We Have a Serious Problem. Canada First™ is the Wrong Answer
Build all the bridges
US President Donald Trump has placed tariffs on his country’s closest neighbours and allies and overtly switched his country’s support to the aggressor in Russia’s illegal invasion of Ukraine. It’s an inversion of the international order that will disrupt decades of efforts toward peace and development around the world. Canadian leaders of all stripes are rightly condemning these actions as economically harmful and downright dumb. There is a sense of national unity unlike anything we’ve experienced in decades. Canadians are looking to each other for support and are inspired by what they see.
These abandonments of relationships and responsibilities in Europe and North America follow on decisions that are already doing incredible damage to the health of millions. Trump and Elon Musk are essentially shutting down USAID, cancelling tens of billions in funding that goes to provide essential medications and other supports in the world’s poorest countries.
In early February, I visited Socios En Salud (Partners In Health Peru) in Lima, learning about their innovative programs fighting tuberculosis and HIV, supporting people with mental illness, and serving the most marginalized people in the country. We went to the home of a TB patient who was raising her two granddaughters in a single room among the impromptu dwellings of an informal neighbourhood. As always with PIH, it was clear how the connection between accompaniment workers and patient made it possible to deliver care in seemingly impossible situations.
My visit came just days after the USAID cuts were announced, and numerous life-saving programs were already being compromised. Staff hired the Friday before on a US grant to support Venezuelan migrants with chronic illnesses were being let go on the Monday. Aside from the bare humanity of caring for people in need, perhaps a nation as worried as the United States about people crossing its borders would want to help people feel they had a chance to thrive where they are. Instead, the Trump/Musk cuts will lead to desperation all over the world, putting America’s borders under even greater strain.
A Structural Massacre
One of the programs funded through USAID is called PEPFAR: the President’s Emergency Fund for AIDS Relief. Established under George W. Bush, with Paul Farmer and PIH advising on its development, PEPFAR has provided anti-retroviral medications (ARVs) to people living with HIV in 50 countries around the world. The program has been estimated to save over 25 million lives in the twenty years it has been operating.
I worked in rural hospitals in Mozambique and Zambia before ARVs were widely available. The doctors didn’t want to tell patients they had HIV because they were simply delivering a death sentence. Our wards were full of young people dying from meningitis, TB, Kaposi’s sarcoma and other opportunistic diseases, with no real treatment to offer them, let alone any hope. Every day was filled with heartbreaking tragedy as patients moaned in pain and families wept for those who had died.
Twenty years later, the rates of new cases and of HIV deaths have been cut in half, with PEPFAR the largest provider of the ARVs responsible in many countries. Working in Lesotho, (a country nobody’s ever heard of?!!?) one of our colleagues described HIV medicine as boring. The medicines were now so simple and effective that it had become easy to reach people and successfully monitor and support their care. At the same time, there was a tacit acknowledgment that if anything happened to PEPFAR we might find ourselves right back in the horrific circumstances of the late 1990s.
With PEPFAR’s future now in danger and present a confusing mess amidst the on-again, off-again freeze and thaw of funding, patients and the programs that serve them are left hanging. Experts estimate that even the proposed 90 day freeze in funding would result in 100,000 additional deaths in the next year. Longer-term loss of US support would be even more devastating, increasing sixfold the cases of worldwide in the next four years and leading to six million additional deaths.
Depriving millions of life-saving medications is a structural massacre.
Just as repulsive is the news that the USAID cuts are stopping shipments of RUTF (Ready-to-Use-Therapeutic Food) from two of the world’s largest suppliers. This peanut butter-like paste (the original was called PlumpyNut) was invented in the 1990s as a highly nutritious food to help children from malnutrition. Writing from Burundi, Dr. Jennifer Burin describes how the cupboards that once held boxes of this life-saving treatment bearing the familiar label “from the American people” are now as empty as the bellies of the children.
Paul Farmer often spoke of “structural violence,” the way social structures and inequalities harmed the bodies of innocent people. Depriving millions of life-saving medications is a structural massacre. The wealthiest nation in the world is looking over its fortress walls and saying “we’ve been far too generous with these serfs, time for them to die.” It’s as obscene as it sounds and there’s no reason to paint it lighter colours.
Elbows Up
But why am I talking about things happening in Africa and South America today when our problem is in North America? Canada is under economic attack from a former ally. Our Prime Minister is talking seriously about the risk of annexation. Don’t we have our own issues to be concerned about? Shouldn’t we be putting Canada First?
Without question, we need to respond forcefully to attacks from our once-reliable ally and get our house in order. It is a time for positive patriotism, for caring about who we are and what we do that sets us apart. It is time, as I wrote a few weeks ago, to be unapologetically Canadian, the anti-America. With rare exception, I’m pleased to say, that’s what ordinary Canadians and our nation’s leaders are doing. The surge of national unity in the face of disrespect and threats of annexation is an incredible source of hope.
But there is one leader who has been slow to come around, and whose message still contains the wrong kind of red flags. Pierre Poilievre’s much-vaunted Flag Day pivot to a new message of “Canada First” has been clumsy as he tries to keep his MAGA North base onside. He understood the moment he thought he was in. A right-wing renaissance with objective journalism in freefall and his Republican fellow-travellers ascendant. A fight with Trudeau over a moribund carbon tax. An enormous lead in the polls and an apparently easy stroll from Stornaway to Sussex Drive. Shifting gears to the new moment has been hard, and it’s awkward to watch a politician asking himself in public whether he should do the right thing. Poilievre’s hedging of bets up until this latest moment of crisis say a lot about his instincts and who he’s worried about displeasing.
More specific to the question of Canada’s place in the world, however, was something he said in Iqaluit last month. He was promising investments in Arctic defence, an admittedly much-needed be part of a robust rebuild of Canadian defence capacity in a more dangerous world. It’s how he said he would pay for it that set off alarms.
"All of these improvements will be funded by dramatically cutting foreign aid, a lot of which goes to dictators, terrorists and global bureaucracies. I will be bringing our money home with massive cuts to these wasteful and corrupt foreign aid grants."
- Pierre Poilievre, 10/2/25
This was after Trump and Musk had frozen US Aid and were starting to dismantle the structures that assist countries in need. At a time when Canada’s neighbour is cutting foreign aid and alienating allies, Poilievre thinks we should be doing the same. Is this his pivot? To follow Trump’s down the same cruel and counterproductive isolationist path?
Of Canada’s total international aid in 2022-23, over a third went to Ukraine. Trump has called Ukrainian President Volodymyr Zelensky a dictator, is that what Poilievre is referring to? His recent comments following Trump and Vance’s disgraceful treatment of Zelensky in the White House suggest otherwise, but would he be ready to step up with added support for Ukraine now that the US is siding with Russia? With Elon Musk echoing Putin on Ukraine by calling Canada “not a real country”, the archaic notion that only empires deserve independence is again gaining ground. Canada needs to be a stalwart defender of sovereignty and international law everywhere.
Or perhaps he’s talking about the other two-thirds which go either through multilateral programs like the Global Fund, or are delivered in partnership with Canadian agencies through bodies like Global Affairs Canada? Anyone who has had anything to do with these programs can tell you that they are highly vetted with strict reporting requirements. Even in countries where the governments are repressive, the programs are designed to get aid to the people being repressed. Poilievre has been around parliament long enough that he knows this very well, he’s just hoping a vague scapegoat of foreign, crooked others will be a useful tool to anger Canadian voters.
And then there’s the slogan. In response to Trump overturning every international norm, Poilievre boldly sought out new branding. His podium placards now read “Canada First”. So what’s wrong with that? Well, if imitation is the sincerest form of flattery, Trump should be blushing above his own “America First” signs, a slogan he’s been using since 2016. But not only is it derivative of the person we should be distancing ourselves from, it’s also a motto with an infamous history, a direct descendant of the America First Committee. This was the organization, with such luminary anti-semites at its head as Henry Ford and Charles Lindbergh, that advocated for Hitler and against American involvement in World War II.
I’ll leave it to readers to decide whether Poilievre’s echo of Trump’s echo is ahistoric ignorance or a protofascist DOGEwhistle. The point is that Canada cannot, in our language or our actions, be sending the message that we’re going to go it alone. We cannot put our most immediate and selfish interests ahead of what the world needs, because we will need the world.
When it comes to foreign aid, Canada is a responsible and respected actor in assisting countries in need to develop their capacity to support their own citizens. This is generosity, but also self-interest, an investment in a safer and healthier world. Foreign aid is part of a larger strategy of building alliances of mutual support among sovereign nations, and of participating alongside other wealthy nations in a shared project of a better world.
In the months ahead, Canadians will draw on incredible reserves of fortitude. But if we only look inward for strength, we may end up emulating Trump instead of repudiating him. Now is no time to turn our back on the rest of the world. With our closest neighbour giving us the cold shoulder, or worse, it’s time to build bridges, not burn them down.
Speaking of being as Canadian as can be, Canadian Doctors for Medicare will be hosting their first ever health summit this weekend in Toronto. I’m honoured to be the opening keynote, and would love to see you there if you’re in town. I’ll come back to this space to share some of the learnings from the day.
This is an excellent and informative article Ryan. Thanks for identifying the insidious nature and the goal of Poilievre's "Canada First" program. He is dangerous to Canada and Canada’s respected role in international relations.
Thank you.
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