If the 2024 US presidential election was difficult for pollsters to call, the impact of Donald Trump's second term on global health is even more difficult to predict. He is notoriously unpredictable. Nonetheless, his actions in his first term as president, the 900-page blueprint for his second term known as Project 2025, 1 and his campaign rhetoric provide some clues. Given his predilection for chaos, 2 it is impossible to know which ideas will become reality, but the world should plan for the worst and hope for the best as Trump prepares to deliver the "promised golden age of America." 3 Here, we reflect on the potential consequences for global health.