How should New Zealand health professionals respond to Trump 2.0?

The Trump administration in the United States (US) was installed recently, at the beginning of 2025, but the president and his supporters have moved quickly to up-end the way the country operates.

The British Medical Journal is doing its best to keep up with the changes caused by the new regime in the US, and reported in its 31 March issue¹ that: the National Institutes of Health (NIH) had announced it will cease funding research on climate change; a letter signed by 500 doctors and researchers warned that closing PEPFAR (the US President’s Emergency Fund for AIDS Relief) would kill 6 million people in the next 4 years worldwide; and NIH had been ordered to provide a list of research grants involving mRNA vaccines—it was expected that many or maybe all of these grants willl be cancelled.

Since March, the US has withdrawn from the Global Alliance for Vaccines and Immunization; the One Big Beautiful Bill Act, signed on 5 July by President Trump, is projected to increase the number of Americans without health insurance by about 14 million by 2034; and the new head of the Environmental Protection Agency announced the ban on chrysotile asbestos will be “reconsidered” and there will no longer be limits on greenhouse gas emissions from power plants.^2,3

There are themes in the disorder. One is the socially regressive effect of the changes, as benefits flow to the wealthiest Americans and costs fall most heavily on those with low incomes. Conventions to manage conflicts of interest are ignored, and the Trump family is considerably enriched. There is no respect for science and expert knowledge. Indeed, as shown by the policies on climate and vaccines, as two examples, the wishes of the president and his appointed staff have been executed regardless of advice from professionals. Marginal groups are demonised—this is most painfully apparent in the treatment of migrants. The president has encouraged law-breaking and political violence. The Republican majority in Congress has relinquished its responsibility to check executive excess.

The Trump presidency has surprised many, but it has deep roots. Suspicion of government and democratic institutions and conventions has been a feature of America since European settlement.

Ezra Klein writes:

“Illiberalism is part of the American tradition: Jim Crow. The Red Scare. The internment of Japanese Americans. Operation Wetback. Trump is not the first to name a domestic enemy, decide that their rights are no longer valid and turn the machinery of the state against them.”⁴

However, polarisation and confrontation became more intense following the end of the Cold War—a preoccupation with the external threat posed by the Soviet Union was replaced by fear of anti-American forces within. Politics was increasingly animated by “culture wars” and “aggressive rhetoric redefined political rivals as enemies to be defeated”.⁵ Since 2016, the American conservative movement has become more strident and explicit in its attacks on democratic institutions.⁶ Structural changes that paved the way for Trumpism (and are not confined to the US) include increasing inequalities in wealth, the rise of a new class of the supremely rich, fragmentation of the media and proliferation of curated and untested digital sources of information.

It may feel far away, and it may be difficult to think of anything that we can do personally in Aotearoa New Zealand. Therefore, it is tempting to ignore Trump 2.0, and hope the fuss goes away when a new president is elected in 2028. I think this would be a mistake. The US is physically distant, but only a mouse click or a flight away, and underlying causes of damaging populism are present also in New Zealand. My argument is that the consequences of Trump 2.0 affect us all—but we are not helpless.

Here are three actions that New Zealand health professionals can, and should, take, in my view:

• Support our colleagues in the US.
• Do what we can to continue health gains globally.
• Anticipate Trump-like thinking in New Zealand, and respond vigorously.

1.    Solidarity

The International Journal of Epidemiology (IJE) is one of the oldest and most widely read journals in its field. In March, my co-editor in chief, Stephen Leeder and I wrote to American members of the IJE Editorial Board saying we thought the IJE should take a stand on Trump’s actions, and sought their views.

Here is one of the replies:

“What is happening in the US is frightening. I have never been this alarmed and stressed in my life...

Your editorial could reassure the epidemiological community that IJE will not take part in censoring US science and scientists. We have to be able to live with our ourselves and our conscience. I fear silence is not an option. Non-US-based journals and institutions have critical roles to play in mitigating the unfolding catastrophe.

Thank you for your empathy, braveness and solidarity.” (Email from IJE Editorial Board member, 6 March 2025)

Subsequently, an editorial was published that described the assault on health sciences in the US, and ways to counter these attacks.⁷

This is a small thing to do, but multiplied many times over, let’s not underestimate the power of speaking up.

2.    Aim to limit the losses internationally

Trump has gutted American aid internationally, although it has been the largest source of development funding in many parts of the world. Closures, which have occurred in an abrupt and capricious fashion, may be hugely damaging. For instance, efforts by the United States Agency for International Development (USAID) to control Ebola virus outbreaks in Africa were shut down. (This was “a mistake” according to Elon Musk, who directed de-funding of USAID, but it is uncertain whether work on Ebola can be re-started.⁸)

Good health depends on the rule of law within countries,⁹ and on robust international agreements. These agreements apply not only to infectious diseases such as Ebola, which spread freely across borders, but other problems that are inherently global, such as climate change, widespread chemical pollution and loss of biodiversity.¹⁰ However, Trump’s view of national interest is exceedingly narrow, and he sees international relations as competitive and transactional. In this universe conventions and treaties are suspect because they hinder powerful nations intent on dominating less powerful states.

In the past, New Zealand has been regarded by many as an honest broker in the difficult work of balancing national interests and global wellbeing. Our country was a leader in negotiations for the Framework Convention on Tobacco Control. Recently, New Zealand was at the centre of the overhaul of the International Public Health Regulations. In the future there will be much to do, including:

a)      Agreeing on a new architecture for funding of international development in the absence of USAID.

b)     Determining the future of the World Health Organization (WHO). Trump has signed an executive order to end all US contributions.¹¹ These amount to 15–20% of the WHO budget overall, but are unevenly distributed and some programmes are heavily dependent on American money.

c)      Supporting action on climate change. The globe is heating faster than ever,¹² but Trump has announced the US will withdraw from the Paris climate agreement.¹³ In the past New Zealand has exerted greater influence at international climate meetings than might be expected on the basis of its size alone. The effectiveness of member states depends on steady political commitment and top-class public servants to front the negotiations. It is not clear how strongly the present New Zealand coalition Government will adhere to previous commitments on climate change. Health professionals can be vital influencers¹⁴ through specialist bodies and organisations such as OraTaiao, and may contribute directly by providing technical assistance to bodies such as WHO and the Intergovernmental Panel on Climate Change.

3.    Look out for Trump-like thinking at home

The rise of an authoritarian regime in the US may embolden those inclined to similar views within New Zealand. The risk is high. This country has experienced many of the social changes that contributed to Trump 2.0. They include deepening disparities in wealth and opportunity, a sense of reduced social cohesion and, among many, loss of trust in public institutions.^15,16 Although there were fewer cases and mortality rates from COVID-19 were lower in New Zealand than most other countries, the disruption caused by the pandemic amplified for some the feeling the government does not look out for them.

Actions taken by the present New Zealand Government that resemble moves by ill-liberal populist regimes in the US and elsewhere include growing use of urgency and fast-tracking to minimise public scrutiny of controversial legislation such as the Regulatory Standards Bill,¹⁷ belittling by ministers of doctors who advocate for population health¹⁸ and a cavalier approach to managing conflicts of interest when business is involved with policymaking. 

Here are three examples of accelerating Trumpism I think we should look out for in New Zealand.

a.     “You can’t make an omelette without breaking a few eggs”

This is the argument that one can’t bring about change without moving fast and disrupting the status quo. Maybe good things will come from Trump giving the system a decent shake. Former New Zealand Prime Minister Sir John Key thought so,¹⁹ and Simon Jenkins wrote along similar lines in The Guardian.²⁰

Jenkins compared Trump’s disregard for the established way of doing things with the approach taken by businessmen such as Zuckerberg and Musk. They disrupted at pace, and out of the ashes rose, phoenix-like, world-shaping enterprises such as Facebook and SpaceX. In Trump’s case, wrote Jenkins, “Among the chaos are challenges to convention that were overdue.”²⁰ This includes (according to Jenkins) bloated aid programmes, over-reach at NATO and unnecessary federal interventions in education and health.

Jenkins did not refer to Gough Whitlam, but he might have. Like Trump, Whitlam was a tall man who thought highly of himself, and a powerful orator. He was the leader of the Australian Labor Party and went to the 1972 federal election promising to “crash through, or crash”. He believed he must move fast to achieve reforms such as withdrawing from the Vietnam war, establishing a national publicly funded health service and extending equal pay to women. Post-election, Whitlam unleashed a whirlwind of legislation and regulation, testing to the limit due process and convention.²¹ In New Zealand, a decade later, the fourth Labour Government also thought it necessary to move fast on many fronts to achieve radical change.²²

Trump’s moves are wilful; they are not supported by a coherent and well-argued plan for the country. His actions are frequently unpredictable and inconsistent, and the president shows no interest in feedback on the effects of cutting funding, firing people and upending government bodies. Does shutting USAID lead to leaner, more effective international aid? There is no sign that Trump wishes to find out. Unlike the business examples that are often cited, in Trump world no attention is paid to preserving the capacity to rebuild.

According to Robert Reich, former US Secretary of Labor, “With Trump, you don’t need to look for reasons for apparently crazy actions. This is all about power, and Trump’s thirst for power is all about converting the US into a dictatorship.”²³ I agree with Reich: no other goal makes sense but a new imperial age, and I reject the omelette argument. If good things result from Trump’s interventions, this will be accidental, and will likely be small beer compared with the harm done.

b.     Choosing language to divide and distract

Trump is a master of choosing words to provoke, undermine and belittle opponents. Here are two terms that were not invented by Trump but feature in his rhetoric: “woke” and “DEI”.

The language has gained a foothold here. Winston Peters gave a state of the nation speech, headlining a “war on woke”.²⁴ Simeon Brown, as minister of transport, dismissed road safety as “woke”.²⁵

New Zealanders should not let these taunts pass unchallenged. But let’s not lose our temper. Instead, I recommend we follow the example of the cast of Doctor Who, the long-running BBC show. In the latest iteration all the main characters, the crew of a time machine disguised as a 1950s-era police call box called the Tardis, are people of colour. This led to claims that the BBC had gone “woke”. One of the new actors, Varada Sethu, nailed what I think is the right way of dealing with provocation of this this kind. Sethu said, “Being called woke proves we are on the right track.”²⁶

“Woke just means inclusive, progressive and that you care about people. And, as far as I know, the core of Doctor Who is kindness, love and doing the right thing.”²⁶

Note there are two steps here: 1) rather than objecting to being called woke, Sethu reminds people what woke means, and then 2) she points out that these are generally valued qualities.

On the other hand, there is no reason to engage with “DEI”, despite the attempt by several parties in the present New Zealand Government to make it an issue.²⁷ I suggest we refer instead to concepts that New Zealanders are familiar with, such as acting fairly, widening the talent pool and building effective teams. Most people would agree these are important in their own right. But it is worth pointing out also that fairness, drawing on talent everywhere and teamwork make the world better in a host of direct and practical ways.

In the past, those who worked on New Zealand wharves were almost all men, but in Auckland now there is a remarkably diverse workforce, including a large number of women. According to Roger Gray, boss of the Port of Auckland, this has nothing to do with wokeness and DEI. Gray said “I want a great workforce and I am deeply committed to fairness.”²⁸ Gray said he sought talent wherever he could find it, and he observed that nurturing a workforce was good for the business.

“In a workplace where people feel safe, included and able to thrive and build a career, they give you discretionary effort—they go that extra bit that helps the bottom line.”²⁸

He agreed employment should be on the basis of merit, but Gray pointed out there are different kinds of merit. For example, he said he is keen to get more women on the straddle cranes, because he expects there will be savings on repairs, servicing and down-time.

“It’s quite well acknowledged now within heavy industrial businesses that female plant operators … are often better because they’re less hard on the equipment.” ²⁸

c.     Mythical histories

Trump and the new Secretary of the Department of Health and Human Services, Robert F Kennedy Jr have established a Commission to Make America Healthy Again (MAHA).²⁹

There are two remarkable features of this initiative. One is how little attention is paid to infectious diseases: the Commission’s terms of reference are skimpy but apply mainly to chronic conditions, especially those affecting children. And, like MAGA at large, the Commission assumes a treasured past. The purpose of MAHA is to return the US to a time when there was little diabetes or heart disease, and Americans lived longer and better lives than anybody on the planet. This is fantasy, because there was no such past. Americans have never lived longer and better lives than anyone else. There are indeed modern blights such as over-eating and under-exercising, opioid misuse and high rates of self-harm. US life expectancy at birth has dipped recently. But in general, the health of the population is better than ever. Americans live on average 11 years longer than they did in 1950,³⁰ infant mortality is much reduced, smoking-related cancers have nose-dived and coronary heart disease has fallen by 70% from its peak in the late 1960s.³¹ MAHA includes no serious analysis of what it seeks to achieve, and the danger is that hundreds of millions of dollars will be wasted. It is expected that targets will include minor problems such as food additives and over-use of weight loss medicines, alongside a misconceived assault on vaccines.

When he is in full MAGA mode, Trump invokes an America that was glorious, frontier-tough and masculine. Historian Heather Cox Richardson has described it this way:

“Trump’s undermining of the global economy reflects forty years of Republican emphasis on the myth that a true American man is an individual who operates outside the community, needs nothing from the government, and asserts his will by dominating others.” ³²

Wishful thinking without a sound basis is familiar in New Zealand also. At the last election, National promised to “get our country back on track”. New Zealand First campaigned on “take our country back”. The Prime Minister’s response to those concerned about the new cut-price school lunch programme referred to a golden age when children thrived on marmite sandwiches and apples.³³

How far back do we need to go? This question is never answered, but it was better before, no doubt. Those were truly the good old days. The prospect appeals to many people, even though according to so many measures it is magical thinking and must be challenged.

Conclusion

In his second presidential term Trump proceeds to destroy public health and comprehensive healthcare in the US. There will be knock-on effects everywhere. This is alarming but does not justify despair. In addition to the resistance that is growing within the US,³⁴ there are signs of Trump-rejection elsewhere. For instance, unexpected re-elections in Canada and Australia of sitting governments have been attributed, in large part, to concerns about Trump’s destructive actions at home and abroad.

It is natural to want to shut out the madness overseas and focus on local affairs. I believe this would be a mistake. Health, science and education are deeply political and, as shown by current events in the US, are bound to be targeted by authoritarian governments. Health professionals in New Zealand must speak up, support colleagues who are directly affected, act where we can to reduce the damage to global health and oppose toxic Trump-thinking that washes up on our shores.