President Donald Trump has returned to the White House with a harder-edged agenda, a more ideologically disciplined inner circle, and little appetite for the old rules of global engagement. His second presidency is more calculative, operating with strategic intent, game-theory logic, and a clear belief in zero-sum outcomes, particularly in the realms of trade, industrial policy, and the recalibration of US leverage over both allies and adversaries.

Among the policies with the possibility of revival is international reference pricing for pharmaceuticals – a concept Trump attempted to introduce during his first term via a “most-favoured nation” pricing rule. The policy would have benchmarked US drug prices to those paid by countries like Australia, the UK and Canada; systems that deliver medicines at a fraction of American prices.