Studies and International Relations at the University of Pretoria, told Al Jazeera: “If Africa wants to continue on handouts and aid from the US, then [Trump’s election] is catastrophic.”

Africa, like many other regions, relies heavily on US aid for health and development through the United States Agency for International Development (USAID) — a government agency that leads international development and humanitarian assistance efforts to partner countries.

GRAPHIC Ed Lustan

Over the past 60 years, USAID has partnered with countries around the world to transform global public health. The agency has invested in diverse health initiatives, including efforts to combat diseases like HIV/AIDS and tuberculosis, strengthen health systems, safeguard communities from deadly outbreaks, and promote social and economic development.

Unfortunately, the agency was not spared from the sweeping proposals outlined in a document titled “Mandate for Leadership: The Conservative Promise,” a 922-page agenda crafted by right-wing groups for a second term under Trump.

Published by the conservative Heritage Foundation, the document is part of Project 2025, which seeks to influence the next US administration before it even takes office. The initiative provides policy recommendations, personnel suggestions, and a 180-day action plan.

Though not officially linked to Trump, many experts believe its proposals align closely with his priorities. Despite Trump distancing himself after the project became politically controversial, the involvement of over 100 former Trump officials suggests its policies could shape his second term, especially in areas like global health.

What the radical blueprint suggests

In the “Mandate for Leadership,” Max Primorac, former acting deputy administrator for USAID and senior research fellow at the Heritage Foundation’s Margaret Thatcher Center for Freedom, outlined a chapter calling for specific reforms to USAID that he believes should be implemented by a second Trump administration.

Primorac argued that despite USAID’s longstanding role as the world’s largest funder of global health initiatives, many of its activities have become outdated, focusing more on money spent than measurable outcomes.

He stressed that current USAID health programs often prioritize individual disease responses and inputs, rather than integrating broader health strategies and evaluating tangible results.

“From the 1950s to 1970s, the major recognized threats to human health were infectious diseases such as polio and smallpox, and USAID funded programs ‘in’ a country, not ‘with’ a country,” he said.

“Maternal and child health, food, water, and sanitation programs were often intermittent. USAID consistently financed population control, contraception, and abortion as essential to ‘development.’ Most programs focused on one disease or condition but had little integration with other global health activities. Chronic diseases were ignored,” he added.

GRAPHIC Ed Lustan

He called for a shift in strategy, emphasizing stronger “localization” efforts where USAID would help local governments and organizations in developing countries build self-sustaining health systems.

According to Primorac, this approach would allow nations to respond more quickly and recover more effectively from health crises, as demonstrated by countries with strong health systems during the COVID-19 pandemic.

For partner countries like the Philippines, this would mean focusing on strengthening local capacity and infrastructure, making them more self-reliant and better prepared to handle future public health challenges.

Primorac also recommended that a second Trump administration should implement significant budget cuts at USAID, reverting to pre-pandemic funding levels, and prioritize alignment with US foreign policy and national security objectives.

This would involve streamlining health programs to better reflect American interests and boosting partnerships with local and faith-based groups to improve the effectiveness and accountability of aid distribution.

US health assistance to PH

If the feared US aid cuts mandated by Trump come to pass, the Philippines — long a recipient of US assistance and global health programs through USAID — will also be severely impacted, alongside many African nations.

Between 2018 and 2023, USAID invested over PHP 14.6 billion ($260 million) in various health initiatives across the Philippines. According to the agency, this investment has led to significant outcomes, including the following:

• USAID’s partnership with the Philippines’ Department of Health (DOH) helped identify over 750,000 people with TB and connect them to treatment.
  ‘The TB case notification rate increased by 36 percent from 2022 to 2023.
• Through PEPFAR, USAID played a pivotal role in transforming the Philippines’ HIV response by enrolling over 24,800 individuals on pre-exposure prophylaxis (PrEP), a highly effective HIV prevention drug.
  Additionally, USAID helped start almost half of the country’s HIV treatment clients on the optimized drug regimen, TLD, which has fewer side effects.
• To ensure the continuous availability of life-saving medicines and supplies, USAID supported the DOH in digitally tracking the supply chain at both national and regional levels.
• USAID developed community-based drug rehabilitation treatment protocols for low- and moderate-risk users and established rehabilitation services in 22 local government units.

This year, the US, through USAID, provided significant financial support and rolled out several programs aimed at strengthening the Philippines’ health sector.

In January, Dr. Atul Gawande, USAID’s Assistant Administrator for Global Health, visited the Philippines and joined the DOH in marking World Neglected Tropical Diseases Day. During the event, they launched the “Philippine Multi-Disease Elimination Plan,” a program developed with technical guidance from USAID.

READ: PH ranks high in neglected tropical diseases: What to know

As part of this initiative, USAID also trained Philippine health workers to enhance the monitoring and communication efforts around lymphatic filariasis, a mosquito-borne parasitic disease that affects the lymphatic system. The training aims to improve the detection and prevention of the disease, which remains a public health concern in many parts of the country.

READ: Filariasis in PH: A neglected but discriminatory disease

In March, the US government announced an additional P1.15 billion ($21 million) in funding to combat TB in the Philippines, addressing a persistent public health challenge. The following month, USAID provided P4 million to support efforts aimed at safeguarding the health of women and children in the country.

READ: DOH, USAID commit P1.15B to screen 1 million Filipinos for TB

In September, the US, along with the development agencies of Japan and South Korea, formalized a partnership that will invest P1.6 billion ($29 million) over the next five years. This joint effort is focused on improving health outcomes and advancing Universal Health Care in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM).

READ: Japan, Korea, US invest P1.6B for better health care in BARMM

PH health expert remains optimistic

Despite potential uncertainties surrounding the future of US foreign aid under Trump, a prominent health expert maintains an optimistic outlook.

Dr. Tony Leachon, an independent health reform advocate, expressed confidence that health care cooperation between the US and the Philippines would endure due to the longstanding partnership and the Philippines’ significant role as a global provider of health care professionals.

“In my own opinion, in the area of health care, the Trump administration would remain a strong ally given that the Philippines remains the number one exporter of nurses and the number two exporter of doctors in the world next to India,” Leachon told INQUIRER.net.

READ: One in seven immigrant healthcare workers in US are Filipinos—report

He said USAID has consistently supported the Philippines by helping local government units (LGUs) enhance health systems, improve maternal and child health services, and expand HIV and TB prevention, treatment, and control initiatives.

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Leachon also emphasized the significant contributions of USAID under leaders such as Gawande, who spearheaded LGU-based programs that particularly target infectious diseases, aligning with USAID’s broader health strategy.

“In addition, USAID programs have helped conserve more than 6.3 million acres of forest lands and coastal areas,” Leachon added.

“Since 2013, USAID has facilitated more than $5 billion [approximately P282 billion] in infrastructure investments in the Philippines. I expect that the USA would remain supportive of the Philippines given its strategic role in the Asian region,” he continued.

No change in PH-US ties

President Ferdinand Marcos Jr. shared a similarly positive outlook. Speaking at the Seatrade Cruise Asia 2024 event, he expressed confidence that the Philippines’ relationship with the United States would remain steady.

“I don’t think it will change,” he said, referencing the robust and historic ties between the two nations. Marcos also pointed out that Washington is the Philippines’ oldest treaty partner.

“That hasn’t changed… I will have to see if there’s a major change,” he said.

READ: Marcos: No change in PH-US ties under Trump

In his congratulatory message to Trump, Marcos expressed his keen interest in partnering on key issues that align with the mutual interests of the Philippines and the US.

“We look forward to working with President Trump on a wide range of issues that will yield mutual benefits to two nations with deep ties, shared beliefs, common vision, and a long history of working together,” he said.

“I am hopeful that this unshakeable alliance, tested in war and peace, will be a force of good that will blaze a path of prosperity and amity in the region and on both sides of the Pacific.”

READ: Marcos extends congratulations to Trump, eager to strengthen PH-US ties

Executive Secretary Lucas Bersamin also reassured the public of Malacañang’s confidence that US commitments to the Philippines established under President Joe Biden would continue.

“The Philippines and America have a shared history and we have this desire for peace in this region, so I think the commitments will be followed through,” Bersamin said.

READ: New Trump admin: US-Philippines commitments to carry on – Palace

(Next: Scientists, health experts react to RFK Jr.’s possible ‘big role’ under Trump 2.0)

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