The USA at 250: science in the new gilded age
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Published July 4, 2026
DOI: 10.1016/S0140-6736(26)01333-4 External LinkAlso available on ScienceDirect External Link
Copyright: © 2026 Published by Elsevier Ltd.
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Ok“A republic, if you can keep it.” As the USA commemorates 250 years since the signing of The Declaration of Independence, the “if” in Benjamin Franklin's quip resonates more than ever. The present US administration's injuries and usurpations to the nation's scientific institutions continue to escalate. Some of these abuses have been interrupted by the courts, but damaging executive fiats continue, including the Office of Management and Budget's (OMB) proposed new federal funding rule, Regulation for Federal Financial Assistance. Critics have detailed how it will silence independent experts, codify ideological censorship, prioritise politics over data, and erect new barriers to international collaboration that will stifle federal institutions, academia, and industry alike. The Trump administration's zero-sum approach to peace and prosperity is a folly that contrasts with the history of intellectual freedom and international engagement that has characterised US leadership in health and science.
250 years of US history has created a lot of science to celebrate: 329 Nobel laureates in physics, chemistry, and physiology or medicine; 12 Abel Prizes and 15 Fields Medals. American scientists have pioneered the iron lung and PET; heart surgery and organ transplantation. 200 years after inoculation saved the Continental Army from smallpox at Valley Forge, the CDC led the WHO campaign to rid the world of smallpox. Less than 1 year after the first diagnosis of COVID-19, Operation Warp Speed yielded effective vaccines.
The USA has always put America first, but often with contributions from the same populations the Trump administration now denounces as enemies and agitators. Of those 329 US Nobel laureates, 118 (36%) were born outside of the USA. Many emigrated as refugees fleeing violence and persecution. Albert Sabin, inventor of the live-attenuated oral polio vaccine, arrived in the USA at age 15 years after antisemitic pogroms forced his family to leave their native Poland. Jonas Salk's mother, to whom he credited his interest in medicine that led to development of the first inactivated injectable polio vaccine, was able to follow her sister to the USA at age 12 years thanks to family reunification policies that the current administration derides as “chain migration.” Katalin Kariko, whose work on mRNA technology is revolutionising modern vaccines, was already a highly skilled professional before an economic crisis in Hungary shuttered her laboratory and sent her abroad to continue her research. Such achievements have greatly strengthened the USA and benefited the world: the US administration needs to realise that the two ideas are not mutually exclusive, but rather intimately entwined.
Brain gain is not limited to extraordinary achievements; 20% of physicians working in the USA were born and educated abroad, and many help to fill critical shortages providing primary care in underserved rural and urban communities. Nearly half (46%) of people with doctoral-level degrees working in US science and engineering fields are foreign-born.
The USA has long recognised the value of returning the favour. The federal government established the Fulbright Scholarship programme to promote education and cultural exchange after World War 2. Scholarships send students and researchers all over the world—both to and from the USA—with the stipulation that they return to their home countries and use their experiences to the benefit of local communities. Nearly 450 000 scholarships later, Fulbright alumni have become leaders in their fields, including Mariano Barbacid who helped to isolate the first human oncogene and Rosalyn Yalow who worked to develop the radioimmunoassay test. In 2025, political interference from the Trump administration drove 11 of the 12 members of the Fulbright Foreign Scholarship Board to resign, and their seats remain vacant.
41% of the science and engineering research published by US authors in 2024 included international collaborators. However, in May of this year, NIH officials began requiring advanced permission for foreign coauthorship, scrubbing international collaborations from progress reports, and demanding that grantees promise to abandon foreign partnerships. The new OMB rule threatens to go even further. The text is open for public comment until July 13, but in its current form will impose restrictions on indirect costs, travel, data sharing, and technical assistance that threaten to stifle international cooperation in science and education. 250 years after independence, the country must once again decide how to define itself, and what it wants to contribute to and gain from the rest of the world. Those choices will have far-reaching consequences for medical science.