Back to the Future - The Lancet Looks at the America First Global Health Strategy : Shared by Kul Gautam

An interesting critique of the America First Global Health Strategy - The Lancet

"The world still faces dire health threats that countries cannot fight alone without the infrastructure and medical solutions (eg, research and technology, data and monitoring, market shaping, and procurement) that only an international coalition can sustainably provide. The America First Global Health Strategy is a missed opportunity to mobilise that collective response to today's changed geopolitical, technological, and epidemiological circumstances".

Kul
The New America First Global Health Strategy Goes Back to the Future
The Lancet
November 14, 2025 (estimated based on document number)
Click here for the article

Summary:
After months of dismantling US global health engagement, the Trump administration released the America First Global Health Strategy in September 2025 as its affirmative vision for future US involvement in global health.

The strategy was released following the closure of USAID, a 67% reduction in annual global health awards, discontinuation of support for Gavi (the Vaccine Alliance), and withdrawal from WHO.

The State Department strategy outlines three pillars: making America safer, stronger, and more prosperous, focusing on HIV, tuberculosis, malaria, polio, and global health security.

The strategy commits to negotiating bilateral, multi-year agreements with recipient countries by December 31, 2025, with implementation beginning by April 2026. It pledges to fund 100% of frontline commodity purchases and 100% of frontline healthcare workers who directly deliver services to patients.

However, the majority of the 71 US-supported countries will be required to transition to full self-reliance during the agreement term.

All US government health foreign assistance programs will be administered by the State Department rather than through multiple agencies.

The strategy emphasizes disease surveillance, outbreak containment, promotion of American health products abroad, and eliminating what it calls a "culture of dependency" among aid recipients. Critics note the strategy's silence on continued support for routine immunization, maternal health, and comprehensive pandemic preparedness, and express concern that the rapid phase-out timeline could reverse hard-won gains against major infectious diseases.

Quotes:
"After months of effectively dismantling the architecture of US global health engagement by closing the US Agency for International Development, reducing its annual global health awards by an estimated 67%, discontinuing support for Gavi, the Vaccine Alliance, and withdrawing from WHO, the Trump administration has released its affirmative vision of what comes next."

America First Global Health Strategy
Marco Rubio (Letter from the Secretary) / U.S. Department of State
United States Government
Click here for the full document 

1. U.S. aid has saved millions, but the system is “broken.”
The document claims U.S. global health aid (especially PEPFAR) has saved 26 million lives, but is now inefficient, wasteful, and fosters dependency. Only ~40% of funds reach frontline care; ~60% go to overhead, technical assistance, and management.

2. The strategy reframes global health as a tool for U.S. interests.
Rather than emphasizing global solidarity, the plan positions health aid as a lever to:
• Protect Americans from outbreaks
• Compete with China
• Expand markets for U.S. health products
• Strengthen strategically important bilateral relationships

3. Pillar 1 – Make America Safer.
Build dense bilateral surveillance networks in every country; detect outbreaks within 7 days; respond within 72 hours; surge U.S. staff, diagnostics, and countermeasures; integrate HIV/TB/malaria labs into a single outbreak surveillance system.

4. Pillar 2 – Make America Stronger.
Shift from multilateral/global programs to country-by-country bilateral agreements.
These will require:
• 100% U.S. funding for commodities and frontline workers initially
• Gradual co-financing by partner governments
• Strict performance benchmarks and data-sharing with the U.S.
• Major cuts to technical assistance and NGO intermediaries
• Integration of HIV/TB/malaria/polio programs into national systems
• Expanded use of private sector and faith-based providers
The long-term aim: move most countries to “full self-reliance” and significantly shrink U.S. program footprints.

5. Pillar 3 – Make America More Prosperous.
Use health aid to promote American business:
• Prioritize procurement from U.S. companies
• Promote U.S. pharmaceuticals and diagnostics in emerging markets
• Support regulatory recognition of FDA-approved products abroad
• Grow commercial partnerships in logistics, labs, clinics, and data systems
Outbreak containment is framed as an economic safeguard for the U.S.

6. Strong critique of NGOs and multilateralism.
The report argues NGOs perpetuate themselves, inflate overhead, create fragmented systems, and resist transition to government control. The plan shifts power and funding away from NGOs toward governments, private companies, and faith-based groups.

7. Aggressive timeline for restructuring.
By Dec 31, 2025, most major recipient countries should sign new bilateral agreements.
By April 2026, implementation begins under the new model.