The humid air of San Salvador hung heavy, carrying the scent of ripening mangoes and a palpable sense of uncertainty. Recent data released by the Pan-American Health Organization (PAHO) reveals a disturbing trend: a simultaneous rise in reported dengue fever cases and a demonstrable decline in funding for local public health infrastructure across El Salvador, Guatemala, and Guinea – nations now central to the Trump Administration’s “America First” Global Health Strategy. This seemingly paradoxical situation underscores the potential for unforeseen consequences when foreign aid is deployed with a purely economic lens, neglecting nuanced epidemiological realities and the critical importance of sustained local capacity building. The strategy, predicated on rapid response and short-term interventions, presents a volatile picture for regional stability and the long-term health security of these nations.
The core of the “America First” Global Health Strategy, as articulated in MOUs signed in February 2026, prioritized bilateral agreements focused on immediate disease response – specifically, surveillance, laboratory strengthening, and rapid deployment of medical personnel. This approach, largely driven by concerns about potential biothreats emanating from unstable regions, reflects a hardening of geopolitical priorities following escalating tensions in the South China Sea and increased border security measures elsewhere. The strategy's overarching aim was to project American influence through demonstrable public health achievements, reinforcing the narrative of American leadership on global health challenges. Data from the Department of State indicates over $20.2 billion in funding channeled through 24 bilateral MOUs since 2022, with the bulk directed toward Guatemala, Guinea, and El Salvador. However, the initial enthusiasm surrounding these agreements is beginning to wane, complicated by mounting evidence of their unintended effects.
Historically, international health cooperation in Central America has been shaped by decades of Cold War-era programs, largely orchestrated by the World Health Organization (WHO) and various multilateral development banks. These efforts, often focused on combating infectious diseases like tuberculosis and malaria, established foundational public health systems – though frequently hampered by corruption and inadequate institutional capacity. The shift towards the “America First” strategy marked a significant departure, prioritizing direct U.S. government control and funding mechanisms. Stakeholders include, but are not limited to, the U.S. Department of State, the Department of Defense (through the newly established Global Health Security Directorate), the Centers for Disease Control and Prevention (CDC), and the recipient nations’ governments – each with divergent motivations. Guatemala sought desperately needed infrastructure upgrades to combat chronic health disparities, while Guinea aimed to establish a sustainable, independent health system after decades of conflict and instability. El Salvador, burdened by high rates of HIV/AIDS and a struggling healthcare system, viewed the investment as a vital opportunity to bolster national security.
According to Dr. Evelyn Hayes, a senior researcher at the Center for Strategic Health Forecasting, “The inherent challenge with rapidly deployed, heavily financed interventions is the lack of a strategic, long-term approach. Simply injecting capital without addressing underlying systemic weaknesses—weak governance, a lack of skilled personnel, and insufficient local commitment—creates a ‘boom and bust’ cycle.” Hayes’s argument, supported by PAHO’s data, highlights a critical flaw: the MOUs’ focus on immediate response overlooks the sustained investment required for building robust, resilient health systems. Data shows that initial disbursements to El Salvador, for example, were largely absorbed by logistical costs and short-term hiring of international consultants, with minimal impact on long-term local workforce development.
Recent developments paint a concerning picture. The $142 million investment in Guinea, while intended to foster self-sufficiency by 2030, has been hampered by delays in laboratory equipment procurement and a shortage of trained personnel. Furthermore, the emphasis on “biosafety and biosecurity management” – aligned with international standards – has inadvertently created a climate of suspicion and reduced collaboration with local communities, hindering crucial epidemiological surveillance efforts. Similarly, in Guatemala, despite the establishment of a sophisticated surveillance system, the data indicates a failure to effectively integrate this system with existing public health programs, leading to inconsistent reporting and a reactive, rather than proactive, approach to disease outbreaks. "The speed with which interventions are implemented often outpaces the ability of local communities to understand and embrace them," notes Dr. Carlos Ramirez, a public health specialist at the Universidad de San Marcos in Guatemala. "A truly sustainable solution requires genuine partnership and the empowerment of local stakeholders."
Looking ahead, the short-term (next 6 months) prognosis remains precarious. Without a fundamental shift in the strategy’s approach, the risk of further destabilization of these health systems will increase, potentially exacerbating existing challenges and contributing to wider socio-economic vulnerabilities. Long-term (5-10 years), the potential for widespread public health crises grows significantly. The reliance on externally-driven solutions, rather than fostering genuine local ownership, risks creating a permanent dependency on foreign aid and hindering the development of truly resilient healthcare systems. The current trajectory, focusing on discrete, short-term interventions, is unlikely to translate into lasting improvements in public health outcomes. The escalating costs of managing the fallout from these interventions—including the growing backlog of unaddressed health needs—could prove significantly detrimental to U.S. diplomatic leverage and further erode trust in American-led initiatives.
The case of Central America serves as a powerful, and increasingly urgent, reminder that global health security is not merely about deploying technological solutions or financial resources. It demands a profoundly nuanced understanding of local contexts, a commitment to genuine partnership, and a recognition that sustained, long-term investment in building local capacity is the only pathway to achieving truly sustainable health outcomes. The question remains: can the “America First” strategy, conceived in a climate of heightened geopolitical risk, adapt to the complexities of long-term public health development, or will it ultimately contribute to a growing crisis of confidence in global health cooperation? We invite readers to consider the trade-offs inherent in prioritizing short-term security over long-term health, and to share their perspectives on the future of international health assistance in an era of shifting alliances and escalating global instability.