Introduction
How do business interests and ideologies shape national and global healthcare policies? This is a perennial question for health policy analysts, and the current large-scale changes in the US health administration provide a real-time laboratory to study it. In the months since the current US administration took office, there has been no shortage of commentary on the administration’s actions on health, both within the US and on a global stage. Commentators have for instance highlighted the likely consequences on women’s health,[1] research on LGBTQ++ issues,[2] global health campaigns,[3] and future pandemics,[4] among many other points of critique. Indeed, a great number of leading health scientists and campaigners have come to the fore to voice the need to protect minority rights and the right to independent scientific research. Yet, the dynamics playing out at present can only be appreciated by understanding the confluence of influences on the current administration’s actions on health institutions. This understanding is also vital to ascertain the possibility that these influence may shape health policy agendas in other parts of the world.[5] Already, we have witnessed similar dynamics around gender rights in parts of Europe,[6] Africa,[7] and elsewhere. In addition, some of the same forces that are influencing the current US administration’s health agenda also extensively fund conservative health movements in other parts of the world.[8]
This paper analyses the confluence of influences that influence the current US administration and the likely effects they have on global health policy and national health policy agendas outside the US. The influence of ultra-conservative Christian nationalist think tanks such as the Heritage Foundation and its Project 2025 manifesto – a 900-page ultra-conservative policy wish list drafted in 2024 [9] – is vital in this context and has been highlighted by previous commentators. While the administration’s chief advisor Elon Musk has been less vocal about health issues, the libertarian ideology he and other tech billionaires represent remains significant, particularly as it is embedded in a global network of influence, power, and social media discourse. In addition, Secretary of the Department of Health and Human Services (HHS), Robert F. Kennedy Jr. brings a well-documented science-sceptic stance to his position.[10] Kennedy’s stance partly overlaps with the ultra-conservative Christian right, as represented in Project 2025, but also aligns with populist trends in other countries that do not necessarily flag themselves as religious.
At face value, these three dominant realms of influence are difficult to reconcile, hence closer scrutiny is in order. On the one hand, Elon Musk, with at least five (out of a reported 14) of his children conceived through IVF[11] and a self-avowed ‘cultural Christian’[12] stance; on the other hand, the Heritage Foundation and its Project 2025 manifesto, which contains a full chapter on how to align US health services with conservative Christian family values, a project that Kennedy supports, but to which he adds a populist science-sceptic flavour.[14] Despite these apparent differences, there are several important overlaps that exist between these positions and that exceed well-document contempt for ‘woke policies’ or ‘junk gender science’.[15] The analysis below is based on Project 2025, and particularly on Chapter 14 of that manifesto, on Kennedy’s presidential campaign speech of August 2024,[16] on a high-profile health conference run by the Heritage Foundation in December 2024,[17] and on various public statements by Elon Musk.
Free science
The first influential pillar upon which the current US health agenda is built is a notion of science freed from government interference and corruption by big business. In Project 2025, the FDA, NIH and CDC are portrayed as inherently corrupt, a fact that is substantiated, in the authors’ account, by private company donations to the agencies and a system of revolving doors between the two sides. Between government corruption and the ‘woke’ agenda, the Project states that the HHS has “lost its way” and singlehandedly contributed to a “precipitous” drop in life expectancies, “with white populations alone losing 7 percent of their expected life span in just one year”.[18] The threat evoked, particularly to ‘white’ populations, is taken as a reason to dismantle the agencies involved and replace current staff with “honest scientists”[19] who can provide “unbiased science studies”[20] to doctors.
Both the Heritage Foundation and Kennedy continuously evoke the spectres of “giant for-profit corporations”[21] that have created the chronic disease crisis, aided and abetted by willingly captured state agencies. In his speech of August 2024, Kennedy mentioned “insidious corruption at the FDA, the NIH, the HHS, and the USDA” as a cause for the “chronic disease epidemic”, as well as for the fact that, according to his speech, “1 in 36 children are now autistic” (scientific sources for these figures are not provided). At the same time, notwithstanding the fact that both Project 2025 and Kennedy seek to weaken regulatory agencies in health, prominently including the FDA, Kennedy has praised the fact that “hundreds” of chemicals in Americans’ foods are banned in Europe.[22] At the Heritage Foundation meeting, the Trump presidency was predicted to usher in a “golden age of science” by getting rid of the current “red tape” that hinders science and prevents America from being healthy.
While Musk has not involved himself heavily in the debate around ‘free science’, he is known to have a strained relationship with the FDA over his brain implant company Neuralink,[24] and a diminution of regulatory agencies fits within his libertarian stance.
Free market choice
A second pillar is the notion of free market choice, that is, a health market unencumbered by government interference. The Covid-19 pandemic is used as the foil upon which government’s control of individuals’ health is projected, and Kennedy’s vaccine scepticism is to be understood in this context. The core of Project 2025’s health policy, as also stated in the Heritage Foundation’s Health Summit of December 18 2024, is to restore patients’ “control of their healthcare” and to entrust the patient-physician dyad to make the right healthcare decisions without government interference. Decision-making, choice, and affordability can be improved through market competition and innovation and by removing regulatory burdens on doctors. Health, in this perspective, would become a purely individual concern. Drastic restrictions of the CDC’s mandates, as well as cuts to the Medicaid and Medicare budgets are justified through this rhetoric of putting choice and responsibility back into patients’ and physicians’ hands; in their words, re-establishing the individual’s “sovereignty” over their own health. The agencies, in this reading, stand in the way of the free market and consumer sovereignty through their alleged links with Big Business, which, for instance, is said to have led to the redaction and suppression of scientific evidence during Covid-19.[25] Alleviating science and regulation from corporate influence, as per pillar one, in this view is a necessary first but not sufficient step toward consumer sovereignty. A vital second step is to free patients from the shackles of third-party payments. The thinking is that once consumers pay for their own health, this consumer sovereignty would in turn further promote free and unbiased science; in the words of a speaker at the December 2024 Heritage health event: “Consumers ought to be paying for the largest part of our healthcare, and they’d be demanding proper evidence.” The freeze on National Institutes of Health grants is to be understood in the context of how suspected ‘woke’ policies and corruption have enabled a class of administrators acting as “super-doctors” to be the sole guardian of the nation’s health research agenda, suppressing consumer choice.[26] In analysing this perceived problem of corruption, however, the marketing pressure that ‘big pharma’ puts on doctors and other aspects of pharmaceutical capture go unmentioned. The discourses also leave unexplained how a push against big business measures up against the financial proximity of the Heritage Foundation, Musk, and Kennedy to large corporations.
Bifurcated Pronatalism
While Musk is generally quieter on health issues than on other topics, the strongest overlap between Project 2025’s chapter 14 and Musk’s libertarianism lies within a pro-natalist stance. This then is the third pillar of the current administration’s health agenda – but this is also where potential ideological clashes may threaten the fragile coalition between the different camps. For Musk, according to a Bloomberg report,[27] declining global fertility rates are “not just a crisis, but the crisis”, a mantra that Musk has repeated in most of his public appearances over the past two years. Having fathered a reported 14 children himself, according to the Bloomberg investigation Musk has also donated US$10 million to the foundation of the Population Wellbeing Initiative at the University of Texas, Austin. In 2023, the director of this institute, Dean Spears, published a New York Times op-ed entitled “The World’s Population May Peak in your Lifetime. What happens next?”.[28] The risk that Spears and Musk see in a population that is being “decimated”, according to a Musk interview at an Italian rally,[29] is one that in his account needs to be tackled through political and economic means, for instance by supporting childbearing women financially, as Victor Orban has done in Hungary. Musk also sees the benefits of reproductive technologies in stemming the population decline – for Musk and Spears, the new eugenics movement and pronatalism are in fact natural companions.
Meanwhile, in keeping with its Christian conservative stance, Project 2025 too identifies strongly with a pronatalist agenda. The Project prominently states that “Nothing less than America’s long-term survival is at stake”.[30] As has been documented,[31] the manifesto puts heavy emphasis on its pro-life position. It highlights the centrality of “stable and flourishing married families”, which are built on the backs of “working fathers”. In keeping with its overall Christian conservative ideology, the Project, however, is much more ambivalent about reproductive technologies than Musk and others who see pronatalism aligned with new eugenics; the Project for instance insists that health policies “should never place the desires of adults over the right of children to be raised by the biological fathers and mothers who conceive them”.[32] The fundamental rejection of embryo destruction in Project 2025 stands in some contrast to the embrace of fertility technologies by Musk, Spears and other libertarian influencers of the Trump administration. Kennedy, meanwhile, reportedly has a rather ambiguous stance toward pro-life issues.[33]
Given the centrality of pro-life issues in Project 2025, could assisted reproduction be the cliff upon which the current health coalition perishes? In an Executive Order on February 15 2025, President Trump ordered to lower barriers to IVF including reducing out-of-pocket costs for treatments, signalling that he sees reproductive technologies as wholly separate from bans on abortion and the research use of embryonic tissues. While this Order may, for now, appease both the libertarian wing of his supporters and the Christian conservative one, it is likely that this is a temporary truce only, with the issue likely to return to the top of the agenda before too long.
Lessons to be drawn
At present, it remains to be seen how the significant lobbying power of large pharmaceutical and medical device firms on the one hand, and health insurance companies on the other, will impact the current US administration’s health agenda. From the above, ‘Big Pharma’ may seek to combat some of the more extreme anti-‘giant corporation’ rhetoric that Project 2025 is based on. Private health insurance companies, meanwhile, are likely to gain considerably from a decimation of Medicare and Medicaid.
Outside the US, the dramatic fallout of the US administration’s withdrawal from the World Health Organization (WHO) and from global health funding through PEPFAR and USAID is felt strongly.[34] In addition, the ideological template that is supporting current dynamics in the US are likely to be replicated in many other countries. The financing of ultra-right forces is ongoing in many parts of the world, and the takeover of digital public opinion has already happened through Musk’s purchase of the social media platform Twitter (now X). As a 2021 EU report finds, the influence of the ultra-conservative Christian right is already palpable in many European countries, and it has made decisive inroads in Africa through concerted funding campaigns; this influence was said to be instrumental for Uganda’s recent restrictions of LGBTQ++ rights.[35] Musk’s influence vastly exceeds the US, both through his outsized power over social media discourses and through his attempts to influence election outcomes in countries such as Germany. Finally, the populist science-sceptic stance represented by Kennedy has gained ground in many regions since the Covid-19 pandemic and is likely to become stronger as the political landscape in many regions further fragments. It behoofs the global health policy community to signal the confluence of these forces where they appear and to highlight its discrepancies and inconsistencies.
References
1 Harman, S. We must fight even harder to protect women’s health in the era of Trump and the global right. BMJ 2025;388:r459. doi: https://doi.org/10.1136/bmj.r253
2 Harman, S. We must fight even harder to protect women’s health in the era of Trump and the global right. BMJ 2025;388:r459. doi: https://doi.org/10.1136/bmj.r253
3 Brown, R.L., Comé, S., Baidoo, J., Latela, M. USAID cuts threaten America’s most successful global health campaign. The Christian Science Monitor, Feb 14.
4 Yamey, G., Titanji, B. K. Withdrawal of the United States from the WHO — How President Trump Is Weakening Public Health. New England Journal of Medicine, March 5 2025, DOI: 10.1056/NEJMp2501790.
5 Datta N. Tip of the iceberg: Religious extremist funders against human rights for sexuality and reproductive health in Europe 2009–2018. European Parliamentary Forum for Sexual and Reproductive Rights 2021 Jun (pp. 2021-06).
6 Indelicato ME, Magalhães Lopes M. Understanding populist far-right anti-immigration and anti-gender stances beyond the paradigm of gender as ‘a symbolic glue’: Giorgia Meloni’s modern motherhood, neo-Catholicism, and reproductive racism. European Journal of Women’s Studies. 2024 Feb;31(1):6-20.
7 Nakweya G. Anti-LGBTQ+ laws in Africa harming health and research. The Lancet. 2024 Apr 6;403(10434):1323-4.
8 McEwen H. The US christian right and pro-family politics in 21st Century africa. Palgrave Macmillan; 2023.
9 The Heritage Foundation. Mandate for Leadership: The Conservative Promise. https://www.project2025.org/
10 Herper, M. In RFK Jr.’s emails to his niece, a trail of vaccine criticism. STAT News, Jan 28, 2025. https://www.statnews.com/2025/01/28/rfk-jr-emails-to-niece-vaccine-criticism-stat-annotates/
11 Moore, S. Elon Musk has welcomed his 14th child – how can any parent thing that’s a good idea? The Telegraph, March 4th 2025. https://www.telegraph.co.uk/news/2025/03/04/how-can-elon-musk-think-a-14th-child-is-a-good-idea/
12 Hills, S. Elon Musk now calls himself a ‘cultural Christian.’ What does that mean? The Christian Science Monitor, Dec 18 2024. https://www.csmonitor.com/USA/Society/2024/1218/elon-musk-cultural-christian-richard-dawkins
14 BBC Verify Team. Fact-checking RFK Jr’s views on health policy. Nov 15 2024. https://www.bbc.com/news/articles/c0mzk2y41zvo
15 See supra note 9, p. 462
16 Robert F. Kennedy Adress to the Nation, August 23 2024. Available in full at https://www.c-span.org/program/campaign-2024/robert-f-kennedy-jr-makes-presidential-campaign-announcement/648143
17 Heritage Foundation Dec. 18 2024 event: Restoring American Wellness: How Can Policy Help Make America Healthy Again? Available to stream here: https://www.heritage.org/public-health/event/restoring-american-wellness-how-can-policy-help-make-america-healthy-again
18 See supra note 9, p. 449
19 See supra note 16
20 See supra note 17
21 See supra note 16
22 See supra note 16
23 McFarling, U.L., Chen, A., Owermohle, S. Growing number of federal health agencies are combing grants for taboo words, unnerving researchers. STAT News Feb 13 2025.
24 Kelly, A. U.S. regulators rejected Elon Musk’s bid to test brain chips in humans, citing safety risks. March 2 2023. https://www.reuters.com/investigates/special-report/neuralink-musk-fda/
25 See supra, note 17
26 The Executive Order entitled Establishing the President’s Make America Healthy Again Commission of Feb 13 is seen as a first concrete step in this direction; it establishes a commission chaired by RFK to assess the “childhood chronic disease crisis” and offer a plan to resolve it in 180 days.
27 Alexander, S., Hull, D. Elon wants you to have more babies. Bloomberg Business Week, June 21 2024.
28 Spears, D. “The World’s Population May Peak in your Lifetime. What happens next?” New York Times Sept 18 2023. https://www.nytimes.com/interactive/2023/09/18/opinion/human-population-global-growth.html
29 Slobodian, Q. Elon Musk wants us to have more children: Demography is the new front line of the culture wars. New Statesman July 26 2024.
30 See supra note 9, p. 449
31 Walsh, J. Project 2025 has bad medicine for HHS. The Nation June 4, 2024. https://www.thenation.com/article/society/project-2025-trump-hhs/
32 See supra note 9, p. 451
33 Messerly, M., Cancryn, A. Project 2025 author rejected for top health position. Politico News, Nov 21 2024. https://www.politico.com/news/2024/11/21/project-2025-author-rejected-for-top-health-position-00190887
34 Buse, K., Gostin, L., Kamarulzaman, A., McKee, M. The US withdrawal from the WHO: a global health crisis in the making. BMJ 2025;388:r116 http://doi.org/10.1136/bmj.r116
35 See supra note 5