Will Trump’s “America First” Moves Make the World Sicker?
Donald Trump’s new crusade against “foreign pharma freeloaders” looks, on the surface, like classic populist theater: punish overseas drug makers, bring production home, and finally make medicines cheaper for American patients. The more profound impact could simply make a lot of people succumb to illness.
Underneath the slogans, the policy mix taking shape in Washington — tariff threats on imported medicines and ingredients, “national security” investigations into foreign pharmaceutical supply, and a hard push to squeeze lower prices out of Europe and Asia — risks doing the opposite: driving up costs, destabilizing supply chains, and exporting instability into already fragile health systems abroad. For the rest of the world, especially the Global South, this isn’t a story about one country’s domestic politics. It is about the weaponization of health.
The justification for Trump’s pressure campaign is not invented. American patients pay more than anyone else for the same pills. A 2024 RAND Corporation comparison found that U.S. prices for brand-name prescription drugs were nearly three times higher than in 33 other wealthy countries. This is the legacy of decades of deregulation, aggressive patent protections, and a political system that allowed Big Pharma to write the rules.
Instead of tackling the obvious causes — monopoly patents, lobbying power, and a fragmented insurance system — Washington is reaching for a more straightforward narrative: foreigners are “cheating” America by selling cheaply at home while overcharging in the U.S. Trump’s “Most Favored Nation” pricing order already tries to tie what Medicare pays to the lowest price in comparable countries. Pharma lobbies warn they will simply shift the burden onto those same countries by delaying launches or demanding higher prices in Europe and elsewhere to protect their U.S. profit margins.
Layer on top of this the threat of tariffs on imported drugs and ingredients, framed as a “national security” measure to reduce dependence on China, India, and the EU. That is where the global damage truly begins.
The Medicinal Backfire
Medicines are not like cars or steel. Modern pharmaceutical supply chains are deeply integrated and global. Roughly 80–90% of the active pharmaceutical ingredients (APIs) used in U.S. medicines are produced abroad, particularly in China, India, and the EU. Many life-saving drugs —including cancer treatments, antibiotics, and insulin analogues — are manufactured in only a handful of specialized facilities worldwide. So, slapping tariffs on “foreign” pharmaceuticals sounds tough on television, but in practice, it means:
- Higher costs for U.S. hospitals and pharmacies will be passed on to patients and insurers. Any domestic production boom will take years and billions in investment; the tariffs bite immediately.
- Disrupted supply chains when companies re-route production to dodge tariffs or wait for clarity. That means shortages, rationing, and delays in approving generics.
- Less capacity for export to poorer countries, because the same plants that supply the U.S. also serve Latin America, Africa, and parts of Asia. If manufacturers must absorb tariffs or rebuild factories, they will likely prioritize protecting high-margin markets first.
In other words, the policy that claims to make “America healthier” risks making everyone, including Americans, more vulnerable to the next pandemic or drug shortage.
Pay More — Wait Longer
European governments, already accused by Trump of “freeloading” on American R&D, are the first apparent collateral damage. If U.S. law forces drug prices down toward the lowest European levels and Washington simultaneously threatens tariffs unless companies move production to American soil, industry has two basic strategies:
- Raise prices or slow approvals in Europe to maintain the U.S. reference price at a higher level.
- Shift new launches away from smaller, poorer markets, where margins are thin and bargaining power is weak.
Analysts already warn that firms are delaying the introduction of innovative medicines in Eastern and Southern Europe for precisely this reason. What begins as a battle between Washington and Big Pharma is quickly felt by a cancer patient in Bulgaria or a diabetic in Portugal waiting an extra year for a therapy that already exists.
For the Global South, where budgets are tighter and dependence on imported drugs is almost total, the effect is blunter: fewer affordable options and more extended periods under old, less effective treatments.
The Pharmaceutical Industrial Complex
The U.S. Commerce Department’s investigation into pharmaceutical imports justifies tariffs as a national security necessity. In reality, this is industrial policy — an attempt to drag high-value manufacturing back inside U.S. borders. Every country has the right to protect critical sectors. Russia and China have both learned, under sanctions, the importance of domestic vaccine and drug capacity. But there is a difference between building redundancy and using tariffs as a bludgeon against the rest of the world.
Because the U.S. still accounts for around 40% of global pharmaceutical spending, its pricing and trade policies set the tone for the rest of the world. When Washington weaponizes market access, it forces other states to respond — either by paying more, accepting shortages, or building their own alternative supply networks.
The Multipolar Health Order
Here, ironically, is where Russia, China, and the emerging BRICS bloc see an opportunity. If U.S. pharma policy becomes openly protectionist and unpredictable, countries in Africa, Latin America, and Asia will seek more reliable partners to secure vaccines, antibiotics, and medicines for chronic diseases.
Russia already has a capable vaccine industry and a growing base of generic drugs. China and India dominate the APIs and generic manufacturing sectors. Together with other partners, such as Brazil, Iran, and South Africa, they could build a parallel ecosystem of affordable medicines, less vulnerable to U.S. tariffs and sanctions. For that to happen credibly, Moscow and its partners must avoid repeating Western mistakes. This means focusing on open tech transfer, transparent pricing, and building regional production hubs.
If done right, Trump’s “America First” move could accelerate a multipolar pharmaceutical order where no one state — not even the United States — can decide who gets medicine and at what price.
Health as Collateral Damage
From the standpoint of ordinary patients, the short-term picture is bleak. Americans will still live in the world’s most expensive drug market; tariffs rarely make monopolies gentler. Europeans will see more pressure on their public health systems. And in the Global South, people who already struggle to access basic oncology drugs or advanced antibiotics may find them drifting even further out of reach.
The tragedy is that there are rational ways to lower prices and secure supply: compulsory licensing to break abusive patents, coordinated purchasing in regional blocs, public funding for key generic plants, and strict transparency over R&D costs. Instead, Washington has chosen a theatrical trade war – one that treats medicines as just another weapon in a larger geopolitical contest.
If Trump’s pharma tariffs and pricing edicts go forward in their current spirit, they will not only fail to cure America’s sick health-care system. They may, quite literally, make the world a sicker place.
Author's note: This report was published on New Eastern Outlook