Historically, global health initiatives like PEPFAR (President’s Emergency Plan for AIDS Relief) and the Global Fund to Fight AIDS, Tuberculosis and Malaria have been built on a foundation of decentralized, adaptive funding models. These programs, while demonstrably effective in combating specific diseases, fostered a network of partnerships with international organizations, NGOs, and local governments, often leading to flexible resource allocation and a capacity for rapid response to evolving needs. The “America First” strategy challenges this approach, demanding strict adherence to pre-defined targets within bilateral agreements. The stated goal is to “rapidly transition U.S. technical assistance from supporting individual clinical sites to supporting governments in taking over key functions,” a shift that has raised concerns about the long-term sustainability of healthcare systems in recipient nations.
Recent developments in the past six months further underscore the strategy’s focus. The World Health Organization’s (WHO) efforts to coordinate a global response to the emerging Xylospora variant, initially detected in Southeast Asia, saw a delayed US response, with initial funding and technical support contingent on the negotiation of a bilateral agreement with Vietnam, a process that took nearly three months. This contrasts sharply with the rapid, collaborative global response during the COVID-19 pandemic, where the US was a key contributor to early vaccine development and distribution, albeit often outside of established multilateral frameworks. The Xylospora incident highlighted a key tension: while the US prioritized containment, its actions were perceived by some international partners as reactive and lacking the proactive engagement characteristic of previous US health diplomacy.
Experts within the think tank, the Center for Strategic and International Studies (CSIS), argue that the strategy’s emphasis on co-investment—requiring recipient governments to contribute financially and meet pre-defined benchmarks—is a necessary step for ensuring accountability. “The current system lacked a clear mechanism for measuring impact,” stated Dr. Emily Carter, Senior Fellow at CSIS’s Global Health Policy Center. “For too long, funding was allocated without sufficient oversight, leading to inefficiencies. A performance-based approach, while potentially disruptive, is crucial for optimizing resource utilization and fostering genuine partnerships.” However, critics, including representatives from Oxfam International, contend that such a rigid system risks undermining local ownership and exacerbating existing inequalities, particularly in fragile states with limited capacity for robust governance.
Looking forward, the strategy’s short-term impact will likely be felt in the intensified negotiations surrounding bilateral agreements. The stated goal of completing these agreements with the vast majority of recipient countries by December 31, 2025, is an ambitious timeline, potentially leading to a fragmented landscape of international health security efforts. In the long term (5-10 years), the strategy could lead to more resilient national healthcare systems in participating countries, bolstered by demonstrable performance metrics. Conversely, a poorly implemented strategy, characterized by bureaucratic hurdles and a lack of genuine collaboration, could further erode trust in international health institutions and undermine global efforts to combat emerging infectious diseases. The success – or failure – of the “America First” Global Health Strategy hinges on a delicate balance between safeguarding U.S. national interests and maintaining a cohesive, globally coordinated response to the ever-evolving challenges of international health security.
The core question remains: can a strategy rooted in a renewed emphasis on national security effectively address the complex, interconnected nature of global health threats, or will it ultimately prove to be a short-sighted approach that jeopardizes both U.S. national interests and global health security?