Millions of the worlds most vulnerable people are facing the coronavirus pandemic with worse health care than they had just a few years ago because of the choices of one man: President Donald Trump .

Trumps changes to U.S. foreign aid a tiny portion of the American governments budget but traditionally the largest source of funding for many international charities forced some clinics to close and reduced supplies for others. His policies left key medical teams understaffed in countries where the highly contagious coronavirus is expected to spread rapidly. And now, as the pandemic extends its reach, hes doing even more to block global health aid.

Last week, Trump dealt his latest blow to the global health system: suspending U.S. funding for the World Health Organization. He accused the body of mismanagement in addressing the spread of COVID-19, the disease caused by the virus. But his own pre-coronavirus policies are likely making the pandemic worse than it would otherwise have been more deadly, more damaging to societies worldwide, and slower to wind down.

In 2017, Trump enacted an expanded version of the global gag rule, a policy tying U.S. aid to a promise from recipients not to perform or promote abortion. That move cut off more than $150 million in funding for medical charities over the following year, according to the Government Accountability Office. Months later, he ended support for a United Nations agency providing reproductive health care globally. Trump further weakened the U.N. health system in 2018 by cutting U.S. aid to the agency responsible for Palestinian refugees primary health care.

The president used executive authority to make those moves without the approval of Congress, where lawmakers, including Republicans , have rejected his sweeping proposals to further reduce foreign aid. If Congress hadnt prevented other Trump efforts to slash international assistance, the situation would be even worse.

Still, the damage hes done is clear, global health experts say, and has disproportionately reduced medical assistance to people who were already disadvantaged: refugees, women and girls, men who have sex with men. Health care professionals argue that the consequences of Trumps decisions made their work harder even before they were asked to confront the challenge of COVID-19.

We are all witnessing that the absence of U.S. leadership in the way that were used to seeing is having real implications, said Sheba Crocker, a former State Department official now with the charity CARE USA, which addresses health care among other needs of the global poor.

Expanding The Gag Rule And Limiting Vital Help

President Ronald Reagan first imposed the global gag rule on abortion. Also known as the Mexico City Policy, it has since been revoked by every Democratic president and reinstated by every Republican president. Until Trump, however, the policy was only applied to the portion of U.S. aid that went to family planning services. The Trump administration first broadened it to a restriction on all global health funding, not just money for reproductive care, and then expanded it further in 2019 to cut support for groups simply for donating to organizations that mention abortion.

The wide-ranging results of Trumps version of the rule are visible in places like Kibera, a slum in the Kenyan capital of Nairobi that is home to at least 170,000 people.

A group called Family Health Options Kenya used to run three to four outreach clinics each month in various parts of Kibera. But Trumps policy meant it lost $1.5 million in aid. The organization can no longer afford to operate the clinics in Kibera removing one of the few health services available to residents in an area that is expected to get hit especially hard by the coronavirus because of how difficult it is to socially distance in such cramped living conditions.

For some of the worlds poorest communities, sexual health organizations are essential for more than family planning services. In some areas, they provide the only affordable medical care, covering not just essential reproductive services like abortions and testing for sexually transmitted infections, but also immunizations, nutritional care, tuberculosis treatment, HIV services, maternal-child health care, and clean water and hygiene resources.

So when funding is cut off from these organizations, its not just reproductive health care thats lost. The policy is undermining the entire health system, said Jonathan Rucks, senior director of policy and advocacy at PAI , an international group that promotes reproductive health care.

Rucks told HuffPost that the global gag rule will have especially dire effects on rural and other hard-to-reach communities as the coronavirus crisis hits them. Youve really hamstrung any ability to respond in that timely and holistic fashion, he said. The U.S. is going to be expected to provide a lot of support to these countries that are not going to have the providers to work with. You have communities without care. You have undermined your mobile outreach to hardest-to-reach populations.

All of this is going to make the impacts of COVID-19 so much worse because there are communities quite literally without providers, he continued.

Meanwhile, global family planning services that were already weakened under Trump are at risk of receiving even fewer resources as funds are shifted to battle the pandemic, which could put millions of vulnerable women and girls at even greater risk.

The expanded global gag rule has harmed many trusted health care providers worldwide, weakening health care systems and disrupting access to services for communities who rely on them, Monica Kerrigan, executive director of Planned Parenthood Global, told HuffPost. These very providers are now fighting to respond to the COVID-19 pandemic and continue to provide essential services with inadequate resources.