Aftershocks

Aftershocks is a timely and urgent examination of what happens when public health systems-and the democratic institutions that sustain them-are pushed to their limits.

Set against the first year of the second Trump administration, the book traces a period of rapid policy change, institutional erosion, and escalating consequences for global health through the lens of the HIV response. Drawing on policy analysis, frontline insight, and lived experience, Dr. José M. Zuniga reveals how decades of hard-won progress became newly vulnerable.

Yet this is not only a story of breakdown-it is a story of perseverance in the face of sustained strain. From local health departments striving to maintain essential services to global programs adapting to shifting U.S. commitments, the book highlights the resilience of those working to hold systems together under pressure.

Bridging politics and public health, Aftershocks connects decisions made at the highest levels of government to their real-world impact on communities. It offers readers both a critical understanding of systemic fragility and a forward-looking framework-Horizons 2028-for rebuilding more resilient, equitable health systems.

At its core, this book is both a warning and a call to action, affirming that even in times of disruption, collective response can shape a more just, healthy, and sustainable future for everyone, everywhere.