In the race for the White House, where do US President Donald Trump and his Democratic challenger, former Vice President Joe Biden, stand on public health? Susan Jaffe reports from Washington, DC.
As the COVID-19 death toll in the USA climbs past 205 000 and the number of cases exceeds 7·15 million, the coronavirus is the dominant health and economic issue on the minds of many American voters. The USA leads the world in both cases and fatalities, which have disproportionately affected communities of colour. But President Donald Trump counters that several other countries have a higher death rate as a percentage of their population. The distinction, although accurate, has not improved the public’s opinion of his pandemic response. Recent polls show only 40% of the public approve, although 82% of his fellow Republicans say he is doing a good job.
Trump’s plan to tackle the pandemic for his second term, should he be re-elected, is short on details. In August, the campaign released a list of priorities for the next 4 years containing brief phrases and no specifics. His COVID-19 priorities include a “return to normal in 2021” and a commitment to producing all COVID-19 medicines and supplies for health-care workers in the USA. He would refill stockpiles of supplies and medicine for future pandemics, and provide a COVID-19 vaccine by the end of 2020.
Trump has been reluctant to support recommendations from the Centers for Disease Control and Prevention (CDC) for people to wear masks outdoors and has questioned the pessimistic warnings of the CDC and other government scientists. Earlier this month, Trump said he believes a vaccine could be ready before election day (Nov 3)—an assertion CDC Director Robert Redfield has contradicted.
Unlike more conventional presidential candidates, Trump does not intend to issue formal policy proposals or position papers. With less than 5 weeks remaining before the election, his campaign says he will share “details about his plans through policy-focused speeches on the campaign trail”.
Trump has not articulated a vision for public health in his second term other than eliminating the Affordable Care Act and women’s right to abortion, said Georges Benjamin, a physician and executive director of the American Public Health Association. “In terms of COVID-19, he is over-relying on the speedy production of a vaccine that we don’t yet know is safe and effective”, he said. If Trump is re-elected, Benjamin expects “he will continue the destructive efforts to undermine science”.
Joe Biden’s campaign has released a total of 51 policy proposals outlining how he will accomplish his goals if he wins in November. His COVID-19 response includes creating a national strategy that gives the federal government—not the states—the primary responsibility for battling the pandemic. He would issue a nationwide requirement to wear a mask and has a plan to meet the country’s demand for medical supplies, protective equipment, and rapid testing. “We’ll put the politics aside and take the muzzle off our experts so the public gets the information they need and deserve. The honest, unvarnished truth”, Biden said when he accepted his party’s nomination for president in August.
“Unborn children have never had a stronger defender in the White House”, Trump told pro-life supporters in January at their annual rally protesting the Supreme Court’s 1973 Roe v Wade ruling that legalised abortion across the nation.
Trump’s priorities for a second term promise to “protect unborn life through every means available”. The latest evidence of that commitment is his nomination of conservative Judge Amy Coney Barrett to the Supreme Court after the death of Justice Ruth Bader Ginsburg, a champion of women’s rights. As a federal appeals court judge, Barrett has a record of decisions and other writings critical of abortion rights and the Affordable Care Act.
Trump also supports the Hyde Amendment, which prohibits Medicaid, the government-funded health insurance for low-income families, from covering abortions. About one in five women in the USA rely on Medicaid, including a large proportion of Black and immigrant women, according to Ana Langer, a physician and director of the Women and Health Initiative at the Harvard T H Chan School of Public Health. “So that’s another very important instrument that can be used to eliminate taxpayer-funded reproductive health services.”
Biden would ask Congress to repeal the Hyde Amendment and would eliminate restrictions on federal family planning funds. He would restore the protection against health-care discrimination for LGBTQ+ patients that the Trump administration removed. He is also a strong supporter of the Roe vs Wade decision, along with his vice presidential running mate, California Senator Kamala Harris.
“Women’s rights and women’s health are under assault like we haven’t seen in the last 50 years”, Biden said during last year’s Democratic primary campaign. “It’s clear that these [Republican] folks are going to stop at nothing to get rid of Roe. And it’s clear to me that we just have to be strong defending it. I support Roe … and quite frankly, I always will.”
“If Joe gets in, your Second Amendment is gone”, Trump told a Florida rally earlier this month, referring to the constitutional provision his supporters believe gives individuals the right to own guns. After the mass shooting at a school in Parkland, FL, Trump tentatively supported raising the minimum age to purchase a gun to 21 years, as well as more extensive background checks, among other steps. “Fortunately, the President does not appear to have seriously pursued most of these gun control policies”, according to a report from the conservative Heritage Foundation.
The only mention of gun violence among Trump’s priorities focuses on defending police. He would hire more police officers, increase penalties for assaulting a police officer, and “keep dangerous criminals locked up until trial”.
Widespread gun violence afflicting the USA is a public health epidemic, according to Biden. He has promised to repeal legal protection for gun manufacturers, expand background checks for gun buyers, ban military-style assault weapons and high-capacity magazines, create a buy-back programme for assault weapons, limit gun purchases to one per month, and end online sales of firearms and ammunition. These measures to reduce the thousands of deaths per year due to gun violence can be implemented without restricting Second Amendment rights, according to the Biden campaign.
2 days after Trump was sworn in as president in 2017, he reinstated and expanded the Mexico City Policy. Also known as the global gag rule, it requires non-governmental organisations (NGOs) to agree, before they can receive most US global health aid, that they will not perform abortion or advise women on how to get the procedure. NGOs must also agree that they will not use non-US funds for abortion services or counselling. The restrictions apply not only to US aid for family planning, but also to US funding to fight HIV/AIDS provided under the President’s Emergency Plan For AIDS Relief, as well as other assistance to prevent malaria and malnutrition and improve child and maternal health, among other initiatives.
Under Trump’s “America First” doctrine, his administration has requested significant cuts in the global health budget, claiming that the USA was doing too much and other countries needed to do more. Congress largely rejected those cuts, said Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation.
In April, 2020, Trump halted funding to WHO, claiming the organisation had mismanaged the COVID-19 response. A month later, Trump announced that the USA was dropping out of WHO and transferring its financial contributions to the US global health budget. The US absence is particularly concerning as scientists across the world work on developing a vaccine against COVID-19.
“Fair, equitable, and timely distribution of a COVID-19 vaccine will be one of the most difficult challenges facing the global community in a very long time”, said Kates.
Although there is little information about Trump’s second-term global health agenda, Kates does not expect any major changes. “It is highly likely that in its second term, the Trump administration would continue to move in the same directions on global health, including its posture towards the rest of the world.”
Biden would reverse the decision to leave WHO, restore US financial assistance, and cancel the global gag rule. Under a Biden presidency, the USA would also rejoin the 2015 Paris Agreement on climate change, aimed at slowing Earth’s warming temperatures and reducing the detrimental impact on human health and the environment.
This year, deaths due to drug overdoses, including opioids, have increased by an average of 13%, according to data for 40% of the country obtained by The New York Times. If that level continues, the increase in drug overdose deaths would be the highest since 2016. In 2017, Trump declared the rampant abuse of opioid painkillers a public health emergency. After that decision, Trump’s bipartisan Commission on Combating Drug Addiction and the Opioid Crisis issued detailed recommendations for action. The administration followed up by securing $6 billion to fight opioid abuse, creating a plan to reduce opioid prescription refills and to improve addiction treatment support services. Trump’s second-term priorities do not address the opioid epidemic, although he claimed in his speech accepting the Republican nomination for president that drug overdoses will increase if Biden is elected.
Biden would assure that Americans have access to health care, including substance abuse treatment and mental health services, both of which are essential health benefits that health insurers must provide under the Affordable Care Act, the health law Trump wants to repeal. Biden would invest $125 billion for prevention, treatment, and recovery services, ensure that drug companies are held responsible for contributing to the problem, end overprescribing of opioids, and promote alternative methods of pain management.
Published: 03 October 2020
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