In Zambia’s Copperbelt, a 37-year-old security guard named Saulo Kasekela died of AIDS on 7 March at a mission hospital in Mpongwe, his lungs destroyed by tuberculosis after he lost access to antiretroviral medication. He was one of an estimated 100,000 Zambians who stopped taking HIV treatment after U.S. PEPFAR funding was frozen in January 2025.
Modelling studies estimate the disruptions caused more than 120,000 deaths across sub-Saharan Africa by November 2025, including more than 13,000 children. In April, the State Department warned Zambia it would lose all remaining HIV funding unless it signed a minerals access agreement by 30 April. The memo prepared for Secretary of State Marco Rubio stated that Washington would only secure its priorities by demonstrating “willingness to publicly take support away from Zambia on a massive scale.“
That is one end of what Trump’s health politics now looks like in practice. Healthcare debates around Trump are often framed as domestic arguments about insurance or federal power. They are not domestic anymore.
Europe’s Price Model Under Pressure
Belgium’s Deputy Prime Minister Frank Vandenbroucke put the European version of the problem plainly at a Labour Day event in Leuven on 1 May.
He said the Trump administration wants to dismantle Europe’s medicines and health insurance model by pushing for higher drug prices and undermining collective reimbursement systems. “He is not merely an opponent of Europe,” Vandenbroucke said of Trump. “He hates the welfare states we have built here.” In February he went further, telling VRT that the U.S. is acting “not as an ally, but as an adversary” on medicines.
Trump has signed an executive order directing the Department of Health and Human Services to establish a Most-Favoured-Nation pricing mechanism, pushing other wealthy countries to pay more for medicines so that U.S. prices can fall. If Washington succeeds, the result will land directly in European reimbursement budgets and in the political struggle over who still gets treated on equal terms.
The Burden Falls Unevenly
When American policy turns conditional or erratic, the damage does not spread evenly.
Wealthier systems can absorb shocks for longer, even if they complain loudly. Poorer systems cannot. Beyond Zambia, PEPFAR cuts have closed 32 wellness centres serving over 20,000 HIV-positive people, eliminated index testing that previously identified 70 per cent of all new infections, and left pregnant women with HIV tested only once during pregnancy rather than three times. These are not administrative inconveniences. They are the structural conditions under which people die.
That hierarchy matters for Europe too. Belgium and its neighbours face pricing pressure and trade threats. But the consequences of losing that argument are measured in reimbursement rows and budget lines. In Zambia, they are measured in chest X-rays and empty wards. The political fight is the same one. The stakes are not.
War Turns Supply Chains Into Health Risks
The Iran war adds another layer.
The conflict has disrupted pharmaceutical air routes through Gulf hubs including Dubai and Doha, threatening cold-chain deliveries for cancer medicines and temperature-sensitive drugs. India’s pharmaceutical sector, which supplies roughly 20 per cent of global generic drug volumes, is absorbing higher freight and energy costs that do not stay in one region. They move through the entire global medicines system.
American pressure on European pricing, fragility in global health aid, and war-disrupted medicine routes all point to the same reality. Healthcare now depends on geopolitical stability more than most politicians admit. Trump did not create that vulnerability. He is making it considerably harder to manage.
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