The Current State of Public Health

In the weeks following the Presidential inauguration, the administration’s approach to public health has begun to take shape through a series of rapid policy shifts and executive actions. These early moves, from the withdrawal from international health partnerships to domestic regulatory changes, highlight a deliberate recalibration of the federal government’s role in healthcare and disease prevention.

The rustle of policy papers in Washington D.C. echoes in the decisions made at hospital bedsides, clinic consultations, and emergency rooms. These changes are set to reshape the terrain of public health – a terrain that is already scarred by pandemic fatigue even five years down the line, staffing shortages, and the relentless climb of chronic diseases.

For physicians, these changes are not just some abstract political maneuvers. They are felt in the uncertainty of a parent questioning vaccines, the frustration of a diabetic patient rationing insulin, and the exhaustion of tracking disease outbreaks without reliable data.

While the long-term consequences remain uncertain, the immediate effects are raising questions about equity, preparedness, and the balance between state autonomy and federal oversight.

How will these policies alter the practice of medicine, the resilience of public health infrastructure, and the U.S.’s position as a leader in biomedical innovation?

Let’s examine the administration’s actions, their implications for public health infrastructure, and the challenges they pose in a nation still grappling with endemic diseases, healthcare access disparities, and evolving global health threats.

Also read: Top Medical Breakthroughs of 2024

Global Health Retreat

On January 20, 2025, President Trump signed an executive order withdrawing the United States from the World Health Organization (WHO), ending a decades-long partnership. The U.S. had been poised to contribute $958 million to the WHO’s 2024-2025 budget – 15% of its total funding – critical for programs combating infectious diseases, maternal mortality, and vaccine inequity. This decision carries empirical consequences, especially for physicians.

WHO’s surveillance networks (like the Early Warning Alert and Response Network (EWARN)) provide early warnings for threats like avian flu and Ebola. Without access to this intelligence, U.S. hospitals may face delays in preparing for emerging pathogens.

Initiatives like COVAX, which relied on U.S. funding and logistics, are at risk of being stalled. This could prolong vaccine-preventable diseases in underserved regions and increase importation risks.

As China expands its health aid in Africa and Asia, the U.S. may find its influence beginning to cede. Can we still continue to be global advocates for raising awareness on health priorities if we are no longer part of the bigger picture?

For infectious disease specialists and frontline providers, the loss of WHO collaboration complicates efforts to coordinate care for travelers, immigrants, and communities vulnerable to cross-border outbreaks.

Silenced Science

The administration’s restrictions on federal health agencies have left physicians to traverse through a data desert without a compass.

Since 1952, the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR) has been a bedrock of clinical guidance, offering real-time updates on disease trends and treatment protocols.

Its suspension leaves healthcare providers without a unified source for tracking respiratory viruses, antibiotic-resistant infections, or the emerging threat of bird flu in the U.S.

The removal of public datasets containing terminology related to diversity, equity, and inclusion (DEI) from federal websites can force providers to rely on fragmented state reports.

This restricted access can complicate how physicians can provide care for chronic conditions and tackle public health threats, as well as hinder their ability to manage infectious diseases.

CDC personnel have been instructed to cease collaboration with WHO, severing ties to global research networks and clinical trial partnerships. This lapse in communication means that a pediatrician in Ohio may lack data on a measles cluster in a neighboring state, or an ER physician in Texas might miss early signs of an avian flu spillover.

The administrative burden of piecing together discordant information falls on already stretched healthcare teams.

Leadership in Question

The appointment of Robert F. Kennedy Jr. as the secretary of the Department of Health and Human Services (HHS) has sparked debate within the medical community. While Kennedy’s focus on investigating toxic food additives aligns with efforts to address obesity and diabetes, his history of vaccine skepticism raises alarms.

The administration, as a whole, wants to focus on disease prevention. A renewed focus on nutrition and environmental toxins could empower primary care providers to address the root causes of conditions like hypertension and autoimmune diseases.

On the other hand, Kennedy’s anti-vax rhetoric risks emboldening anti-vaccine movements, further complicating efforts to rebuild trust in immunization programs.

In light of the recent drop in childhood vaccination rates, this rhetoric could further exacerbate the spread of vaccine misinformation and distrust. Physicians must balance cautious optimism with vigilance as we wait to see how the HHS will be reshaped under this new leadership.

Policy Shifts

1. Medicaid Restructuring and Coverage Gaps

Proposals to convert Medicaid to block grants or per-capita caps will grant states flexibility but threaten coverage for millions. Under such a structure, the federal government would offer states a fixed amount of money (block grant) or a set amount per Medicaid enrollee (per-capita cap) to run their Medicaid programs.

While this gives states the wiggle room to design their own rules, it also means states may cut coverage or benefits if costs exceed the fixed funding.

Physicians in rural and underserved areas – already grappling with hospital closures — anticipate surges in uncompensated care as low-income patients lose eligibility. This could lead to unpaid bills and strained resources in an already drought-like landscape.

The expiration of enhanced Affordable Care Act (ACA) subsidies in 2025 could further strain practices. These subsidies help lower premiums. Without them, healthier patients may drop coverage, leaving older/sicker patients in the insurance pool, driving up premiums by over 75% on average.

2. Deregulation and Its Double-Edged Sword

The administration’s “one-in, ten-out” regulatory rule aims to reduce bureaucracy but risks eroding patient protections. According to the rule, for every new regulation created, ten existing ones must be removed.

Though the aim is to cut back on regulatory costs, this rule presents a threat to safeguards that are essential for patients.

For instance, less federal oversight might speed up AI tools for diagnosing diseases or managing records. However, without rules to prevent bias or protect patient data, algorithms could make flawed decisions or expose sensitive data.

The leniency toward pollution controls on factories or vehicles may contribute to more air pollution. For doctors, this means more patients with asthma attacks, heart disease, or COPD exacerbations.

3. Chronic Disease Focus Amid Research Cuts

The “Make America Healthy Again” initiative prioritizes obesity and diabetes prevention through programs like nutrition education or wellness incentives. This could help doctors work with patients to address the root cause of chronic diseases.

Yet, parallel cuts to NIH funding, particularly for infectious disease research, raise questions about the nation’s preparedness for the next possible pandemic. With reduced funding, fewer studies on new viruses or antibiotic-resistant bacteria would exist. In the event of another pandemic, treatments and vaccines would take longer to develop.

For context, here’s a look at how much the administration predicts it will save by making these cuts in the healthcare sector.

Data source: House Budget Committee Proposal
Image Source: PwC

Drug Pricing and Import Tariffs

If revived from Trump’s first term, the Most Favored Nation (MFN) Model could result in lower costs for patients but at the risk of drug shortages if manufacturers limit U.S. supply.

The MFN model works on setting Medicare Part B drug prices to the lowest prices paid in other countries. Patients may see reduced out-of-pocket costs for certain drugs, but physicians could face delays in accessing critical therapies due to manufacturer-designed shortages.

The Trump administration had also proposed 25% tariffs on goods from Canada and Mexico and 10% on Chinese imports, targeting industries like pharmaceuticals and medical devices. While designed to reflect the administration’s “America First” trade priorities, these steep tariffs could disrupt the U.S. healthcare supply chain.

The U.S. also relies heavily on imports for generic drugs and active pharmaceutical ingredients (APIs), the core components of medications. China supplies a large number of these APIs for U.S. drugs.

The proposed tariffs would raise production costs for manufacturers already operating on razor-thin profit margins. Being unable to absorb tariff costs, these companies would be forced to exit the market, threatening the supply of critical medications like injectable cancer therapies, antibiotics, and anesthetics

Increased costs for drugs and medical devices would trickle down to consumers. Yale’s Budget Lab estimates long-term drug prices could rise by 1.1%, straining Medicare/Medicaid budgets and out-of-pocket costs.

The Association for Accessible Medicines warns that tariffs could force manufacturers to halt production of low-margin drugs, worsening shortages. AdvaMed (representing device companies) argues that tariffs threaten R&D investment and could cause shortages of medical equipment American patients depend on for care.

For physicians, these tariffs and the resulting shortages would force difficult triage decisions (like delaying chemotherapy) and increase reliance on less effective alternatives.

Patients could become habitual of skipping doses or splitting pills due to unaffordable medications, which would worsen chronic disease management. This, in turn, would impose upon physicians the responsibility of navigating patient concerns about rising out-of-pocket expenses and advocating for exemptions of critical medical products.

Economic Policies

The crackdown on immigration with tighter visa policies may worsen staffing shortages, particularly in rural areas reliant on foreign-trained nurses and physicians.

Other policy changes like the NIH budget cuts are already driving medical experts currently working in the U.S. to consider a change in scenery. These factors will exacerbate the already alarming shortage of skilled medical professionals nationwide.

Final Thoughts

For physicians, the early days of this presidency have laid bare a stark reality: the exam room is no longer insulated from the policy arena. The withdrawal from WHO, the silencing of the CDC, and the upheaval of Medicaid are not distant political acts; they are forces reshaping the daily rhythms of care.

At this time, in light of these policy shifts, we physicians face dual burdens: dealing with the practical fallout of these policies while preserving the integrity of their oath. The resurgence of measles demands renewed advocacy for vaccines. The loss of data transparency requires vigilance in tracking outbreaks locally. The threat of coverage gaps calls for creative solutions to keep clinics open and patients insured.

The physician’s role has always transcended politics – it is rooted in science, compassion, and an unwavering commitment to those in need. In examining these policies, we are reminded that public health is not a partisan issue but a collective responsibility.

The road ahead will test the resilience of both the medical professions and the systems it upholds. As physicians, our task is clear: to bear witness, to adapt, and to advocate – not for ideology, but for the health of the communities we serve.

In doing so we honor the trust they place in us, ensuring that even in uncertain times, the practice of medicine remains a beacon of hope and healing.