Given the pace at which public health systems have been disrupted since President Trump’s second inauguration, José M. Zuniga set out to catalogue this transformation—not only to bear witness, but to chart a path to reimagining those systems.
With his book, Aftershocks: Trump 2.0, Public Health, and Our Better Angels, Zuniga considers these changes through the lens of the global HIV response. What he reveals is a system that was already straining under an imposed austerity when Trump took office in January 2025. The book then convincingly explains why HIV programmes—both domestic and international—were vulnerable to an administration th at weaponised efficiency and exploited an institutional willingness to bend to executive dominance. The result of these disruptions, Zuniga concludes, is “the structures that sustained the HIV response were strong enough to endure neglect—but not strong enough to resist intentional destabilization.”
… The challenge Zuniga poses [in “Aftershocks”]… is not just whether a new administration will correct any damage done by Trump-era policies, but also whether it would commit to the more politically tricky task of helping build a public health system that eliminates the uncertainties around funding and access that had strained the global HIV response well before Trump took office for a second time. A system that can withstand “worst-case governance rather than best-case leadership.”
“Aftershocks” has much to say beyond this, with a broadinterest in how public health has shifted under Trump. The Make America Healthy Again movement, for instance, earns its own chapter, which ties in later to reflections about the ongoing assault on science and measures Zuniga believes are needed to reclaim the public health narrative.
— Andrew Green, Freelance Journalist and Contributing Reporter for Devex; book review published 8 October 2026 in The Lancet HIV
Aftershocks shows how quickly political decisions can weaken public health institutions leaving affected communities to live with the deleterious consequences. José Zúñiga then turns to the AIDS movement for a path forward that prioritizes following the evidence, centering the leadership of affected communities, organizing relentlessly, and holding leaders accountable as a playbook for rebuilding public health and confronting future crises.
— Dr. Jirair Ratevosian, Senior Fellow, Duke Global Health Institute
Aftershocks is a searing chronicle of the first year of the second Trump administration and the human cost of political decisions that destabilized public health systems, deepened inequities, and eroded trust in science and governance. Blending evidence, lived experience, and sharp political insight, the book lays bare the fragility of systems once assumed secure and documents the widening human toll of weakened institutions, abandoned communities, and policies that turned preventable suffering into collateral damage.
— Shannon Hader, Professor at and former Dean of American University’s School of International Service, and past UN Assistant Secretary-General
Drawing on analysis and firsthand accounts, Aftershocks maps how shifts in funding, leadership, and policy in the second Trump administration rippled through agencies responsible for epidemic preparedness, community health, and international HIV relief. More than a chronicle of disruption, the book ultimately issues a call for a future public health landscape that is stronger, more equitable, and more humane, using lessons from this period to guide renewed commitment to protecting health at home and abroad.
— Harold Phillips, Executive Director of the National Minority AIDS Council, and former Director of the White House Office of National AIDS Policy