by Gabriela Arguedas-Ramírez
Five years ago, I wrote an editorial arguing that authoritarian and right-wing populism were a threat to global health and bioethics. Early this year, with colleagues from the US and the UK, we published a piece about pandemics, bioethics and populism.
Since then, the global scenario has become dreadfully worse. What began as a right-wing populist movement in the US is morphing into fascism, according to several highly respected specialists. This is not happening only in the US. Several governments and political movements are moving quickly towards different forms of anti-democratic regimens.
Moreover, cultural and social movements expressing antidemocratic and authoritarian characteristics, such as the climate change negationist movement, radical antivaccine movements and violent anti-scientific activists denying the severity of the COVID19 pandemic, have been gaining traction since the pandemic, validated and legitimized by anti-democratic leaders such as Trump, Bolsonaro and others.
This new political reality has devastating implications. Recent decisions taken by the President of the US, such as: cutting humanitarian aid, selecting a famous conspiracy theorist and antivaccine activist, such as Robert F. Kennedy Jr., as Health Secretary, dismantling the CDC, the FDA and the NIH, threatening universities, research centers, and even scientific journals, and leaving the WHO are having disastrous effects worldwide. These decisions are causing preventable deaths and are undermining scientific and technological progress, while debilitating international cooperation that is essential for global health.
Attacks against scientific and academic freedom and freedom of speech obstruct global solidarity. Early signs of this radical antidemocratic political turn were disregarded by most people in the scientific and bioethics communities. It’s time to learn from that mistake. Based on Trump’s health policy decisions during the pandemic no one should have expected evidence-based policies during his second government. During the past political campaign, he was completely transparent about his health and environmental policies agenda. The dismantling of public health infrastructure in the US should worry every healthcare practitioner, scientist and bioethicist, not just in the US, but globally, because we have to acknowledge that these decisions, when adopted by the US government, have reverberating effects reaching every region around the world.
Nature published an editorial in February 2025 about lessons to learn from the COVID-19 pandemic. The authors quote Joanne Liu, former president of Médecins Sans Frontières, saying: “The science will deliver if we have a new emerging infectious disease, …I think it will be the people who aren’t going to deliver.”
It’s not “the people” in general who are not going to deliver. It’s the people in power and especially the people who concentrate the most power in a globalized world. Elon Musk -who until recently was the most powerful non-elected official in the US government “has sent out a host of tweets calling “USAID a criminal organization,” comparing foreign aid to “money laundering,” and calling USAID employees an “arm of the radical-left globalists.” Trump, echoing Musk, said the agency was “run by a bunch of radical lunatics.”
USAID is not a perfect organization that deserves to be defended without any criticism. In the Global South the legacy of USAID interventions has left a bittersweet aftertaste, to put it mildly. Nevertheless, I disagree with those who believe that dismantling this agency is good news for the rest of the world. In my view, that position is cynical because it does not contemplate the devastating effects of the sudden closure of hundreds of global health programs in the most vulnerable places.
Many organizations in the global health ecosystem require structural changes, but now it seems that extinction is more likely than transformation. Global solidarity and cooperation are more distant than ever from being accomplished. During the pandemic it became evident that global health diplomacy and efforts to achieve global health solidarity ended up being hijacked in the complex web of geopolitical maneuvers and interests, while LMICS became the battleground of disputes among super-powers. Now the situation is worse.
That is why I find it disturbing that these and many other atrocities, including the war in Gaza and Ukraine, hadn’t received enough attention in bioethics and global health settings. We can disagree on many issues and reject homogenizing narratives about complex historical conflicts, but indifference and self-censorship are ethically unacceptable.
Global health and global bioethics communities have a duty to address, in any way they can, the profound impact of Trump’s scientific and health policies, in the context of growing distrust towards democracy, scientific expertise and human rights. Global Health’s history is rooted in colonial and imperial trajectories, and, consequently, requires continuous self-reflection and political will to change. However, it is also true that there has been enormous progress in many areas, but now those advances are rapidly disappearing.
Destroying is easy, building back better (as we all know, in the aftermath of COVID19) is very difficult and sometimes impossible. Democracy (in particular liberal democracy) is an imperfect political system; but even imperfect democracy is preferable to authoritarianism, or worse, fascism. There is robust empirical evidence that demonstrates how democracy and health are deeply intertwined. Health is a sociohistorical and political product, and not only a biological state. Societies can be organized to create and redistribute health, or to concentrate health on a minority while distributing disease, loss of quality of life and premature death to the majority.
This is precisely what the social, commercial and legal determinants of health reveal. But, despite inequities in democratic societies, they do a better job in creating the conditions for a healthy life than non-democratic societies.
That is why global bioethics and global health must take seriously the fact that democracy everywhere (although to different degrees) suffered the impact of the COVID19 pandemic. COVID19 has had corrosive effects on already endangered democratic institutions as a result of amplifying the inequalities and injustices within democracies.
In Latin America demagogues and antidemocratic leaders such as Milei in Argentina, Bukele in El Salvador, and Chaves in Costa Rica, among others, are taking advantage of this atrocious political climate, while key epidemiological indicators in their countries are blinking red. Infant mortality is increasing in several countries in Latin America, maternal mortality has been skyrocketing since the start of the COVID19 pandemic, as well as food insecurity, non-communicable diseases and violent deaths.
We need to acknowledge, understand and confront what this new reality implies. To do so, we need to break free from silence, fear and isolation. As Timothy Snyder says, referring to how to resist fascism: do not obey in advance.
Author: Gabriela Arguedas-Ramírez
Affiliation: University of Costa Rica
Conflicts of Interest: None declared