( this article was written before news broke on the Trumps testing positive)

For anyone who had the misfortune of tuning into the first U.S. Presidential Debate earlier this week, the phrase, “elections have consequences” was likely one of the one true things uttered by Donald Trump during a furious, head-spinning 90-odd minutes.

I thought about this statement upon seeing a news story that one man – the U.S. President – was responsible for the vast majority of misinformation, or the ‘infodemic’ regarding Covid-19. Evanega and colleagues analyzed 38 million English-language articles in the media from January to May of 2020, finding that Trump was invoked 37.9% in media articles that involved misinformation, of which only 16.4% of articles were in the context of ‘fact checking’. On the surface, this fact probably doesn’t surprise us – Trump has been spewing falsehoods from the very beginning of the pandemic, even when he knew otherwise. During the debate, Trump openly mocked Joe Biden for wearing a mask and keeping his crowd sizes small and within regulations. We really shouldn’t be surprised by much. But pause on the fact that the person elected by the population to lead the country is now responsible for so much death and illness in the U.S., and the sheer magnitude of what Trump has done to derail the U.S. response through his personal actions comes into greater relief, exacerbated by the range of missteps taken by his administration nationally and in a global context.

Indeed, elections have consequences. In 2016 and for the three and a half years that have followed, the U.S. and the world more broadly have been facing the repercussions of Donald Trump’s election. Covid has just put his leadership in a starker context, but the signs have been there all along, well before he was even President. The overarching lesson in this entire debacle with Trump is that we had an undue hope that our institutions were strong enough to withstand him, and better yet, perhaps remake him into a more reasonable leader. What we have failed to account for was his ability to remake these institutions and what the consequences of this are going to be for years to come. For example, Trump has weaponized the use of social media to spread misinformation about Covid – and we can certainly expect that this will happen in health emergencies to come, particularly under Democratic administrations. He has destroyed trust in the CDC, which will take years to rebuild even under the best of circumstances. The reordering of the U.S. Supreme Court as well as the lower courts is going to impact access to health services in the U.S. for decades to come. And globally, the rankling of the WHO and international system by the Trump Administration provides a playbook for errant leaders for the foreseeable future.

One of the major lessons for health policy and systems from the Covid era is that it has underscored how important politics and governance are to the health sector. Picking up on one thread of that – elections and leadership – I’ve recently thought a lot about how it isn’t just about elections mattering just for the citizens of that particular country, but how as a global community, we have a stake in who is elected to our various governments. To wit, it is important that we no longer see elections in other countries, let alone powerful ones like the U.S.,  as often entertaining, slow-motion train wrecks, but rather, see the consequences to the people of those countries as well as internationally.  This applies to so many other countries on a range of rights issues – planetary health and the treatment of religious, ethnic, racial and gender minorities as examples.

As we emerge from the horrors of 2020 (and likely beyond), there is much work that needs to be done to strengthen international cooperation, and nationally, to ensure that we strengthen trust and accountability with governments, establish safeguards in health agencies such as the CDC and the soon to be erstwhile Public Health England to protect them from politicization, and to demand more from our candidates and elected officials regarding health, social justice and emergency preparedness. I have lived in the U.S. since 2002, and every four years, we hear the refrain, ‘this is most important election of your lifetime’. 2016 proved that and has put us in a position where the stakes could not be higher in 2020. While we will have to suffer through two more debates with Trump ranting and raving, we can hope that in a few weeks, there will be a new leader who takes the value of human life seriously. It is then up to us to advocate for or make policy that ensures that a single leader never puts us at risk in this way again.