Actively holding the line

In this issue of CMAJ, Ghali discusses one of the myriad announcements made by US President Donald Trump since his second inauguration in January 2025: cuts to scientific research funding.¹ Ghali highlights the need for urgent overhaul and strengthening of Canada’s research funding system as researchers in the United States face this threat. Cuts to research funding are among many initiatives of the new US executive administration aimed at wielding economic power as a political weapon to advance interests that appear to range from economic to nationally protectionist to ideological. As the editors of many medical journals have noted, almost all these initiatives will negatively affect human health in the US and beyond.^2–5 Fear and dismay are natural responses to executive orders that people know will cause harm, and they should be validated. However, active responses are crucial to minimize harm. How can Canada respond?

As Kickbusch argued in The Lancet, although the withdrawal of the US from the World Health Organization (WHO) leaves a distressing funding and data gap for the organization, 193 WHO member states remain, and the exit of the US presents an opportunity to reconsider how the WHO operates, to overhaul it to be less reliant on funding from the US, and to redefine global health multilateralism to be more robust, adaptive, and relevant.⁶ Moreover, international data sharing must be optimized and robust artificial intelligence tools adopted to monitor health threats. Canada should play an active role in pushing for and shaping a WHO that can function independently of any single capricious member state. Canada should also increase its contributions to the WHO and to global health aid at this time.

Editors of Clinical Microbiology and Infection recently summarized how policies that will stymie US clinical research, access to necessary data, and transparent communication of research findings will seriously affect both regional and global health.⁵ President Trump’s appointment (despite strong opposition) of anti-vaccine activist Robert F. Kennedy Jr as US secretary for the Department of Health and Human Services (HHS) underscores the US executive leadership’s antiscience agenda.⁵ Canada must respond by actively supporting the generation of robust science. Governments should ensure sufficient funding for conducting health research as an urgent priority, as outlined by Ghali.¹ Moreover, they should heed repeated calls⁷ to facilitate the timely sharing of health data between provinces in Canada through legislation that includes provisions for linkage to administrative health data — deidentified at the patient level — with a waiver of consent, so that up-to-date disease trends for Canada can be shared with international collaborators.

President Trump recently described the border between Canada and the US as an “artificially drawn line” when he implied annexation of Canada by the US through economic measures.⁸ It would seem that the president considers many lines meaningless and to be crossed without thought. Clark and Abbasi, in their recent editorial in The BMJ,² decried Trump’s executive orders on “defending women from gender ideology extremism” and related orders to HHS scientists to remove themselves as authors from papers; they rightly pointed out that politically motivated orders about banned words cannot erase evidence-based terminology and standards of research reporting and publication that have evolved from study and expertise. Editors of journals in the JAMA Network recently drew their line, restating their journals’ commitments to upholding high standards of scientific and editorial integrity and “ensuring the broad and faithful dissemination of scientific findings.”⁴ CMAJ editors join our international colleagues in recommitting to upholding the publication of robust evidence that supports health, regardless of political ideology.

This journal has called out past Canadian governments that acted to stifle research and silence researchers.⁹ Now is not the time for any government to follow that playbook; 2025 is a year to facilitate the publication of Canadian science, to help fill gaps in international health knowledge consequent to US policies. Reliable North American health data that originate from Canada are more important than they have ever been. Now is the time to fund Canadian health researchers properly and to support them to share their work, publish in reputable journals, and collaborate internationally.

See related article at www.cmaj.ca/lookup/doi/10.1503/cmaj.250406