Lawrence O. Gostin discusses the importance of equity and science in the face of threats to global health security.

In a conversation with The Regulatory Review, global and public health law expert Lawrence O. Gostin reflects on recent shifts in U.S. health policymaking and their consequences for public health domestically and abroad.

Within the first week of President Donald J. Trump’s inauguration, he issued executive orders that have unsettled long-standing norms for U.S. leadership in global and public health. Since January 2025, the Trump Administration has withdrawn the United States from the World Health Organization (WHO), implemented a freeze on foreign assistance funds, and initiated massive cuts to the funding and staffing of the research, public health, and regulatory agencies that are charged with safeguarding the public’s health and safety. These actions, Gostin explains, have risked undermining the United States’ leadership in global health security.

Gostin discusses how the Trump Administration’s changing health policymaking priorities, coupled with reductions in agency force and funding cuts, could weaken the United States’ ability to respond to health emergencies, including ongoing challenges such as the spread of H5 influenza in dairy cattle and the resurgence of measles. Drawing on decades of experience at the intersection of law, policy, and global health, he offers insights into how courts play a role in shaping health policy and why effective global health governance demands policies grounded in equity and evidence-based practices. In the face of current challenges and uncertainties ahead, Gostin underscores that investments in scientific regulatory agencies and public health remain the most sustainable path toward realizing health security for all.

Gostin has been recognized as one of the most influential leaders shaping policy in the United States and globally. At Georgetown University Law Center, he serves as distinguished university professor—Georgetown University’s highest academic rank—the founding Linda D. & Timothy J. O’Neill Professor of Global Health Law, and co-faculty director of the O’Neill Institute for National and Global Health Law. He also holds faculty appointments at the Georgetown University School of Medicine and the Johns Hopkins Bloomberg School of Public Health.

Gostin directs the WHO Collaborating Center on National and Global Health Law and has advised WHO on numerous high-level initiatives, including its International Health Regulations and its member states’ Pandemic Agreement. A lifetime elected member of the National Academy of Medicine and the National Academy of Sciences, Gostin has chaired multiple National Academy committees on health emergencies, including those that reported on emergency preparedness, smallpox, and pharmaceutical safety. He currently co-chairs the Nature Commission on Quality Health Information for All.

Throughout his career, Gostin has shaped global health policy responses to major epidemics, including AIDS, Ebola, Zika, influenza, and COVID-19. His scholarship is among the most widely cited in the field. Gostin’s contributions to health law have been recognized with numerous honors, including the National Academy of Medicine’s Adam Yarmolinsky Medal and the American Public Health Association’s Distinguished Lifetime Achievement Award. He has also been appointed to Sigma Xi, the Scientific Research Honor Society.

The Regulatory Review is pleased to share the following conversation with Lawrence Gostin.

The Regulatory Review: Historically, the United States has been a funder of and a model for global health initiatives. Can you describe the Trump Administration’s early actions relating to WHO and the United States Agency for International Development (USAID)?

Gostin: The world is experiencing cascading global shocks, tightly interwoven with population health—the COVID-19 pandemic, climate change, and humanitarian crises. On January 20, 2025, global health experienced a shock of another sort, the inauguration of President Donald J. Trump. On day one, President Trump issued an executive order giving one year’s notice of the intention to withdraw the United States’ membership in WHO.

That same executive order immediately blocked all funding to WHO, disavowed the International Health Regulations, and pulled the United States from the WHO Pandemic Agreement. He directed staff of the Centers for Disease Control and Prevention (CDC) who were seconded to WHO to return to Atlanta and even instructed other personnel from CDC and the U.S. Department of Health and Human Services to cease communication with WHO. Another executive order that day froze all new obligations and disbursements of foreign assistance funds. Soon afterwards, U.S. Secretary of State Marco Rubio issued an immediate halt to all ongoing foreign assistance activities.

And all of that was only the first week.

TRR: What effects will these actions have on U.S. global health leadership and preparedness for public health emergencies?

Gostin: The United States was instrumental in creating WHO and ratified the WHO Constitution in 1946—a legally binding treaty. In the decades since, the United States has been WHO’s largest donor and most influential member. American leadership at WHO helped eradicate smallpox in 1980 and is now close to eradicating wild polio. The United States will now be on the outside looking in while crucial decisions are taken at the World Health Assembly, which is WHO’s decision-making body.

The United States may lose rapid and full access to crucial surveillance data derived from WHO’s vast global network of diseases. This would include surveillance data on major health threats faced domestically, including measles and avian H5 influenza. WHO’s network of over 310 response units can put out diseases before they reach our shores. All that is at risk.

On May 20, 2025, the World Health Assembly adopted a historic Pandemic Agreement— which was propelled by the failures of global solidarity during COVID-19. But following President Trump’s withdrawal from WHO, the United States will not be party to the agreement nor reap the benefits of participation. Its absence also weakens the agreement’s vision for universal international cooperation. Still, the agreement will be transformational in improving scientific cooperation and equity in future health emergencies.

By disavowing the recent amendments to the International Health Regulations and withdrawing from Pandemic Agreement, we will no longer be a party to the global governance of infectious diseases.

TRR: Beyond the United States’s role in WHO, how will recent changes in domestic priorities—such as cuts to public health spending, research funding, and agency staffing—undermine U.S. preparedness for health emergencies?

Gostin: Major cuts of funding and staffing, along with reorganization of U.S. health agencies, weaken our capacities to detect and respond to potential health emergencies. The Trump Administration, for example, has slashed infectious disease research at the National Institutes of Health. These cuts make it harder to understand novel pathogens and to develop lifesaving vaccines and therapeutics. The Centers for Disease Control and Prevention (CDC) has also suffered major cuts, as have state and local health departments. CDC’s cuts will decimate its country offices around the world, while also severely weakening the agency’s domestic public health capacities.

The President’s budget proposed draconian cuts to the National Institutes of Health and CDC—nearly 40 percent and 50 percent, respectively—would further weaken the nation’s public health and biomedical research enterprise, upending decades of progress in advancing public health, safety, and life expectancy.

Moreover, in our federalist constitutional system, tribal, state, and local health departments are on the front lines of preparedness and response. Funding cuts in this realm will impact our ability to surveil and respond to diseases and to conduct immunization campaigns. Secretary of the U.S. Department of Health and Human Services Robert F. Kennedy, Jr.’s well-known suspicions of vaccine safety will also undermine vaccination rates. In particular, the Secretary has commissioned a special study of the links between MMR vaccines (measles, mumps, and rubella) and autism, even though the National Academy of Sciences already conducted a definitive study showing no connection.

TRR: During the COVID-19 pandemic, you emphasized the importance of public trust in the guidance and leadership of “scientific agencies.” How might public distrust in the CDC shape domestic and international perceptions of U.S. leadership during future health emergencies?

Gostin: I co-chair the Nature Commission on Quality Health Information for All. The Commission is documenting the pervasive use of false and misleading information in public health. We are now seeing federal health agencies, as well as many state agencies, themselves acting as purveyors of mis- and disinformation.

This can have a corrosive effect on community health and safety. It may mean that members of the public will refuse to follow public health guidance, such as recommendations for vaccinations and social distancing. The public may instead follow misleading advice, such as taking harmful medications like Ivermectin during the pandemic or using vitamin A or iodine to treat measles.

One of public health’s most important roles is to provide evidence-based guidance on health behaviors. Yet, due to the influence of social media—and, increasingly often, even government itself—the public is increasingly exposed to confusing and often harmful advice.

TRR: The United States is currently facing a serious measles outbreak, a disease that was previously thought to be eliminated domestically. What does the resurgence signal about the fragility of public health gains?

Gostin: The multi-state measles outbreak centered in Texas shows the damage that can be done when the public receives false and misleading information. Vaccination rates for measles and other fully preventable childhood diseases are plummeting, falling well below levels needed for community immunity. In some communities, the rate of religious opt-outs from school-based vaccinations hovers around 40 percent, whereas more than 95 percent vaccination coverage is required to achieve herd immunity against measles. The precipitous drop in childhood immunizations is responsible for the current measles outbreak and is highly likely to fuel future outbreaks of preventable childhood diseases.

TRR: What role can courts play in shaping a right to health?

Gostin: The courts have pushed back on the Trump Administration’s weakening of science and public health, but only temporarily and mildly. In Department of State v. AIDS Vaccine Advocacy Coalition, a divided Supreme Court rejected the Trump Administration’s emergency request to lift a federal district court order directing the agency to pay $2 billion in foreign-aid reimbursements for work already done.

Justice Samuel A. Alito, Jr., joined by three Justices, dissented, characterizing the lower court order as exacting a “$2 billion penalty on American taxpayers”—an odd characterization given that the U.S. Congress has already appropriated the funds and the work has already been performed. The district court enforced the payment of currently obligated funds but allowed USAID to proceed with a mass termination of grants and contracts. Still in its early stages, the case continues. The courts had pushed back, but it was mild and measured. Above all, it will be insufficient to spare programs that save lives.

An avalanche of litigation against research funding cuts is ongoing. Notably, Harvard University has filed a lawsuit against the Trump administration for ending $450 million in biomedical research grants to the university.

TRR: You have underscored the importance of centering principles of human rights and equity in global health policymaking. Can you explain why?

Gostin: The COVID-19 pandemic revealed gaping inequities in affordable access to lifesaving vaccines. Early in the pandemic, the United States and other high-income countries pre-purchased virtually the whole global supply of vaccines, leaving very little for low- and middle-income countries. Equity is important for its own inherent value. All human beings, regardless of where they live, have equal dignity and value. But even beyond its inherent value, equity is important for health security. Viruses left unchecked in one country will spread to neighboring countries, regions, and globally. And when viruses take hold in a population, they can change and mutate, creating pathogens that are more transmissible and less susceptible to treatments. That is exactly what happened during the COVID-19 pandemic as dangerous variants such as Delta and Omicron devastated populations everywhere. In global health, we have a saying: “No one is safe until everyone is safe.”

The recently adopted WHO Pandemic Agreement focuses on equitable distribution of lifesaving medical products. It creates a Pathogen Access and Benefits Sharing system that fosters scientific exchange of pathogen samples and genomic sequencing data together with more equitable distribution of pandemic products. And it promotes regional diversification of manufacturing of those products so the low- and middle-income countries are not reliant on charitable donations, which seem to always come too little and too late. The treaty would also encourage the transfer of technology to manufacturers in low- and middle-income countries.

TRR: What advice would you give U.S. policymakers looking to use domestic reforms to strengthen global health?

Gostin: I would simply say this: Funding for science and public health is the best investment one can make to secure a healthier and safer future for all of us.

First, we should invest generously in America’s scientific agencies such as the National Institutes of Health, the U.S. Food and Drug Administration, and the CDC. That will not only help prevent diseases from spreading and taking lives. It will also power our economy by spurring innovation in vaccines and therapeutics. Second, we should invest generously in global health—through institutions such as WHO, Gavi, and the Global Fund, as well as through direct foreign aid through USAID and the United States President’s Emergency Plan for AIDS Relief. These investments cost very little but advance U.S. national interests more than soldiers and bombs ever can.