Harbinger of Apocalypse
Elucidating Global Healthcare Pitfalls in Trump’s Policies
by Chester Leangee Datoon
Amidst the technological advancements in the global healthcare industry, it is irrefutable that these changes are mostly reserved for the Western elites. From changes in vaccine development to formulating novel drugs for emerging and chronic conditions, developed countries have monopolized these services, leaving countries in the East and Global South to depend on supply.
Hence, the January 2025 memorandum of US president Donald J. Trump concerning the stop work order on the United States Agency for International Development (USAID) in supplying certain pharmaceutical products threatened the global supply of antiretrovirals for Human Immunodeficiency Virus (HIV) and antimycobacterial for Tuberculosis.
Diseases that were considered ‘death sentences’ before are poised to reemerge simply because of the upcoming supply issues. Patients who have already contracted HIV would be faced with a double-edged dilemma — difficulty in procuring life-saving medications as well as an onslaught of snide remarks rooted in homophobia.
While it might seem like the decision of one president should not affect everyone, in the grand scheme of global healthcare, it elucidates an unseen yet inevitable problem — that, in the seemingly forward-moving industry lies a deteriorated supply chain.
Pestilence: Laying the Roots of Crisis
The absence of a quality and fully functioning healthcare and pharmaceutical manufacturing industry in our country had its roots in colonialism. Under the guise of providing better and more accessible healthcare services, the Spanish Galleon Trade transported medicinals from Acapulco to Manila, marking the transition from crude drug preparations to herbs to foreign importation of prepared finished products. Through the combined endeavors of importation dependency and exclusion of folk and local medicine, foreigners have crippled numerous countries into possibly establishing their own local drug manufacturing industries.
As the age of colonization ended, countries like the Philippines never truly recovered. While galleon ships have long been discontinued due to obsolescence, cargo ships and airplanes became their modern counterparts. Though foreigners who usurped the land have long fled the country, the ever-imperialist US siphons endeavors of local manufacturing through intensified lobbying of intellectual property regulations and trade agreements that discourage the Philippines from imposing higher tariffs. Notably, Filipino ruling elites served as their puppets — successfully monopolizing the trade and distribution of imported pharmaceuticals to the country.
The hierarchical nature of the global drug supply sheds light on the persisting feudalistic tendencies of society. Rather than advocating for measures that ensure self-sufficiency in local drug manufacturing and interdependence, Western countries tend to hoard equipment, knowledge, and skills as this would be cost-efficient and income-generating to them. In turn, the elites of developing countries, ever-adamant in emanating the wealthy life of the Westerners, morph into insatiable middlemen, driving the prices of medicines higher and higher to attain lavishness.
Thus, the wealthy elites that control the global supply chain are akin to pests that perpetuate imbalance in the world, profiting from the hard-earned money of patients and the poor.
War: A System Built on Exploitation
Nonetheless, beyond import dependence, the issue of biopiracy remains. One classical example is the case of Ilosone or Ilomycin, the innovator brand for the antimicrobial Erythromycin that was isolated in the country. While its discovery would have been difficult had it not been sent to America with far better equipment, the action of the pharmaceutical company to completely erase Aguilar’s roots in the development process highlights that even if countries today seldomly colonize, Western powers could still stifle the growth of other countries through intellectual piracy.
Erythromycin is just a tiny speck in the dunes of biopiracy in the pharmaceutical industry — foreigners perpetually exploit the endemic flora and fauna of the East and Global South to further their hold in the global supply chain. When groundbreaking discoveries are made, patents are filed immediately to stake their claim early, leaving these countries taken advantage of. Medicines that could have been locally produced are made impossible due to this prevailing patenting system.
Beyond this issue, the seeping influence of the West is evident in developing countries. In the case of the Philippines, financing research & development and optimizing resource use for drug manufacturing is never seen as a priority compared to excessive importation of products. Furthermore, through scholarships, opportunities, and salaries equivalent to the country’s annual wage, local scientists and researchers go to other countries just to obtain the humane treatment withheld from them in their motherland.
At its core, pharmaceutical goods imported into the country are built from local natural resources by hands that bleed Filipino. In the end, those same toiled hands pay almost twice the price for finished pharmaceutical products, due to distributor and middlemen charges.
The age of war has never truly ended; rather, it has morphed into intangible forms that hinder the progress of developing countries.
Famine: All for the Money
Elementary economics talks about the inevitability of scarcity; finite resources amid soaring demands necessitate people to prioritize or make wise and beneficial policies. Yet, the very meaning of scarcity has been distorted by multibillion-dollar pharmaceutical companies imposing exorbitant prices on patented drugs under the guise of ‘covering research costs.’ In reality, most of their finances are used to further dubious practices in the drug development industry.
Under the candle of novel drug discovery lies the shadow of research data falsification. As multibillion-dollar companies fund research sinkholes — instead of shutting down studies with little positive results — companies disguise them to be more appealing and noteworthy. Of the numerous drugs available today, some have penetrated the market where they should not have, and big pharmaceutical companies typically offer money to continue to mask the identity of these drugs. From funding patient groups to research fabrication, the business model of most pharmaceutical companies keeps up their pretense of ‘martyrdom’ amidst doing financial and physical damage to patients.
In the Philippine context, practices of harming patients, whether financially or physically, are present and unfortunately thriving. Last 2024, the issue of Bell Kenz Pharmaceuticals alleged commission of doctors to prescribe medicines from their brand for extra income was brought into the senate. This form of healthcare professional and pharmaceutical company relationship threatens patient and medication safety by wholly removing the critical role of pharmacists in rational drug use. Patients bear the brunt of being prescribed medicines that they may not need all for the sake of money.
In relation to this, the bureaucratic and centralized nature of the Philippine pharmaceutical supply chain remains one of the primary reasons why out-of-pocket spending is frequent among Filipino patients. Though policies like the Mandanas-Garcia ruling equip local government units to readily procure medicine, measures to effectively forecast and procure medicine are absent. With the lack of capacity to procure drugs for themselves as well as poor communication between government healthcare entities, it does not come as a surprise that numerous medicines expire in warehouses due to poor distribution and use.
Pharmacy practitioners have claimed that they have entered a paradigm shift — from product-centered to patient-centered. However, the entirety of the healthcare and pharmaceutical industry still glorifies and places money and income at the forefront. It begs the question of whether the scarcity of medicines that patients bear the brunt daily is natural or synthetic.
The impoverished and marginalized suffer famine in the form of scarcity solely because of poor resource allocation. So long as pharmaceutical and healthcare companies do it all for the money, service users and grassroots healthcare professionals will continue to remain in agony — breaking their backs day and night for a scarcity that should not have been.
Death: A Chronicle Foretold
Given all these societal factors, it comes as no surprise that Trump’s recent memorandum sets the fight against HIV and Tuberculosis one major step backward. With the US funding one-fifth of the annual budget of the World Health Organization as well as spearheading the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), developing countries in the Global South and the East heavily rely on these initiatives for antiretroviral and antimycobacterial medications.
As Trump strives to shut down these programs, patients coming from poor countries would have to pay more in order to live and survive. Non-governmental organizations (NGOs) that advocate for this issue and offer free services also find it more difficult to sustain their programs, forcing patients to subscribe to expensive medications that may impact their adherence to their medication regimen. Through this phenomenon, it is not impossible for mortality cases of diseases affected by Trump’s stop work order to rise simply because of his irrational and American-centric policy.
Beyond the issue of supply and demand, peering through the lives of HIV patients highlights that Trump’s actions threaten their right to life. For the Philippines, which is considered one of the countries with the fastest-growing HIV epidemics, the US president’s action serves as a ‘gotcha’ moment for the conservative and religious Filipinos who still think of HIV as Gay Related Immune Deficiency (GRID). In a country where reproductive and sexual health discussions suffer heavily simply because of being labeled as taboo, old and new HIV patients would inevitably cling to the shadows and never test themselves out of fear. This leads to a disease progression from a manageable one to an unmanageable one.
Thus, while conservative individuals see Trump’s action as noteworthy as it also brings up the defective US President’s Emergency Plan for AIDS Relief (PEPFAR) policy, it is irrefutable that this initiative has saved and is saving countless lives. Beneath the issue of medicine supply championed by Trump is a blatant case of racism, homophobia, and disregard for humanity. His actions echo the sentiments of superiority with disregard for others — patients would now have to fight for the limited supply just to make their every day easier. It becomes a greater issue as local governments of developing countries seldom bat an eye on healthcare issues, prioritizing their monopoly and staying in the seat of power instead of the betterment of their countrymen.
While they say that death comes for all, it does not mean that easily preventable deaths should be disregarded. The paper that contains Trump’s memorandum does not simply stop pharmaceutical manufacturing workers — it also kills the lives of numerous patients. Within the disregarded problem of the global supply chain, Trump’s actions have chronicled and heralded the apocalypse once more.
Resisting the Apocalypse
Only a few know whether Trump will rescind the policies that he implemented since he started his second time in the White House. Still, his inhumane policies elucidate the need to address the long-persisting issue within the global pharmaceutical supply chain as well as how society views HIV patients. As patients continuously contract diseases, demand for medicine will always be present. Whether one resides in a developing or developed country, prioritizing accessible, sustainable, and equitable healthcare should become the primary goal.
Given Trump’s American-centered policies, it is the optimal time for the Philippines to invest in local drug manufacturing. Through better resource allocation for research and development and optimization of the entire process from raw goods processing to finished products quality control, a self-sufficient Philippine pharmaceutical company is realized that can weather global medicine shortages. It is through these initiatives that the country will slowly be free from being import-dependent.
The apocalypse of HIV and tuberculosis will dawn once more so long as these diseases are treated with stigma and medication supply are threatened. However, one could weather this impending doom albeit difficult — the need to inculcate the importance of medicine and healthcare shall serve as the panacea brought by the harbinger of such apocalypse.
