The Science Policy Implications of a Trump Presidency

Protectionism and Isolationism

At numerous times throughout the campaign, Candidate Trump expressed dissatisfaction with a variety of free-trade agreements. These include the North American Free Trade Agreement and the Trans-Pacific Partnership. Mr. Trump repeatedly spoke about bringing manufacturing jobs back to the United States, through tariffs and other trade restrictions that might give an advantage to manufacturers based in the United States. He also spoke about the Brexit decision in positive terms and seems to have aligned the sentiments of his supporters with the sentiments of those who voted for “exit” in that famous British referendum.

In a related fashion, Mr. Trump spoke against the current approach to the North Atlantic Treaty Organization (NATO) alliance and to the broader concept of global U.S. engagement as a means to contain expansionist aggression by governments such as those of the Russian Federation and the People's Republic of China. Indeed, the Trump campaign's slogan of “America First” is identical to that employed by isolationist movements in the United States prior to each of the 20th century's world wars.

In general, protectionist trade policies and isolationist foreign policies tend to trend together in national sentiment, and this certainly would be a fair representation of the pre-election discussion by Mr. Trump and his supporters. However, it is far from clear whether such sentiments will result in major shifts in U.S. foreign policy. At the time of writing, only a few of the Trump administration's nominations for cabinet-level posts have been announced, and those that have been discussed in the foreign policy arena have seemed to be relatively moderate. It is also unclear as to how much impact revision of free-trade agreements would have on international dealings important to gene and cell therapy.

Tax Policy

Another general policy area in which Candidate Trump put forward some strong predilections was in the realm of tax policy. Mr. Trump has called for dramatic cuts in corporate and personal income taxes. Objective analyses of the proposed cuts would indicate that they would likely result in dramatic increases in federal budget deficits. If such deficits were to be contained without cuts to the federal entitlement programs (Medicare and Social Security) or to national defense, substantial reductions in discretionary spending would be required. Some have worried that large tax cuts could result in downward pressure on federal research funding. This is far from certain, however. One need only look to the policy of the Republican-led Congress of the mid-1990s to see a period when tax cuts were paired with the famous doubling of the NIH budget.

Healthcare Policy

One of the Trump campaign's signature promises was to repeal the Affordable Care Act (ACA), also known as Obamacare. The concept of repeal of the ACA was quite popular among Congressional Republican candidates as well, so some form of repeal seems to be highly probable. The most likely scenario that has been discussed, however, is that of “repeal and replace,” meaning that popular portions of the ACA will remain, such as a prohibition of lifetime health insurance coverage caps, exclusion of coverage of pre-existing conditions, and the extension of benefits for dependents through their 26th birthday. In contrast, it seems very likely that the current funding mechanisms for health insurance for low-income Americans will be repealed. This could have substantial negative financial impacts for academic medical centers in the United States. Such academic medical centers are major contributors to gene therapy research, so there is definitely a danger that these changes could adversely impact U.S. gene therapy science.

Science Policy

The only area of science policy with a substantial record of public comment by the Trump campaign is that of global climate change. Candidate Trump has repeatedly refuted the evidence of global climate change due to human activity, and has proposed substantial changes to public policy based on that stance, including withdrawing the United States from the Paris accords. While it is not clear that this approach will have any implication for biomedical research, it is generally troubling to many scientists. Importantly, the Trump administration has not signaled strongly whether there would be support for increasing funding in areas that might directly benefit Americans suffering from diseases that might be amenable to gene therapy, such as cancer and neurodegenerative diseases. This would seem to be an area in which a new Trump presidency might still be influenced in a positive direction.

A Challenge to Mr. Trump

Given this overall analysis, there is definitely an opportunity for a Trump presidency to make a positive impact on gene therapy research in the United States and around the world. There have been predictions that the post-election “lame duck” session of the U.S. Congress may pass a proposed 21st Century Cures Act, which could provide positive momentum toward increasing NIH funding for biomedical research going into the Trump presidency. One of Mr. Trump's most vocal supporters, former House Speaker Newt Gingrich, was the architect of the famous doubling of the NIH budget in the 1990s, which had major positive impacts on the acceleration of innovative therapies and breakthrough discoveries that have enabled those therapies.

So our challenge to Mr. Trump is this: Outdo the Clinton–Gingrich NIH doubling with at least another doubling of NIH funding to a level in 2021 of at least $70 billion.

If that were done, it would indeed be a legacy worth trumpeting.