English physicians who, in 1802, introduced in India Jenner’s cow pox vaccine, replacing the then prevalent Indian system of inoculation, hoped, albeit mistakenly, that cow-worshipping Hindus would accept it, at least more readily than the puritanical Christians who considered it to be against their faith. Perhaps they never envisaged that two centuries later, the American heartland would still defy vaccine mandates citing the primacy of faith and the right to choose. Given his distrust of the US department of health and human services and its domestic policies allegedly corrupted by a woke mindset, President Donald Trump will certainly make drastic changes to the HHS and its subordinate agencies like the Centers for Disease Control and Prevention, National Cancer Institute, and the Food and Drug Administration. In spite of being domestic departments, all these have large global programmes interconnected with other US departments, such as the United States Agency for International Development or The President’s Emergency Plan for AIDS Relief. A shift in the stance of this behemoth, the largest funder of global health programmes, would destabilise the world’s health security and de-escalate a number of US-India health programmes.
Topping that list is the Joe Biden-initiated Quad Cancer Moonshot programme for the Indo-Pacific region with the United States of America, Australia, Japan, and India as partners, part of Biden’s larger plan for a quantum increase in capacity for cancer research through the diversification of clinical trials and large-scale collaborations along with addressing global health inequity. Trump, in contrast, wants to focus on what he thinks are more immediate and specific needs, such as paediatric cancer research or making experimental, unevaluated drugs directly available to terminal patients through the ‘Right to Try Act’ he got passed in 2019. This legislation betrays his future intentions to override established norms in the cancer drug industry and in the FDA for fast approvals, particularly in the context of FDA-led global projects like Project Orbis. Project Asha, another FDA initiative from its Oncology Center of Excellence, entrusted to increase cancer trials in India, may also see hard days ahead. A bipartisan Congress, usually supportive of cancer research, saved the NCI the last time but now a more pliant Capitol Hill might allow Trump to cut funding for the NCI, adversely affecting two new NCI-sponsored grants for India. One is to develop an AI-enabled digital pathology platform for diagnosis, prognosis, and prediction of therapeutic benefit, and another for AI-based automated radiotherapy treatment for cervical, oral, and laryngeal cancers. Featuring prominently in the hitlist could also be the US-India Cancer Dialogues protocol as well as the $1.58 billion pledge from USAID to GAVI, the vaccine alliance which will help India’s nationwide cervical cancer vaccination programme. Hopefully, other USAID programmes for tuberculosis eradication, AIDs prevention, primary healthcare, and projects like WASH for sanitation in schools would be affected less.
India might have to share other woes due to reduced or non-funding of global health agencies like WHO and others that Trump views as exploitative and unimportant for US interest. Prioritising personal whims over tested science, ignoring vaccine-preventable diseases, and devaluing international collaboration are not the way forward to Make America Healthy Again.
