Antibiotic Resistance and Political Influence on Global Health Research

Narrative

Politically, "resistance is futile", or so it would seem so far. Therefore, this piece is about antibiotic resistance (AR), and how the Trump/Kennedy Jr.'s alternate reality on social and health issues would likely impact it and the research aimed at better understanding it, both in the US and worldwide. AR is, to put it in a single line of text, the acquired ability of bacteria to survive in the presence of antibiotics that should have killed them. When resistant bacteria causes an infection, an antibiotic treatment intended to cure the disease would fail, putting the life of the patient at risk. AR has been recognized as a major health threat worldwide, killing about 1.14 million people per year (1). As our understanding of AR is itself experiencing a shift (2), the change of winds in the US can stall the transition into a better understanding of AR and the designing of new strategies that may actually help harness this public health threat.

That the Trump administration is dismantling the scientific apparatus of the US is no secret—a very peculiar way to "make America great again". This can be seen in the dramatic budgetary cuts to all domains of science (3); but also in the continuous pounding against universities, and the ubiquitous xenophobia affecting foreign students and perhaps even conference attendants. The consequences of this policy are hard to imagine, both nationally and globally; although the precise effect upon AR research cannot be stated at this time, it is rather obvious that it will be hit along all other areas of biomedical science, especially those dealing with infectious diseases (4). The cancellation and no further rescheduling of the President's Advisory Council on Combating Antibiotic Resistant Bacteria meeting, that was due in late January 2025 to develop the 2025-2030 National Action Plan for Combating Antibiotic Resistant Bacteria, reveals that AR is not among the health priorities of this administration. But this is not the only problem that AR research is facing.

"Antibiotics are societal drugs", said Stuart Levy in 1997 (5), alluding to the impact of AR upon society, perhaps larger than the individual impact of successful antibiotic therapies. But the phrase is also true in the opposite direction: society influences the efficacy of antibiotics, as we are now learning. Socioeconomic factors, from gross national income, to health expenditure and infrastructure, to corruption, are all more closely linked to AR prevalence than the clinical use of antibiotics. This goes contrary to the common notion that AR is mainly driven by antibiotic usage and that by curbing the use (and misuse), AR should also be controlled (6). Therefore, we are in the midst of a transition, from AR mitigation strategies centered on "antibiotic stewardship" in clinical practice; into integrative, One Health approaches, that are greatly in need of new research to guide them. The World Health Organization (WHO), and the UN itself, are slowly making this shift, as can be seen in recent documents (6). But this requires new research to delve into concepts that have now been banned from the US official vocabulary: "disparity", "inequalities", "socioeconomic"... even "climate change"; all these have a deep impact on AR, but cannot be mentioned in government documents—and are unlikely to get funds for conducting research. Even gender plays a role in AR (7), but banning also DEI (Diversity, Equity and Inclusion) notions would further hinder research on this topic. All in all, most of the studies assessing socioeconomic drivers of AR does not come from the US: of 14 recent papers included in a recent systematic review on the subject (2), only two have a co-author (the same one) from the US. Nevertheless, by further discouraging research on these issues, it seems clear that the US is not likely to become involved in what could very well be our last chance to mitigate AR.

However, the damage may not be only to research on AR, but to the problem itself. By cancelling financial aid to poor countries, especially the one aimed at improving healthcare access and infrastructure, and diminishing poverty, the very conditions that we are now learning are the most closely related to AR will get worse, and so will AR itself. Also, while the US has a long history of causing or enabling wars that increase poverty and destroy healthcare infrastructure, this trend has only escalated under Trump, both in Europe and the Middle East. In both cases, a link between such wars and increased AR has been documented (8, 9). As war is also being brought to Latin America, AR is likely to increase there too. Finally, even within the US, by aggravating disparity, reducing healthcare access, and perhaps even increasing corruption, the "big beautiful bill" is creating conditions that have proved to be strongly correlated to AR, even in high income countries (10). The latter goes directly against the "America first" motto; but the former does too, as resistant microbes do not know of borders or walls, and will get into the US within migrants, wounded soldiers (11), and even foodstuff.

Then there is the vaccine issue. There are no vaccines against the most pressing resistant bacterial pathogens; therefore, it would seem like the otherwise unconscionable attack on vaccines and vaccination programs fostered by Kennedy Jr. would nevertheless have no impact on AR. However, the role of vaccines in preventing infections that could lead to secondary illnesses caused by resistant bacteria, and to unnecessary use of antibiotics, has been acknowledged. It has been calculated, for instance, that vaccines could reduce the use of antibiotics by 2.5 billion doses per year, a 22% decrease (12). Furthermore, there are several vaccine candidates targeting multi-resistant bacteria, that could potentially prevent infections caused by these microbes, a much better approach than curing the diseases.

However, if the vaccine research field perceives that the vaccinophobia keeps growing, now with the open support of the Department of Health and Human Services (and spreading beyond the US), all those research efforts could slow down hoping for better times for business.

But vaccines are not the only quarrel that Trump/Kennedy Jr. have against pharmaceutical companies. Perhaps it is because Big Pharma is such an easy populist target, after so many years of unwarranted high prices and many other kinds of abuse. However, pharmaceutical companies still are the main source of research and development of new drugs, including antibiotics; and new antibiotics, despite many efforts to find other options, are still the best bet at tackling AR. Affecting the pharmaceutical agenda could potentially push companies farther away from the antibiotics field, already perceived as "bad business" (13), diminishing the already thin pipeline of new antibiotics.

The combination of misinformation peddled by Trump and Kennedy is already causing AR problems: the concomitant abuse of azithromycin during the COVID-19 pandemic, and the diminishing rates of pertussis vaccination, have been linked to an increased prevalence of macrolide resistance in Bordetella pertussis (14). In the end, perhaps it is good that Trump got the US out of the WHO—and I mean it for the rest of the world. Because had the US remained in the WHO, it could try to impose its bizarre health agenda upon this international organization, jeopardizing interventions and research on crucial issues pertaining AR. But now, albeit without the monies coming from the US, but also free of the negative influence, the WHO could act in the better interest of the rest of the world. Then, only time would tell if the US catches on, when (if) it awakens from the delusion.

References

1. GBD2021 Antimicrobial Resistance Collaborators, Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050 Lancet 404, 1199-1226 (2024).

2. C. F. Amábile-Cuevas, S. Lund-Zaina, Non-canonical aspects of antibiotics and antibiotic resistance Antibiotics 13, 565 (2024).

3. A. Bhatia, I. Cabreros, A. Elkeurti, E. Singer, Trump has cut science funding to its lowest level in decades NY Times May 22, 2025).

4. Science News Staff, Trump's proposed budget details drastic cuts to biomedical research and global health Science www.science.org/content/article/trump-s-proposed-budget-details-dramatic-cuts-biomedical-research-and-global-health, 2025).

5. S. B. Levy, Antibiotic resistance: an ecological imbalance Ciba Found. Symp. 207, 1-9 (1997).

6. C. F. Amábile-Cuevas, Antibiotic stewardship: what for? Front. Antibiot. 4, 1680329 (2025).

7. D. Batheja, V. Saint, Z. Dobreva, S. Goel, S. Lewycka, E. Mutua, S. Nayiga, S. Paulin-Deschenaux, S. J. Simpson, R. Steege, E. Westwood, E. Charani, M. Mpundu, A. Balachandran, Integrating gender and equity commintments in the revised global action plan on antimicrobial resistance Lancet 406, 1200-1203 (2025).

8. G. Granata, E. Petersen, A. Capone, D. Donati, B. Andriolo, M. Gross, S. Cicalini, N. Petrosillo, The impact of armed conflict on the development and global spread of antibiotic resistance: a systematic review Clin. Microbiol. Infect. 30, 858-865 (2024).

9. K. Moussally, G. Abu-Sittah, F. Gordillo Gomez, A. Abou Fayad, A. Farra, Antimicrobial resistance in the ongoing Gaza war: a silent threat Lancet 402, 1972-1973 (2023).

10. A. Ghataure, E. L. Gilham, E. Casale, E. J. Harvey, C. De Brún, V. Finistrella, D. Ashiru-Oredope, Association of factors linked to health inequalities and the risk of antibiotic-resistant infection in high-income countries: a systematic scoping review JAC Antimicrob. Resist. doi.org/10.1093/jacamr/diaf1190 (2025).

11. S. J. C. Pallett, S. E. Boyd, M. K. O'Shea, J. Martin, D. R. Jenkins, E. J. Hutley, The contribution of human conflict to the development of antimicrobial resistance Commun. Med. 3, 153 (2023).

12. T. Jesudason, Impact of vaccines in reducing antimicrobial resistance Lancet Microbe 6, 101040 (2025).

13. C. F. Amábile-Cuevas, Society must seize control of the antibiotics crisis Nature 533, 439 (2016).

14. PAHO, PAHO calls for strengthened vaccination and surveillance amid the spread of antibiotic-resistant pertussis in the Americas www.paho.org/en/news/26-8-2025-paho-calls-strengthened-vaccination-and-surveillance-amid-spread-antibiotic 2025).