The Scoop
The State Department is rolling out a new approach to global health aid that will focus on bilateral agreements with enforceable terms, according to a report on the plan reviewed first by Semafor.
The “America First” strategy, as it’s titled internally, aligns with a broader bid by the Trump administration to pare back international assistance that doesn’t focus on “the interests of Americans.” It follows sweeping cuts across federal agencies, including the hollowing-out of the US Agency for International Development and the pausing of some funding for PEPFAR, the federal government’s central AIDS relief program.
“Health assistance is humanitarian in nature, but it’s also a strategic investment,” a senior State Department official told Semafor. “Every dollar that we spend, every dollar on foreign assistance, [as] the Secretary said, consistently has to be in the national interest.”
The Trump administration has already developed draft plans for global health cost-sharing that it expects to share with countries in the coming weeks, though the State Department official said it’s “open to negotiation” about the terms of the individual agreements.
While each deal will likely differ under the new strategy, the administration has vowed to pay “100% of the frontline costs” that it previously paid for — including frontline healthcare workers — until the start of the next fiscal year. The administration’s goal is to begin implementing the new agreements by next spring.
For future years, the percentage of global health costs covered by the US versus other nations will change. Some of the bilateral agreements are expected to include third-country allies that also deliver assistance, in an effort to reduce overlap.
The Trump administration also plans “to change the regional makeup a little bit” in terms of which countries are prioritized for investments, the senior department official told Semafor.
Countries seen as key allies, for example, may experience greater support than those less friendly to the US.
“Africa is going to continue to be a focus, but we’re going to invest more in Western Hemisphere. We’re going to invest more in Asia-Pacific. We’re investing a quarter of a billion dollars in the Philippines, which is something we’re really, really excited about,” the official said.
“They are going to be bespoke, country-level strategies and plans that are based on the disease metrics, based on the wealth, based on the strategic location of the countries.”
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The Trump administration hopes its strategy can reduce what it has argued is a “culture of dependency” created by previous international assistance practices. The State Department’s stated goal is for countries to become more self-sufficient and for various public health programs to eventually shift to “long-term country ownership,” according to the report outlining the plan.
“We have a broader set of foreign assistance, and also diplomatic sort of benefits and carrots, that we can give countries as part of this compact structure to make sure that they are properly incentivized to assume responsibility for [their] national health care architecture,” the official said.
Some countries will experience “changes in funding” as a result of the incoming shifts. It’s unclear how much money the US plans to spend with this new program, but it’s likely to be lower than prior years. In the fiscal year 2024, the US spent around $10 billion on global health.
The president’s fiscal year 2026 budget proposal recommends roughly $4 billion for global health funding. That may mean particularly acute changes in Africa, where PEPFAR was a critical program.
“Part of the purpose of integrating all these foreign assistance into the State Department is to make sure that our diplomatic and sort of strategic priorities are always represented,” according to the official.
“We’re integrating this across different diseases for the first time,” the official added, describing increased disease surveillance as a critical goal.
The new plan comes as US-Africa watchers in Washington who spoke with Semafor raise quiet concerns about the Trump administration’s openness to working with multilateral health institutions like Africa CDC, which works on communicable diseases that cross national borders.
There is language in the new report endorsing “multilateral relationships for targeted purposes,” however, “with a focus on identifying surveillance capabilities that the United States is not able to obtain through a bilateral relationship alone.”
The administration plans to discuss its new global health strategy at the upcoming United Nations General Assembly, slated to take place in New York this month, and hopes for agreements to be ready and operational by early next year.
Notable
- In August, the State Department announced its plans to provide $93 million in new food aid to 13 countries, many of them African nations, Semafor reported.
- One of President Trump’s first presidential actions was to sign a notice of the administration’s plans to withdraw from the World Health Organization.
Yinka Adegoke contributed.