The emergence of COVID-19 in 2020 led to sweeping economic and social changes around the world as governments grappled with how to contain the pandemic. Experts continue to debate the effect of local and national response measures on the U.S. economy, international trade, education, and other matters at the forefront of the 2024 election. 

Beyond the death toll, which surpassed one million people in the United States, the pandemic exacerbated economic, social, and racial disparities and shed light on other public health issues, including insufficient mental health support. It also highlighted the limitations that public health institutions such as the U.S. Centers for Disease Control and Prevention and the World Health Organization (WHO) face in fighting disease within and across borders. During the first year of the pandemic, President Donald Trump froze U.S. funding for the WHO and began the process of withdrawing from the organization, which President Joe Biden later reversed.

At the same time, the United States’ response to the COVID-19 outbreak raised concerns about its ability to weather future large-scale biological or viral threats. Many analysts say that Washington’s disjointed response exposed health system frailties; underscored the challenges of disseminating accurate, accessible public health messaging; and revealed an overall lack of pandemic preparedness. Hospitals struggled with shortages of essential equipment such as ventilators, beds, and masks as global supply chains for such products—many based in China—were severely disrupted. 

Also of concern is the United States’ ability to manage other major public health challenges, such as the worsening U.S. opioid epidemic. The synthetic opioid fentanyl, in particular, has become a massive U.S. foreign policy and national security challenge in recent years, as the drug’s supply chain largely runs through China and Mexico. Both Presidents Trump and Biden engaged with China on the issue during their terms, including by reaching agreements to more strictly regulate fentanyl and boost efforts to curb the manufacturing and distribution of the drug’s precursor chemicals, though the crisis persists. 

The political divides that emerged amid the pandemic could now threaten the future of U.S. global health programs that once operated with strong bipartisan support. For instance, the outcome of both the presidential election and the makeup of the next Congress could impact the reauthorization of PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief, and the millions of people to whom it provides life-saving medications and services.