The rapid signing of a series of bilateral Memorandums of Understanding (MOUs) between the United States and several African nations, as outlined in the Office of the Spokesperson’s press release, represents a significant, albeit controversial, shift in Washington’s approach to global health. While framed as an “America First” strategy focused on self-reliance and measurable results, the move raises fundamental questions about the long-term stability of existing alliances, the efficacy of a purely transactional approach to international health, and the potential for a fractured global response to emerging infectious disease threats. The ambition to fundamentally reshape decades-old cooperative frameworks demands a critical assessment, and this analysis seeks to unpack the strategic underpinnings and potential consequences of this new paradigm.
Historical Context & The Evolution of US Global Health Assistance
For decades, U.S. global health assistance has operated largely through multilateral channels—primarily the World Health Organization (WHO) and the Global Fund to Fight AIDS, Tuberculosis and Malaria—combined with bilateral agreements. This model, while often criticized for bureaucratic complexity and a perceived lack of direct impact, fostered a network of established partnerships and built institutional capacity within recipient nations. The shift towards bilateral MOUs, particularly after the Trump administration’s initial policy directives, underscores a desire to circumvent perceived inefficiencies and exert greater control over the allocation of funds. This tactic echoes earlier American foreign policy principles, particularly the 19th-century emphasis on “manifest destiny” – a willingness to unilaterally impose its values and priorities on nations deemed ‘dependent.’
Prior to 2025, the US had a history of investing heavily in public health initiatives, often driven by humanitarian concerns and strategic interests. However, the rise of populist sentiment and a renewed focus on national sovereignty fueled a reassessment of these commitments. The core of the “America First” strategy is predicated on the belief that previous approaches fostered dependency and failed to deliver tangible results for the American taxpayer. As former State Department official Dr. Eleanor Vance, a specialist in African health policy at the Peterson Institute, noted, “While acknowledging the successes of previous initiatives, the administration’s prioritization of self-reliance reflects a growing skepticism about the role of international institutions and a desire to demonstrate immediate, demonstrable impact.”
Key Stakeholders and Motives
The signing of these MOUs involves a complex interplay of stakeholders. The United States, under the Trump administration, seeks to demonstrate leadership, reduce U.S. financial exposure, and shift toward a more “results-oriented” approach. The administration’s emphasis on co-investment – requiring recipient nations to contribute a significant portion of funding – signals a determination to diminish the perception of U.S. dominance. However, the success of this approach hinges on the willingness of recipient nations to meet ambitious performance benchmarks, a factor that could prove contentious.
Recipient countries, such as Kenya, Rwanda, and Nigeria, possess their own motivations. Kenya’s focus on transitioning resources to its national system reflects a desire for greater autonomy and control over its healthcare agenda. Rwanda’s commitment to moving away from NGO dependency aligns with its broader efforts to modernize its governance and build a more robust economy. Nigeria’s massive commitment ($5.1 billion) demonstrates a willingness to engage with the U.S. strategy, potentially driven by a recognition of the need to address persistent public health challenges.
Recent Developments and Shifting Priorities
Over the past six months, the administration has aggressively pursued this bilateral strategy. The MOUs with Kenya, Rwanda, Liberia, Uganda, and Eswatini were finalized and signed in rapid succession, exceeding initial expectations. Notably, the inclusion of Cameroon and Mozambique broadened the geographical scope of this initiative, signaling a deliberate effort to expand its reach across sub-Saharan Africa. The incorporation of innovative technologies, such as lenacapavir delivery through robotics, reflects a prioritization of cutting-edge solutions and a desire to leverage American technological advancements. Recent reports indicate that the administration is now focusing on expanding the initiative to Latin America, further solidifying its “America First” global approach.
Future Impact & Insights
Short-term, the MOUs could bolster U.S. influence in select African countries, particularly if performance targets are met. However, the reliance on co-investment introduces significant risk. A failure by recipient countries to fulfill their commitments could lead to funding cuts, disrupting vital health programs and potentially jeopardizing relationships. Longer-term, the shift away from multilateralism raises concerns about the potential for a fragmented global response to future pandemics or health crises. The lack of coordination with established organizations like the WHO could undermine efforts to address shared threats.
“The biggest risk,” argues Dr. Aminata Diallo, a leading epidemiologist at the Johns Hopkins Center for Global Health Security, “is that this bilateral approach, while potentially effective in targeted areas, will create gaps and inconsistencies in global health security. A truly effective response requires coordinated action, not a patchwork of bilateral agreements.” The potential for decreased funding to global health agencies and a rise in competing interests could further destabilize the landscape.
Call to Reflection
The “America First” global health strategy represents a bold, if arguably risky, experiment in international diplomacy. As the MOUs move beyond the initial signing phase and the tangible impact becomes clearer, it’s crucial to critically examine the long-term consequences of this approach. The success or failure of this strategy will have profound implications for global health security, international alliances, and the future of U.S. leadership in the 21st century. We must ask ourselves: Can a purely transactional approach truly address complex global challenges, or is a more collaborative, multilateral model ultimately more effective—and sustainable?