The First 45 Days in Public Health under The Trump Administration

Alyssa Pointer 2025

On January 20th, Donald J. Trump began his second term as the President of the United States. During his campaign, President Trump remained vague on platforms about public health.  Despite Trump distancing himself from Project 2025, the 180-day transition playbook organized by the Heritage Foundation, many are concerned that the Trump Administration is following the conservative think tank’s outlines for public health. President Trump stated, for instance, intent to leave abortion to the states after his first term, during which he appointed justices to overturn Roe v. Wade. He further declared his nomination for United States Secretary of Health and Human Services to be Robert F. Kennedy, who, in an interview with Fox News back in 2023, claimed that “autism comes from vaccines” and that he would prosecute Dr. Fauci. Kennedy has since been confirmed as head United States Secretary of Health and Human Services (HHS), and hopes to crack down on toxic substances in food and how they affect chronic medical conditions such as obesity and diabetes, but many are concerned about his lack of qualifications and his comments on vaccines which could cause hesitancy to take vaccines causing a lack of herd immunity.  Let’s take a look at the first 45 days of public health under the Trump Administration.

DAY 1 (January 20, 2025). President Trump signed an executive order withdrawing the United States from the World Health Organization (WHO), a supranational body that plays an essential role in public health. During the pandemic, the WHO established health guidelines and opened data, allowing for a coordinated global response. According to Forbes, the U.S. contributes hundreds of millions of dollars to the WHO, with U.S. contributions comprising around 15% of the WHO’s two-year budget for 2025. Withdrawal from the WHO jeopardizes funding for research, disease prevention, and health programs and further endangers the United State’s voice in global health policy and intelligence.

On the same day, President Trump issued another executive order titled the Initial Rescissions of Harmful Executive Orders and Actions. Several of the recessed orders addressed global health security and the COVID-19 pandemic. Specifically, Executive Order 13987 (Organizing and Mobilizing the United States Government To Provide a Unified and Effective Response To Combat COVID-19 and To Provide United States Leadership on Global Health and Security) established the National Security Council Directorate on Global Health and Security and Biodefense and a Senior Director position to oversee it. Though most of the provisions regarding COVID-19 and Global health security aren’t directly relevant now, President Trump's executive order eliminated the two positions that helped direct global health security under the Biden Administration: the Directorate of Global Health Security and Biodefense and its Senior Director at the National Security Council. President Trump’s order additionally rolled back Executive Order 14087, which previously lowered prescription drug costs for Medicare and Medicaid. This ends the $2 copayment cap on generic medications and nullifies policies that allow Medicare to negotiate for lower drug prices.

Another executive order, the America First Policy Directive to the Secretary of State, was signed to put core American interests first in foreign policy. The State Department is responsible for directing foreign assistance programs administered by the State Department and USAID, including global health assistants. It oversees PEPFAR and other aspects of diplomacy regarding public health. This “America First” foreign policy will define how global health programs will be shaped.

President Trump also signed the executive order Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government. This executive order’s purpose was to define sex as either male or female and remove recognition of gender identity. Residing executive orders issued by President Biden prevented and combated discrimination based on gender identity or sexual orientation. This affects all federal agencies and programs, especially PEPFAR and other U.S. global health programs aimed at supporting the LGBTQ+ community may be impacted. This also means a lack of recognition and removal of protection based on gender identity and sexual orientation.

Trump additionally passed the executive order Reevaluating and Realigning United States Foreign Aid. This 90-day pause pauses funding and review for all U.S. foreign assistance in order to assess their alignment with American values. This order freezes new spending on almost all global health programs funded through foreign aid. Many fear that this may end global health research as a whole, as the U.S. Agency for International Development (USAID) is one of the only sources of reliable data on metrics such as nutrition, mortality, and education in many countries.

Updates:

• Day 5 (January 24) The USAID issued a notice on the implementation of an executive order for a stop-work order on foreign assistance affecting U.S. and global health programs, with key programs at risk without a waiver.

• Day 9 (January 28) Secretary of State issues blanket waiver for life-saving humanitarian assistance programs, excluding abortion, family planning (unless it's part of waived activities), gender, DEI (diversity, equity, and inclusion), and transgender surgeries.

• Day 12 (February 1) PEPFAR (the global HIV/AIDS program) was granted a limited waiver to reinstate care and treatment services, including preventive services against mother-to-child transmission.

• Day 15 (February 4) Other global health programs that address acute maternal and child mortality risks– such as tuberculosis, malaria, and malnutrition– were granted a limited waiver to resume.

• Day 17-18 (February 6-7) A lawsuit challenging the funding freeze of the field by several organizations, A temporary restraining order, and another were issued preventing the government from placing more staff on leave until February 14th. On Feb 13th, they extended the temporary restraining order to the 21st.

• Day 21 (February 10) Two U.S. organizations sought emergency relief from the freeze on funding for foreign assistance through a lawsuit.

• Day 24 (February 13th) The court issued a temporary restraining order blocking the Trump Administration from interfering with foreign assistance funds. On February 18, the government claimed authority to cancel contracts and suspend grants. On February 20, the court reaffirmed the temporary restraining order until a hearing on March 10th.

Day 3 (January 22) President Trump signed an executive order that terminates “Diversity, Equity and Inclusion” (DEI) discrimination in the federal workforce, contracting, and spending, “restoring the values of individual dignity, hard work, and excellence”. The CDC thus eliminated anything with diversity, equity, and inclusion (DEI) mentioned or implied just the day after. The agency removed multiple health-related websites and datasets, including those pertaining to LGBTQ health, HIV, and more. This removal of resources and data is worrying because it is important for the public to have information and resources.

Day 5 (January 24) President Trump reinstated the United States’ membership in the Geneva Consensus Declaration, promoting women’s health, strengthening the family, and abolishing the “international right to abortion”. The Biden administration withdrew from the Consensus in 2021, believing it restricts and undermines women’s sexual and reproductive rights.

Day 6 (January 25) The Trump Administration issued executive actions rolling back patient protections under the Affordable Care Act. This included removing health benefits requirements, allowing insurers to deny coverage because of pre-existing conditions, and defunding ACA outreach programs that aid in insurance enrollment. Several state attorney generals and other healthcare advocacy groups have filed lawsuits against these actions, arguing that they threaten public health and violate federal law. These legal challenges are still pending.

Day 8 (January 27) The administration changed and started a review of USAID, the U.S. government’s international development agency that oversees and/or implements most U.S. global health programs. Hundreds of staff were terminated, and senior USAID career staff were placed on leave.

Updates:

• Day 14 (February 2), the USAID website was taken down. A day later, the USAID building was closed. The president then appointed Secretary of State Rubio as Acting USAID Administrator. President Trump has repeatedly threatened to terminate the USAID altogether.

• Day 16 (February 4), a notice was posted on the USAID website stating that all USAID direct hire personnel would be on administrative leave. Several lawsuits have been filed in protest.

Day 9 (January 28) President Trump signed an executive order trying to restrict gender-affirming care for those under the age of 19, restricting medical institutions that receive federal funding from giving care that targets transgender individuals. Care includes puberty blockers, surgeries, and hormone therapies.

Day 16 (February 4) President Trump signed an executive order titled Withdrawing the United States From and Ending Funding to Certain United Nations Organizations and Reviewing United States Support to All International Organizations, meaning that the U.S. will reconsider and evaluate whether the U.N. matches its goals. It also stated that the U.N. Human Rights Council (UNHRC; the U.S. will not participate in and withhold its contribution to the budget of the body), the U.N. Educational, Scientific, and Cultural Organization (UNESCO; the U.S. will conduct a review of its membership in the body within 90 days), and the U.N. Relief and Works Agency for Palestine Refugees in the Near East (UNRWA; reiterates that the U.S. will not contribute to the body) “deserve renewed scrutiny”.

Day 19 (February 7) The Trump Administration announced a reduction in funds used to support grants to the National Institute of Health (NIH). Many universities and medical institutions rely on the NIH for medical research grants. Funding supports research, typically covering research, construction, utility costs, safety, and security costs. The reduction limits indirect expenses to 15% of the grant, causing potential layoffs, suspending clinical trials, and thus delaying research.

Update:

• Day 22 (February 10) A federal judge temporarily blocked the NIH funding cap, holding off on restrictions until attorney generals could hold a hearing from 22 states on February 21.

Day 25 (February 13) President Trump signed an executive order creating the President’s Make America Healthy Again Commission. Headquartered by Kennedy, its main focus is childhood chronic diseases targeting any potential risk factors– including diet, medical treatments, lifestyle, food production, radiation, and toxic material absorption. President Trump stated that Kennedy is “committed to getting dangerous chemicals out of our environment and out of our food supply, and getting the American people the facts and the answers that we deserve after years in which our public health system has squandered the trust of our citizens.”

Day 26 (February 14): The Trump Administration announced the verbal termination of employees at the Centers for Disease Control and Prevention, the Food and Drug Administration, and the National Institutes of Health. Over the weekend, thousands of employees received firing emails. CDC leadership terminated  10% of the CDC’s workforce. At the NIH, approximately 1,000 to 1,200 were fired. Positions deemed essential– including those working on drug approvals– found themselves with a termination date of March 14, 2025.

Update:

• Day 44 (March 4): Around 180 of the fired CDC employees were reinstated; however, it is unclear if they may be terminated again on March 14th.

Day 30 (February 18) President Trump signed an executive order expanding access to and advancement of in vitro fertilization (IVF)*. This order responds to America’s historically low fertility rate, which has dropped by 3% since 2022, and the growing number of families relying on it but unable to afford treatment. A round of IVF costs can range from $15,000 to $20,000. However, most couples undergo multiple rounds before a successful conception.

Day 37 (February 25) President Trump signed another executive order on the Marking America Health initiative, but this time focusing on “empowering patients with clear, accurate, and actionable healthcare pricing information”. This builds upon the 2019 Executive Order that required hospitals and health plans to publicize pricing information on “shoppable items and services”. This led to two key transparency rules from the Centers for Medicare & Medicaid Services (CMS),  the Hospital Price Transparency Rule (hospitals are required to publish pricing) and the Health Plan Transparency in Coverage Requirements (commercial health plans are required to publish the negotiated rates and net prices of prescription drugs). These efforts were met with not much compliance.

Day 38 (February 26) The first reported U.S. death from measles since 2015 was confirmed by state and local health officials in Texas, addressing a Texan child who was not vaccinated for the illness. Growing outbreaks in Texas and New Mexico have spread to New Jersey, California, New York, Kentucky, Georgia, Rhode Island, and Alaska, marking this the largest outbreak in the U.S. since 2019. Between the two states, more than 130 people are sick. Most are children. Officials are concerned that the average school vaccination rate for measles is below the CDC’s recommendation due to growing misinformation surrounding vaccines.

Day 40 (February 28) U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. has proposed eliminating public participation in many policy decisions. He reversed the 1971 Richardson Waiver requirement, which mandates a period be allotted to the public to discuss decisions on “agency management or personnel or to public property, loans, grants, benefits, or contracts”. The HHS manages $3 trillion in healthcare spending while overseeing the CDC, NIH, FDA, and programs like Medicare and Medicaid.

Update:

• Day 43 (March 3) The formal publication proposal would strip the ability for people to submit thoughts on decisions related to the “agency management or personnel or to public property, loans, grants, benefits, or contracts” and also grants discretion to bypass input when the process is "impracticable, unnecessary, or contrary to the public interest”. This comes after Kennedy's pledge to Congress of “radical transparency.”

Day 45 (March 5) Trump’s nominee for Director of the NIH, current Stanford University professor of medicine Jay Bhattacharya, faced his hearing. He is known for his 2020 open letter that called for less lockdown efforts during COVID-19. Bhattacharya aims to focus on chronic diseases and a “culture of respect for free speech in science and scientific dissent at the NIH.” If he is confirmed, he will oversee the nation’s medical research agency and its budget of $50 billion.

Over the past 45 days, President Trump’s actions have been undeniably monumental, impacting policy and the American people significantly. Whether seen as a turning point or a moment of disruption, their scale and influence are and will be impossible to ignore.