Keypoints:
- US shifts from multilateral health funding
- Aid tied to bilateral benchmarks and co-investment
- Critics warn of global health risks
THE Trump administration has launched its long-awaited ‘America First Global Health Strategy’, signalling a sharp break from decades of multilateral health collaboration. The new plan, announced on Thursday, comes as many international programmes struggle with the impact of earlier US funding cuts.
Bilateral focus over multilateral efforts
According to a US Department of State fact sheet, the strategy prioritises American interests and seeks to make the country ‘safer, stronger and more prosperous’. It shifts health assistance away from organisations such as the World Health Organisation (WHO) and the US Agency for International Development (USAID) toward multi-year bilateral agreements. These deals will be tied to clear performance benchmarks and co-investment requirements, effectively giving Washington greater control over where and how US dollars are spent.
The administration intends to safeguard funding for frontline health workers and essential medical supplies while sharply reducing technical assistance and overhead costs. Officials said that under current programmes, less than 40 per cent of health foreign assistance goes directly to frontline supplies and workers – a ratio the new model aims to reverse.
Key pillars of the strategy
The framework is built on three main pillars:
- Protecting the US from outbreaks by strengthening global surveillance and ensuring epidemics are contained before reaching American shores.
- Using health assistance to build bilateral relationships and press governments toward ownership of their own health systems.
- Leveraging health aid to promote US medical innovation and encourage the procurement of goods from American companies.
This approach, the State Department argues, will help recipient nations build ‘resilient and durable local health systems’ and reduce dependency on foreign aid.
Mixed reactions from experts
Since taking office in 2017, the Trump administration has withdrawn billions of dollars from the WHO, cut USAID’s health budget and scaled back regional health initiatives. Those moves left many programmes combating HIV, malaria and maternal mortality struggling to fill gaps in staffing and supplies.
Public health experts view the latest strategy as both a withdrawal from multilateral health institutions and a bid to reassert American priorities. Critics warn the plan could weaken global institutions and worsen inequalities in lower-income countries by bypassing mechanisms designed for coordinated pandemic responses. Others, however, see potential benefits in the focus on accountability and local ownership, which might address inefficiencies in long-running programmes.
The administration aims to finalise bilateral agreements with most aid recipients by December 31, with implementation slated for April 2026. Whether countries and global health partners – already stretched by funding cuts – can adapt to this new ‘America First’ approach remains uncertain.
