United States presidential election was held on Tuesday, November 5, 2024, in which Donald Trump took a notable lead over Kamala Harris, marking a Republican return to the White House. Besides, the Republicans won a majority in both houses of US Congress which further cements Trump’s power. This development has sparked global discussions. With an antivaccine advocate in his cabinet, concerns for global health are also rising. Trump’s history of “America First” priorities, including cutting foreign aid and rolling back health and climate initiatives, his re-election could pose immediate and long-term implications for the health in Pakistan. Since the 1950s, the US and Pakistan have maintained a complex relationship of strategic cooperation tempered with frequent friction. The US has provided Pakistan with decades of support for public health, maternal and child health, infectious disease, and immunization programs. However, during his previous term, Trump’s policies shifted resources toward domestic needs. This re-election may result in further cutbacks in US health aid, impacting several critical areas. USAID, which has previously funded health programs in Pakistan, could see its budget significantly reduced, restricting vital services to vulnerable communities. If Trump restricts funding and support to public health organizations, it could indirectly strain Pakistan’s polio eradication efforts. In 1965, Pakistan’s family planning program, heavily funded by the US, received up to 40% of its supplies from American support. However, the Mexico City Policy introduced in 1985 blocked federal aid to NGOs offering abortion-related services, counselling, or advocacy. The expansion of this policy under Trump and the reinstatement of the “Global Gag Rule,” will further limit the scope of family planning and reproductive health services in Pakistan, straining an already challenged healthcare system under rising population pressures. In Pakistan, abortion has been legal under certain circumstances since 1990. With one of the highest abortion rates globally, many Pakistani women will face severe health risks or death from unsafe procedures. Trump’s withdrawal from the World Health Organization (WHO) in 2020 further complicated global health initiatives weakening global health programs like immunization and disease surveillance. Pakistan’s reliance on WHO support for infectious disease control and vaccination campaigns is vital, and US disengagement from WHO may weaken Pakistan’s ability to manage public health crises. Pakistan, one of the two last countries still fighting endemic polio, heavily relies on international aid to combat the disease. If Trump restricts funding and support to organizations such as WHO, UNICEF, or CDC, it could indirectly strain Pakistan’s polio eradication efforts by reducing resources and support for health programs that overlap with vaccination outreach. The shift in US climate policy could also weaken bilateral environmental collaborations, such as the “Green Alliance,” which supports climate resilience and sustainable development through key projects, including the $66 million Recharge Pakistan Project funded by the Green Climate Fund, a $4.5 million Climate-Smart Agriculture Program, and investments in renewable energy focused on refurbishing hydropower facilities like Mangla and Tarbela Dams. Trump’s rollover of environmental regulations will also impact Pakistan’s dependency on international support. By weakening US commitments to climate finance, including contributions to the Green Climate Fund and other global climate initiatives, it will be more challenging for Pakistan to secure consistent funding for climate adaptation projects, such as flood resilience, sustainable agriculture, and renewable energy development, which rely on international backing. In light of these challenges, Pakistan must adopt sustainable strategies to build resilience in the health and climate sectors: Strengthen regional partnerships: Pakistan can build partnerships with neighbouring countries like China and Central Asian nations, sharing common interests in health and climate resilience. Expanding cooperation with China under the China-Pakistan Economic Corridor (CPEC) could yield further health sector benefits. Leverage Islamic Development Bank (IsDB) and Organization of Islamic Cooperation (OIC) support: Pakistan could seek funding and technical assistance, focusing on projects aligned with health and climate resilience goals. Engage international foundations and NGOs: By expanding ties with foundations and NGOs, such as the Bill & Melinda Gates Foundation and the Rockefeller Foundation, Pakistan could secure grants, expertise, and project funding to fill gaps left by US aid cuts. Develop domestic climate and health resilience funds: Establishing domestic funds with contributions from affluent Pakistanis and diaspora communities through tax incentives or social impact bonds could provide resources for renewable energy, healthcare infrastructure, and climate adaptation. Tap into carbon credit markets: Pakistan could participate in international carbon markets by implementing emissions-reduction projects like reforestation and renewable energy. Selling carbon credits would attract green investment and generate funding for sustainability initiatives. These strategies would enable Pakistan to mitigate the impact of reduced US support and build a more resilient health and climate sector, ensuring a healthier future for its citizens amidst shifting geopolitical realities. The writer is a medical practitioner.