01 Feb 2021

Major Shifts in US Policy Foreseen, But Challenges Remain

Professor Donald Donahue, Professor of Healthcare Administration and Global Health, University of Maryland, Baltimore

Professor Donald Donahue, Professor of Healthcare Administration and Global Health, University of Maryland, BaltimoreThe transition of administrations is a hallmark of stable nations. It is not uncommon that priorities and policies shift with the change of governments. Sometimes these shifts are minor. At other times, the changes are tectonic.

The arrival of the Biden-Harris administration in the United States on 20 January will assuredly result in the latter.

Since 2016, the U.S. Government has pursued a policy of America First.  This has included withdrawal – either formal or functional – from multi- and bilateral relationships and commitments. 

Humanitarian program budgets were cut and key communications staff such as editors at Voice of America let go. 

Based on his campaign platform and his eight year record as Obama’s vice president, President Biden can be expected to pursue a more expansive and inclusive approach to international relations and humanitarian efforts. 

This will likely include:

  • reengagement with the Paris Agreement on climate,

  • revival of Global Health Security Agenda activities,

  • cessation of withdrawal from the World Health Organization, and

  • a revitalization of development and assistance programs across USAID, Millennium Challenge Corporation, HHS, DoD, and other agencies.

Although significant, these restored priorities will not, however, presage a golden age of humanitarian largess.  There will remain many conflicting demands – some immediate and others more long term – that will constrain humanitarian initiatives.


The instant issue facing the Biden administration is the COVID-19 pandemic.  As this is being published, the numbers of hospital admissions and deaths contributed to by COVID-19 continue to increase.  This is not only the direct impact of COVID-19 or of complication of COVID-19 (i.e. exacerbation of underlying conditions), but also people suffering from other conditions who cannot access otherwise occupied hospital beds.  Hospitals have implemented crisis care standards and emergency medical services systems have placed limitations on who may be transported to hospital.

Despite the historically rapid development of several vaccines (based in part on decades of prior research), the rate of administration within the United States has lagged substantially behind initial governmental projections.  The stated goal of 100 million vaccinations within the first 100 days will take a monumental effort that will likely eclipse other initiatives.


After “catching up” on domestic vaccinations, the Biden White House may turn to extending that coverage internationally.  Challenges to affordability, distribution, equity of access, and administration will be considerable.  So, too, will be the task of overcoming suspicion and anti-vaccination misinformation. 


These challenges – daunting in the best of times – will be increased by the need for economic recovery.  The pandemic has almost universally undermined nations’ economies and inflicted grievous harm on wide swaths of populations.  The need to balance medical and public health imperatives with restoring economic stability remains a necessity poorly addressed priority in much of the world.

The winds of change can be strong.  The Biden presidency will start with Democratic Party control of the US Senate and House of Representatives.  This will make pursuit of the administration’s agenda easier.  But it will not ensure anything.  The Senate is evenly split between the two parties, 50-50.  Under the US Constitution, Vice President Harris becomes the tiebreaker in any stalemated legislation.  While this gives an advantage to the Democratic camp, it does not create an easy pathway for legislation.  Bipartisanship will still be required on many fronts and internal divisions within the parties can complicate negotiations. 


Democrats retained a majority of the House, but lost ground as Republicans picked up multiple seats and the Biden transition team identified three sitting Democratic members for cabinet level appointments, portending a near equal 219 (D) to 212 (R) split. 


Irrespective of the speed of an economic recovery, the US federal government will have to address severe budgetary issues.  The national debt (the total debt, or unpaid borrowed funds, carried by the federal government of the United States measured as the face value of the currently outstanding Treasury securities that have been issued by the Treasury and other federal government agencies) at the beginning of 2016 was $18.2 trillion, equal to the total US Gross Domestic Product (GPD).  Halfway through 2020, the debt had grown to $27 trillion, 136 percent of GDP. 


Changing fiscal policies, growing demands (e.g., an increasing aging population eligible for Social Security and Medicare benefits), reduced revenues due to changed tax laws and unemployment, and unanticipated expenditures (e.g., economic stimulus packages) will compete for limited dollars that might otherwise be invested toward humanitarian pursuits.


This precariousness can be exacerbated by natural disaster (both sudden and gradual, as in drought and famine), disease outbreak, and conflict.  The world may expect more generous intent from the Biden administration, but it will not, by any means, be easier to meet needs.


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