The Consequences of US Retreat From the Global Health Security Leadership.

Upon the commencement of their second term in 2025, the Trump Administration initiated significant policy shifts within health security, driven by an "America First" agenda. This marks a notable departure from the United States' long-standing role as a central and influential leader in global health security. Historically, the US has championed this domain through substantial financial contributions, the sharing of critical technical expertise, and the establishment and support of numerous international health initiatives. This leadership was underpinned by a bipartisan consensus that recognized global health as integral to American values, enhancing its soft power and global standing. Decades of this commitment yielded tangible progress in controlling infectious diseases, strengthening health systems in low- and middle-income countries (LMICs), and fostering essential international cooperation. However, this recent pivot in US policy carries profound implications for the established global health architecture. It is generating a cascade of both tangible and intangible consequences across various health security domains, including funding mechanisms, global health governance, preparedness and response capabilities, outcomes in LMICs, science diplomacy, US soft power, and ultimately, US national security. Given the inherent difficulty in predicting the next pandemic, global solidarity and collective international efforts are paramount. In this, effective prevention and management demand proactive, multidisciplinary preparations worldwide where continued US support and leadership through increased investment in surveillance networks, strengthened international collaboration, and data-driven decisionmaking are instrumental. There is an urgent need for prioritizing global health leadership and ensuring sensible health security policies that reverse the systematic dismantling of established public health infrastructure.