Great thinkers have sought for centuries to convey a crucial truth about humanity’s interconnection. As the poet John Donne wrote: “No man is an island, entire of itself;  every man is a piece of the continent, a part of the main … Any man’s death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee.” Poet Francis Thompson took up the fundamental idea this way: “[T]hou canst not stir a flower without troubling of a star.” And, of course, the Rev. Dr. Martin Luther King, observed: “All men are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly.…”

In health and medicine,  it makes no sense to think of the world in strident terms of us and them. The global coronavirus pandemic provided a harsh reminder that what happens thousands of miles away can have major effects on Americans.

But the current administration has launched multi-front attacks on those it deems “others.” These rapid, little-explained actions will cause significant harm to our health.

They include a slashing of global humanitarian aid and the elimination of overseas public health initiatives. They target non-American production of goods, notably some that affect prescription drugs as well as medical devices and supplies. They are aimed with cruelty at immigrants and advocacy of diversity, equity, and inclusiveness — measures with significant implications for the brilliant minds that provide medical-scientific breakthroughs, and the big numbers of those who staff important research efforts and those who medically treat and care for patients.

The late Colin Powell, in warning U.S. leaders about the dire consequences of hasty, poorly supported but dramatic interventions, coined what he called the Pottery Barn rule: If you break it, you own it. With a blitzkrieg of extreme actions under way by leaders in Washington, D.C., how will all the regular folks in this country account for all that has occurred — and been reversed and then reversed again — in only the first 100 days of the new administration?

Medical advances — notably antibiotics, antivirals, and vaccines — have tamed an array of once-familiar, debilitating and lethal ills. Still, fearsome diseases continue to take a terrible toll in foreign lands.

Mindful of how disastrous the results would be if these plagues got to the United States, courageous doctors, public health experts, and scientists labored in demanding conditions as caregivers and sentinels to avert worsening outbreaks on distant shores.

The administration of the 47th president has slashed this important work.

He empowered his chainsaw-wielding mogul and chief donor, with a corps of unidentified tech-savvy young folks, to tear into the federal government. They purportedly sought waste, fraud, abuse, and imagined huge savings. Even as the president’s Cabinet members were tying up their U.S. Senate confirmations, Elon Musk and his DOGE lads leaped in and schemed to eliminate USAID, the agency through which flowed most of this nation’s foreign assistance funds. This included sums that battled the rapid-spreading hemorrhagic fever Ebola, the health-destroying disease of tuberculosis, and the treatable but still potentially lethal illnesses of malaria and HIV-AIDS. Without U.S. assistance, experts fear these diseases will worsen, spread,  and become more deadly.

As this nation seeks natural resources, allies, and commercial partners around the world, especially in developing parts of the globe, exactly how will business people and diplomats from the wealthiest, most powerful country explain:

§ Why the United States is withdrawing from the World Health Organization. It received a major share of its funding  — a pittance in real dollar terms — from this country. The 47th president has assailed WHO for what he deems its poor handling of the pandemic. Doctors, medical scientists, and public health officials warn that the U.S. exit will blind this country to sentinel programs about the risks of spreading flu, avian flu, polio, TB, and other infectious diseases. Amesh Adalja, M.D., a senior scholar with the Johns Hopkins University Center for Health Security, explained in an interview: “Leaving the WHO will put the U.S. in a position where it will be without full situational awareness of infectious disease outbreaks that are occurring globally, it will hamper the ability of the [U.S. Centers for Disease Control and Prevention] to be most effective in global health, and will likely only increase Chinese influence on the organization.”

§ How this nation cut off relatively small sums (a few billion dollars annually), likely leading to an estimated 11 million new HIV-AIDS infections and 3 million deaths (by 2030) in 55 countries receiving assistance in battling the viral infection under the program known as PEPFAR.

§ How the United States slashed relatively few dollars, leading to drastic reductions in battling malaria. Experts estimate that “just a year of disruption in the malaria-control supply chain would lead to nearly 15 million additional cases and 107,000 additional deaths globally.” In contrast, reducing malaria’s economic burden on African nations where it is most common would boost the continent’s GDP by an estimated $16 billion annually, making those markets even more salient for positive U.S. financial activity.

Flip-flops and critical responses

Administration officials have flip-flopped about who, what, and how much will be cut in U.S. foreign aid. But doctors and public health officials warn that the chaos, distress, and still remaining cuts in humanitarian and medical aid will harm American interests as well as the poor and suffering worldwide. They wrote in a perspective article in the New England Journal of Medicine:

“Since U.S. foreign assistance accounts for about 1% of the federal budget, we are skeptical of cost-savings–based arguments for [the aid’s] elimination. Moreover, the retrenchment of U.S. foreign assistance could have adverse and unpredictable political consequences … Relationships among acute and chronic diseases, food insecurity, political instability, and armed conflict are complex, and food security has declined in sub-Saharan Africa since 2015. The abrupt withdrawal of many USAID-supported programs for preventing and treating malnutrition and reducing child mortality may threaten political stability in Africa and elsewhere.

“The Trump administration’s gutting of USAID and other foreign-assistance programs marks a break from decades of evidence-based practices that have improved lives throughout the world. In addition to pushing millions of people into poverty and leading to an estimated 160,000 or more avoidable child deaths each year, these reforms will undermine health and the economy in the United States. The United States runs the risk of losing the trust of many people in [low- and middle-income nations], which could jeopardize international relations.”

Critics have assailed this country’s spending, say, $1 billion to battle African outbreaks of hemorrhagic fevers. But just consider the potential costs to combat the disease, which spreads like wildfire, if it gained a foothold in the United States. Infectious disease experts tried in 2016 to get a financial handle on what top-line, highly specialized facilities might do if confronted with such a scenario. Just to make rudimentary preparations cost several dozen of these care centers $55 million, the researchers found, explaining:

“The care of a hospitalized patient with confirmed [Ebola] in high-level isolation units requires large specialized teams of nurses, physicians, laboratory technologists, environmental service workers, and waste management specialists, and inpatient care may continue for weeks.”

As for tuberculosis, critics, again, may gripe about U.S. expenses for dealing overseas with this wasting respiratory disease. This nation’s overpowering interest in doing so, however, traces to a grim aspect of the disease — how it has become resistant to existing medications. The poverty, sanitation, poor health care and hygiene in the developing world has fueled a resurgence in drug-resistant TB.

Cases of the rising, “extensively resistant” strain cost as much as $430,000 per patient to treat in the United States — an expense heavily borne by taxpayers. Many of those with drug-resistant TB are poor, unhoused, substance abusers, and downtrodden in many other ways. To ensure their treatment succeeds, medical staff often must rely on “DOT” care — they must stand and watch to double-check that patients take medications and other treatments. As researchers noted of increasing numbers of TB cases in this country: “Drug resistance was extensive, care was complex, treatment completion rates were high, and treatment was expensive … Preventing [multi-drug resistant and extensively drug resistant] TB in the United States will require addressing factors associated with development of drug resistance in countries where foreign-born U.S. patients originate, as well as rapid diagnosis, appropriate regimen selection, [and] robust case management practices …  in the United States.”

It’s accurate to criticize unfair trade practices and to seek to address these. But how will this country get an array of prescription medicines and vital medical devices and supplies no longer manufactured here?

Think back to just a few years ago. Everyone in this nation — especially doctors, nurses, hospitals, and clinics —got a slap of reality regarding supply chains and their role in modern medicine. A global shutdown, especially in manufacturing and transportation, demonstrated this country’s giant, painful reliance on importing vital medically related items. Like PPE, personal protective equipment including many different kinds of face masks, gowns, and gloves. Nasal swabs. Antibiotics. Anesthetics. Ventilators and other breathing assistance devices. And chemicals and goods for medical testing.

A panicked, all-out national push — including with huge federal, state, and local government spending and activity — got this country through a once-in-a-century crisis. Commissions, corporations, medical leaders, economists, and others then pledged to get to work to avert future crises.

The current administration has set off new global alarms with its sweeping tariffs on at least five dozen nations, including America’s closest allies and neighbors. The 47th president, insisting that every other country has “ripped us off very badly,” has defended his plan, which the conservative Wall Street Journal editorial page has described as “the dumbest trade war in history.”

To be clear, the president has turned his tariff regime off and on like the light switch at a teen make-out party. This has created trillion-dollar shifts on the world’s stock markets and contributed to global economic uncertainty not seen for almost a century.

‘Bracing for chaos’

Prescription drugs and many medical devices and goods typically are exempted from tariffs — which inarguably are a tax on consumers. Still, the administration has launched an investigation into U.S. drug imports, and the president has threatened that tariffs are likely to hit these vital products soon. This attack, combined with what has become a major trade war with China — a dominant force in the manufacture of drugs and other medical goods — has shaken experts’ confidence anew. It also forecasts painful cost increases in a sector of the economy that now consumes almost 1 in 5 dollars of the nation’s GDP. As the news site The Hill reported of the shudders shaking U.S. medicine:

“The pharmaceutical industry is bracing for chaos if President Trump follows through on his threat to impose ‘a major tariff’ on prescription drug imports. Tariffs would disrupt international supply chains, force companies to decide whether to pass increased costs on to patients and exacerbate existing drug shortages.  The administration wants more drug companies to onshore their manufacturing, but experts said such a process would take years, while the pain from tariffs could be much more immediate.”

While big-name drugs and their giant corporate makers are seeking work-arounds and may not feel the most harm from tariffs, Fierce Pharma, an industry-focused newsletter, has reported that generic manufacturers will bear the brunt of tariffs’ harms. They will be hit by both costs on their products and the supplies needed to make them:

“[G]eneric medicines and the companies that manufacture them will be uniquely vulnerable in the event of a trade war given just how ‘little resilience’ the industry enjoys compared to its patented counterpart. That’s the take according to Ronald Piervincenzi, Ph.D., CEO of the United States Pharmacopeia —a nonprofit that publishes drug quality, purity, strength and identity standards that are enforced by the FDA and followed by manufacturers. “Ultimately, any disruption to the already fragile generics ecosystem could trigger manufacturing discontinuations, shortages and a multitude of other issues for off-brand drug makers and the U.S. patients who rely on their products ….”

Patients also could be staggered by tariff-related cost spikes for an array of medical devices and goods, including “oxygen equipment, suction pumps … and mobility devices like wheelchairs,” as well as “blood glucose meters, test strips, syringes and continuous glucose monitors,” Rolling Stone magazine has reported, noting:

“Researchers [have] found that around 75% of U.S.-marketed medical devices are, at least in part, manufactured abroad. It also found that respiratory devices—one of the most common medical device imports, and very much not optional for those who rely on them—are likely to be one of the more seriously impacted products.”

The consulting firm Global Data also reported that “13.6% of the total U.S.-marketed medical devices … are currently manufactured in China. Hospital supplies, diagnostic imaging and anesthesia … [these are among] the most common types of medical devices imported to the U.S.; therefore, these types of products are expected to be significantly impacted.”

Assessing fully how tariffs will spike costs for medical devices and goods will take time, experts say. That’s because increasingly complex items like these could be subject to price hikes and shortages due to materials in them — which would be subject to tariffs, even if the final product might not be.

Respondents to national political polls have affirmed it. So did the vote in the last presidential election. Americans have great concerns about a broken immigration system and an insecure border.

But the harsh, xenophobic crackdown on immigrants and immigration in this country has provoked its own backlash, recent polling shows. The sweep of the administration’s immigration efforts undermines some of this nation’s most prized resources: a globally admired medical system and medical-scientific research capacity.

The United States has reaped an unimaginable bounty from the intellectual firepower of foreign-born medical-scientific researchers at the most elite levels. Here’s just one tally of this from the nonpartisan, nonprofit National Foundation for American Policy:, which found that:

“Immigrants have been awarded 40%, or 45 of 112, of the Nobel Prizes won by Americans in chemistry, medicine and physics since 2000 … four of the six U.S. recipients of Nobel Prizes in medicine, chemistry and physics were immigrants to the United States. In 2021, three of the four U.S. recipients of Nobel Prizes in medicine, chemistry and physics were immigrants to America. Between 1901 and 2023, immigrants have been awarded 36%, or 115 of 319, of the Nobel Prizes won by Americans in chemistry, medicine and physics.”

The foundation, as with many other voices in this country, says that America’s long history of welcoming those from other shores and offering them unparalleled opportunities has made the nation a top destination for game-changing researchers, writers, artists, and other world-class talents. That situation could evaporate rapidly — with great, lasting damage, the New York Times reported:

“The Trump administration in recent weeks has canceled or frozen billions of dollars in federal grants made to researchers through the National Institutes of Health, and has moved to sharply curtail funding for academic medical centers and other institutions. It has also, through the [DOGE] initiative, … tried to fire hundreds of workers at the National Science Foundation, an independent federal agency. And it has revoked the visas of hundreds of foreign-born students. To economists, the policies threaten … U.S. competitiveness in emerging areas like artificial intelligence, and to leave Americans as a whole poorer, less healthy, and less productive in the decades ahead.”

Top talents can vote with their feet

Vilifying high-level talent ignores that able and ambitious people are not anchored in this country. Three professors at Yale have decided to abandon the U.S. for Canada, according to a CNN news article. MSN reported that a French institution already has seen a startling response (and distressing one for the United States) to its offer as a haven for American researchers:

“Nearly 300 scholars currently working in the United States have applied for positions at Aix-Marseille University in France, which has announced a program to provide a haven for academics affected by the Trump administration’s policies. Aix-Marseille [is] offering three-year funded placements for approximately 20 researchers … Within a month, the program drew 298 applications, of which 242 met eligibility criteria. Applicants came from prestigious institutions including Yale, Columbia, Stanford, Johns Hopkins, and NASA.”

Rigorous medical-scientific research relies not only on big-name principal investigators but also grad students, new Ph.D.s, and postdocs, many of whom are foreign-born, especially in STEM areas. They work long hours for lesser pay that often doesn’t always match their hard-won academic labors and credentials. Their toil is vital to advancing basic, bench-to-bedside, and top-flight studies.

The administration, with an array of assaults on medical-scientific research, is killing this “seed corn,” including by denying entry or trying to deport foreign-born scholars, canceling (then reinstating!) visas for university students across the country, and threatening to conduct immigration raids in research facilities. As the scientific journal Nature reported:

“Data from the Nature Careers global science jobs platform show that U.S. scientists submitted 32% more applications for jobs abroad between January and March 2025 than during the same period in 2024. At the same time, the number of U.S.-based users browsing jobs abroad increased by 35%.

“’To see this big drop in views and applications to the U.S. — and the similar rise in those looking to leave — is unprecedented,’ says James Richards, who leads the Global Talent Solutions team at Springer Nature … The release of the Nature Careers jobs-board data follows a separate poll of researchers by Nature’s news team, which found that 75% of researchers in the United States who responded were keen to leave.”

News outlets across the country have reported that colleges and universities have counseled international students to rethink their spring break, summer, and fall travel plans, perhaps finding ways to avoid leaving this country to prevent being barred from returning to school. While many colleges and universities had recruited international students with zeal — they often pay higher and full tuition and help bring a global sophistication to campuses — how long will young people from other countries want to study and then become part of a hostile, threatening United States?

The current administration, which is big on sloganeering, talks a lot about Making America Healthy Again. That sounds like a great idea. It will be difficult to do, though, if the nation’s leaders keep up with the aggressive, divisive talk and actions that quickly will prove detrimental to medicine.

Let’s recognize that this country faces a significant shortfall of doctors — and patients are starting to feel the crunch. There are longer waits for appointments, and in swaths of the nation medical care is getting downright hard to find. In the next dozen or so years, according to medical educators, the physician shortage will amount to almost 90,000 clinicians. That is fewer than some glum forecasts calculated, but this is a looming public health problem that will not be easily resolved. It takes a long time and a pile of money and other resources to train doctors. That leaves aspirants with not only demanding years of work but also debts that stack up to hundreds of thousands of dollars.

This country has leaned on the rest of the world to ease its shortages in doctors and nurses, as well as health aides and others involved in medical care. The Migration Policy Institute reported how the pandemic surfaced the big role that foreign-born people of various legal statuses play in U.S. medicine:

“Immigrant professionals have long played an important role in the U.S. health care workforce and make up disproportionate shares of both certain high- and low-skilled health care workers. For instance, the foreign-born accounted for 26% of the 987,000 physicians and surgeons practicing in the United States in 2021 and almost 40% of the 559,000 home health aides.” The group found that 16% of registered nurses are immigrants, while 21%+ of nurses’ aides came from other countries.

While extremists assail immigrants for purportedly taking jobs away from Americans, in health care, experts note, immigrants are holding down many difficult-to-fill roles. These often are low-paying jobs with long hours, heavy lifting, unpleasant, routine tasks, and challenging patient-clients. As David Grabowski, a Harvard Medical School professor, has observed in an interview with the Axios news site:

“Some of the earliest and lasting effects from [President] Trump’s promised immigration crackdowns would be in home health and long-term care, both of which rely on a substantial number of immigrants and undocumented workers … Reducing an already thin labor market could have serious ramifications for aging adults or those with disabilities — and potentially put more stress on family caregivers …

“‘Immigration policy is long-term care policy,’ said Grabowski, who has chronicled how foreign-born workers filled key nursing home roles early in the pandemic. He found nursing homes in regions with a higher share of foreign-born nursing assistants provided more direct care and better quality.”

Waking up to anti-wokeness’ costs

By the way, the administration’s campaign to root out “wokeness” and Diversity, Equity, and Inclusiveness efforts in education — including in medical schools — is another problematic Them and Us initiative. It upends efforts to ensure that underserved patients and communities get the care they desperately need and that medicine has hope for a tomorrow without harmful biases of the past.

Medical schools, for example, warn that they struggle already to enroll sorely needed, under-represented black and Latino doctors. DEI crackdowns, including now those aimed at the accreditors of institutions, will erode any gains. These already were imperiled by lawsuits and other claims that DEI initiatives are themselves discriminatory, especially against white and Asians. As the nonpartisan Kaiser Health News service reported, quoting Norma Poll-Hunter, senior director of workforce diversity for the Assn. of American Medical Colleges:

“If the recent decline in diversity among newly enrolled students holds or gets worse, it could have long-term consequences for patient care, academic experts said, pointing toward the vast racial disparities in health outcomes in the U.S., particularly for black people. A higher proportion of black primary care doctors is associated with longer life expectancy and lower mortality rates among black people, according to a 2023 study published by the JAMA Network. Physicians of color are also more likely to build their careers in medically underserved communities, studies have shown, which is increasingly important as the AAMC projects a shortage of up to 40,400 primary care doctors by 2036.

“‘The physician shortage persists, and it’s dire in rural communities,’ Poll-Hunter said. ‘We know that diversity efforts are really about improving access for everyone. More diversity leads to greater access to care — everyone is benefiting from it.’