Can anyone trust the U.S. government when it comes to their future health? For participants in clinical trials, the answer is a hard no.
The Trump administration’s decision to end funding for the U.S. Agency for International Development (USAID) has resulted in an abrupt halt to the clinical trials the agency funds overseas. Stopping a trial midstream violates core principles of medical ethics: It forces researchers to abandon participants — a mortal sin in medical ethics — and puts trial volunteers at considerable physical risk, a violation of the defining medical ethics requirement to “Do No Harm.”
An equally consequential result of this unexpected and immoral funding freeze is the damage to the fragile, hard-earned trust of research participants everywhere. American pharmaceutical development is the foundation of the country’s top-tier medical innovation. If we are to maintain this standing — if today’s kids are going to access tomorrow’s cures — then the stop-work order for American-sponsored research must be passionately condemned and immediately and permanently reversed.
While the Supreme Court ruled last week to reject the Trump administration’s bid to freeze nearly $2 billion in foreign aid, this is for work that has already been done. We must also ensure that future work and research can continue.
Trust Is Hard to Earn, Easy to Lose
Safe and effective medical products are critical to the public health mission of physicians. Drug, vaccine, and device developers establish safety and effectiveness of medical products via clinical trials. Trials cannot be conducted if developers are unable to recruit and retain research participants. This requires trust.
Trust is hard to come by in medicine, especially in light of the U.S. history of research scandals. From the Tuskegee syphilis study and history of inequitable treatment of certain populations in healthcare and research, to the glut of vaccine mis- and disinformation, faith in science is waning. Americans’ trust in their healthcare providers was already shaky before the new administration’s actions. A poll published in January 2025 reported that Americans’ level of trust in doctors was at just 53% — a 13% increase since the COVID-19 pandemic, but still not very encouraging.
Internationally, trust is an issue too. The mistrust resulting from a dengue vaccine mishap in the Philippines — in which some 80,000 child vaccine recipients were made more susceptible to severe dengue — led to increased hesitancy of other vaccines in that country. In Samoa, the American anti-vaccine organization Children’s Health Defense was connected to the deaths of 83 people (mostly children) during a 2019 measles outbreak, following a visit from its founder, Robert F. Kennedy, Jr.
In his role as the new secretary of HHS, Kennedy recently called the ongoing measles outbreak in Texas, in which one child has died, “not unusual.” He hasn’t yet commented publicly on an unvaccinated adult in New Mexico who tested positive for the measles virus after his death last week.
Combine all this with an administration willing to capriciously slam the door on foreign clinical research support, and the healthcare system is not poised to allay the fears of trial participants everywhere anytime soon.
All Facets of Medicine Rely on Trustworthiness
Trust in the research enterprise goes both ways. All American pharmaceutical sponsors — whether funded through USAID or privately — must live with the fallout of Trump’s inexplicable order.
About half of the clinical trials run in cooperation with U.S. companies are conducted in foreign countries. With potentially unreliable funding, research sponsors may be wary of even starting a trial overseas. As they watch current investments in studies swirl the drain, along with the expensive but now-worthless partial data generated from these interrupted investigations, they may well decide that the enormous costs of mounting trials are not worth undertaking if they cannot count on promised funding. Add in job cuts at drug oversight agencies like FDA, and physicians are likely looking at research pipelines with fewer new agents, and patients who are leery of testing them.
Trust takes years to build but can evaporate in an instant. The current administration appears indifferent to the global nature of disease research and to the painstaking process by which treatments are developed. Meanwhile, hasty and ill-conceived policy decisions will not save taxpayers any significant amount of money. Rather, they will be enormously costly when calculated in lives lost and a future plagued by illnesses that might have been defeated or prevented by medicines that were never manufactured.
What the administration has forced USAID to do is incompatible with the medical ethics principles of “Do Not Abandon” and “Do No Harm.” Every healthcare worker must protest actions that can result in harm to patients or research participants and make future research recruitment impossible. Freezing support for ongoing research is exactly that kind of pernicious action.
Arthur Caplan, PhD, is the Drs. William F. and Virginia Connolly Mitty Professor and founding head of the Division of Medical Ethics at NYU Grossman School of Medicine. Lisa Kearns, MS, MA, is a senior research associate in the Division of Medical Ethics. The views expressed are their own.
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