We are all familiar with the term “arrow of time” – that time proceeds in a one-way direction. I assume that most of us also cling to the idea that there should be a unidirectionality of progress – that we unswervingly move towards a world that offers better and more equitable living conditions for all. UN’s Agenda 2030 with its 17 sustainable development goals embodies this ambition and can be read as a call for a governance system that unequivocally recognizes our interconnectedness when it comes to health and the environment. We are interconnected to the extent that eventually we should be able to abandon the term “global” in global health and just talk about “health” – knowing that health is inherently global.
We who perhaps naïvely believed in the speed and unidirectionality of progress have been dealt a terrible blow over the past few weeks. The new US administration has issued a string of executive actions that signifies nothing less than a retreat from the thinking that is at the core of multilateralism and the liberal world order. Inclusivity, diversity, equity, and cooperation are terms that have been effectively stricken from the political agenda and replaced by the vocabulary of might. I for one have had the feeling of time standing still when exposed to the incessant barrage of orders and decisions that have created an imagery of a world that I never thought I would encounter. Judged by the rhetoric the world is now a place for the rich and powerful – those that already have profited from the “American dream”. Others – even Americans who died in war - qualify as “losers”.
Rather than just lamenting the development that we have witnessed over the past month we should look for countermeasures and remedies. We have already seen that European nations discuss how to step in where U.S.A.I.D. has withdrawn. It is urgent that this discussion is turned into action. The funding freeze has already had devastating consequences in many parts of the world Opinion | ‘We Are Seeing Complete Destruction’: The Damage Done by the U.S.A.I.D. Freeze - The New York Times. Tuberculosis and maternal HIV programs have been discontinued, and humanitarian aid to people impacted by conflicts and war is grinding to a halt. The suspension of U.S.A.I.D will also disrupt initiatives for malnourished children, educational programs, and projects to counteract human trafficking and human right violations. And still this list is not exhaustive.
We should never forget that a politically induced chaos is meant to cause paralysis. It is our duty to resist and to turn chaos into a fertile soil for creativity. Thus, every difficult situation has a hopeful aspect to it. The hope is that political decision-makers in Europe and elsewhere not only will help mitigate the acute impacts of USA’s disengagement from international development and multilateral organizations (like WHO) but will use this opportunity to break with the megatrends that have replaced solidarity with protectionism, offered nationalistic answers to political, economic, and social problems, and increasingly subordinated health to economic goals. The development under the new US administration should be a warning against any attempt to further nourish these trends.
I happened to be in USA the week that started off with Donald Trump’s inauguration as the 47th president. What I saw was disheartening. Never have I seen colleagues treading so carefully and muting their voices so consistently. Thousands of web pages were taken down, fearing that words like “gender” or “diversity” should inflame the new political decision-makers. And the proposed slash of the NIH budget creates uncertainty and bewilderment for the entire edifice of medical research in USA. Ironically, this happens at the 80th anniversary of the document that helped lay the foundation for USA’s research hegemony after the second world war. This document – named Science: the Endless Frontier – was written by Vannevar Bush and published in July 1945. When we now 80 years later see how academia is exposed to increased political control, we should be reminded of what Vannevar Bush wrote about universities: “Support of basic research in the public and private colleges, universities, and research institutes must leave the internal control of policy, personnel, and the method and scope of the research to the institutions themselves. This is of the utmost importance.”
In the current state of affairs, we need creativity when it comes to remedies and cures, but we also need clarity and force in our argumentation. Some of the executive actions on the part of the new US administration might be trial balloons rather than orders set in stone and should be sensitive to reason. We have to step up our efforts to let the new administration know that “hard” power can never substitute for the soft power that the US has built brick by brick (and through U.S.A.I.D., not least) over the past decades, that forcing through bilateral accords is a poor alternative for upholding and strengthening existing multilateral cooperations, and that academic freedom, institutional autonomy, and freedom of expression remain essential for societal development. After the shake-up we have seen over the past few weeks it is crucial that the bits and pieces fall into the right places so that progress continues to flow from the past to the future and not in the reverse way. It is not just a matter of health, solidarity, and equity – it is also a matter of security, for USA and for the world at large.
