The most consequential election

There has never been an election—or probably any single national event—of greater global moment than the impending US election. This could hardly be more evident than from the perspective of planetary health.  If Trump is returned to the White House for another four years and the Republican Party retains control of the US Senate, the prospects for reducing the growing danger of nuclear war appears bleak; and the decisive turn towards a low carbon future within the narrow time window needed to have any chance of keeping global temperature rise below 2°C will also be very much more difficult, if not impossible, to achieve.

On most health policies and those on the social, economic and environmental determinants of health, the past four years in the United States have seen major steps backward. Disregarding of scientific and medical evidence and expertise has had severe impacts not only for Americans, but people worldwide. Ongoing lack of effective national coordination and leadership in addressing the COVID-19 crisis has seen the US with almost 9,000,000 cases and 230,000 deaths – both the largest of any nation, and still accelerating. The nation with the most powerful military on Earth was unable to provide even the most basic personal protective equipment to health care professionals and the public. We have witnessed pressure to suppress COVID-19 testing and surveillance. Globally respected health agencies like the Centres for Disease Control and Prevention and the Food and Drug Administration have been pressured, manipulated and interfered with for sordid political motives inimical to health. 

Bad leadership can come through acts of commission as well as acts of omission. This administration has excelled in both. It is responsible for an estimated over 100,000 deaths from COVID-19 which could readily have been prevented. To make matters worse, there has been an epidemic of misinformation. The Washington Post reported on 22 October that in the final weeks of the election campaign, Trump’s false or misleading claims have exceeded 50 per day, and are likely to reach over 25,000 during his term by election day.

Beyond US borders, consonant with Trump’s personal boasting of sexual assault of women, the administration has worked to limit access to safe abortion and undermine sexual and reproductive health rights. In the midst of the worst global pandemic in a century, Trump has callously irresponsibly taken the unprecedented step of preparing to withdraw from WHO.  

Agencies for social and environmental protection like the Environment Protection Agency have been gutted, their mandate subverted. Decades of hard-won controls on and limits on harmful exposures have been wound back, such as controls on lead emissions, and mercury and other toxic substances emitted from fossil fuel power plants. Recent limited gains in equitable access to health insurance and health care are being reversed. Scapegoating of diverse cultural and immigrant communities has underpinned brutal separations of refugee families and severe trauma to their children. Promotion of gun ownership and incitement to violence have seen gun massacres increase and presidential encouragement of violent extremist groups and plans to attack and kidnap the Michigan and Virginia governors.

Trump was the first individual, within weeks of coming to office, to influence personally the moving forward of the hands of the Doomsday Clock in 2017. During his tenure, the hands have been moved forward progressively to now 100 seconds to midnight, as far forward as they have ever been. The Trump administration has been responsible for the demise of the INF Treaty, the signature agreement marking the end of the first Cold War; has abandoned the Open Skies Treaty; and has walked away from the Iran nuclear deal, the best chance of containing any danger of nuclear weapons proliferation by Iran. 

Trump’s strong indication he does not want to unconditionally extend the New START Treaty as the Russians have offered to do, when it expires on 5 February 2021, if carried out, would mean that for the first time since 1972, a complete lack of treaty constraints on US and Russian nuclear arsenals, cementing a resurgent Cold War. Trump has initiated no new negotiations to replace, let alone build on, what he has destroyed.

Always the most active of the nine nuclear-armed states in seeking to oppose and undermine the Treaty on the Prohibition of Nuclear Weapons, the administration has recently taken the extraordinary step of admonishing governments that have signed and ratified the treaty to withdraw from it. 

At the same time, the administration has made explicit nuclear threats in violation of the UN Charter; escalated further astronomical military spending, including spending on new nuclear weapons systems, forecast to reach up to US$2 trillion over the next 30 years. Current US spending on new nuclear warheads is at an all-time record level.

Demagogues and pathological personalities are to be found disproportionately among those in high office. But never before has such a narcissistic, personality-disordered man bereft of qualifications for leadership, with multiple characteristics which should contraindicate high office, had the capacity to inflict such momentous and long-term consequences beyond their nation’s shores, through the utterly globalised threats of nuclear war and accelerating global heating. 

Scientists and physicians have recently, belatedly, raised their voices in unprecedented ways. The august New England Journal of Medicine, in a commendably forthright editorial on 8 October called in plain language for a change of regime in Washington. They note that “in the United States, leaders have failed” the test of leadership produced by COVID-19.

“They have taken a crisis and turned it into a tragedy. The magnitude of this failure is astonishing. … We have failed at almost every step. … Yet our leaders have largely chosen to ignore and even denigrate experts. …Instead of using these those [disease control] tools, the federal government has undermined them. The Centres for Disease Control and Prevention, which was the world’s leading disease response organisation, has been eviscerated and has suffered dramatic testing and policy failures. … The Food and Drug Administration has been shamefully politicised, …. Instead of relying on expertise, the administration has turned to uninformed opinion leaders and charlatans who obscure the truth and facilitate the promulgation of outright lies. … Although it is impossible to project the precise number of additional American lives lost because of weak and inappropriate government policies, it is at least in the tens of thousands … But truth is neither liberal nor conservative. When it comes to the response to the largest public-health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent.  We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.”

The presidents of the US National Academies of Sciences and Medicine issued a joint statement on 24 September 2020: NAS and NAM Presidents Alarmed by Political Interference in Science Amid Pandemic, concluding: “Any efforts to discredit the best science and scientists threaten the health and welfare of us all.”

On 1 October 2020, the editors of Scientific American endorsed presidential candidate Joe Biden, the first time the journal has ever backed a presidential candidate in its 175 year history. They said:

“The evidence and the science show that Donald Trump has badly damaged the US and its people – because he rejects evidence and science. The most devastating example is his dishonest and inept response to the COVID-19 pandemic, …. He has also attacked environmental protections, medical care, and the researchers and public science agencies that help this country prepare for its greatest challenges. That is why we urge you to vote for Joe Biden, who is offering fact-based plans to protect our health, our economy and the environment.” 

More than 3,700 US scientists have supported a Scientists Statement in Defence of Democracy supported by the Union of Concerned Scientists and the Federation of American Scientists, which urges all people to counter the current trends in the US “away from its roots in democratic self-governance towards authoritarianism” and “sidelining of science as input to public policy”.

The US electoral system, absent an independent national electoral commission, is a long way from a model of democratic participation. An arcane Electoral College system is not fit for purpose. There is vulnerability to partisan manipulations, including gerrymandering, with disenfranchisement of more populous areas; curtailment of voter eligibility and enrolment, and interference in voting access and counting which systematically disenfranchises segments of the population more likely to vote for Democratic candidates. The Bush-Gore debacle in 2000 and 2016 loss of Hillary Clinton to Trump despite her receiving 3 million more votes, and heavily Republican-aligned Supreme Court give little grounds for confidence in a free and fair election. Trump’s failure to commit to respect the election outcome and depart peacefully if he loses, and threat to swiftly suppress protests if he wins, are ominous. It is possible that in desperation to consolidate incumbency Trump might foment an international crisis involving a US military response.

More concerning even than the danger of Trump himself is that Republican Party members have with very few exceptions collectively fallen in behind and embraced Trump; enabling, aiding and abetting him to run amok. This gross moral failure makes the combination of Trump and the Republican Party the greatest immediate threat to planetary health, and the outcome of the coming election a matter of profound importance for the world.

Dr. Ruff is co-president of IPPNW.