U.S. RELEASES “AMERICA FIRST GLOBAL HEALTH STRATEGY.” U.S. Department of State official communication.
To the American People:
The United States is the world’s health leader. More innovative drugs and medical devices
are developed in the United States than anywhere else in the world. If you are sick, there is
nowhere you would rather be cared for than in the United States.
Over the past several decades, we have extended our health leadership globally. We have
helped contain thousands of infectious disease outbreaks around the world, stopping
numerous potential pandemics in their tracks before they could reach our shores. Our
health foreign assistance programs, most notably the President’s Emergency Plan for AIDS
Relief (PEPFAR), have saved over 26 million lives and prevented 7.8 million babies from
being born with HIV / AIDS. There is much to be proud of.
But there are also many problems – our foreign assistance programs are deeply broken.
Our health foreign assistance programs in particular have become inefficient and wasteful,
too often creating parallel healthcare delivery systems and a culture of dependency among
recipient countries. Many of the NGOs who support these programs have committed many
times to helping transition the work to local governments, but little progress has been made.
This is often not because of a lack of willingness on behalf of recipient countries but rather
because of our broken foreign aid system and the perverse incentives that encourage NGOs
to self-perpetuate.
We must keep what is good about our health foreign assistance programs while rapidly
fixing what is broken – and this strategy lays out a plan to do just that. We detail an America
First Global Health Strategy that uses global health diplomacy and foreign assistance
to make America safer, stronger, and more prosperous. We lay out a vision to end the
inefficiencies, waste, and dependency of our current system. In its place, we cast a positive
vision for a future where we stop outbreaks before they reach our shores, enter strong
bilateral agreements that promote our national interests while saving millions of lives, and
help promote and export American health innovation around the world.
We will continue to be the world’s health leader and the most generous nation in the world,
but we will do so in a way that directly benefits the American people and directly promotes
our national interest. We look forward to making this vision a reality in the months and
years ahead.
Sincerely,
Marco Rubio
United States Secretary of State
Executive Summary
The United States is the world’s global health leader. Over the last 25 years, the United
States’ global health programs have prevented thousands of infectious disease outbreaks
from reaching American shores, saved over 26 million lives, and prevented 7.8 million babies
from being born with HIV / AIDS.
However, our global health programs have become inefficient and wasteful. Today, less than
40% of health foreign assistance funding goes to frontline supplies and healthcare workers.
This includes approximately 25% of funds that are used for the purchase of commodities
(e.g., diagnostics, drugs) and approximately 15% of funds that are used to employ over
270,000 frontline healthcare workers (e.g., mostly nurses and community health workers).
The remaining 60% of funding is spent on technical assistance, program management, and
other forms of overhead.
This inefficiency has built up over time for a number of reasons. In the early days of the
HIV / AIDS response, there was minimal health delivery capacity in many of the most
affected countries. As a result, the United States often chose to invest in directly building
health delivery capabilities, often minimally connected to national health systems. While
this strategy was successful in dramatically improving health outcomes, it has also too
often resulted in parallel procurement systems, parallel supply chains, program-specific
healthcare workers, and program-specific data systems.
This problem has only been exacerbated by the significant amount of funding Congress has
continued to dedicate to global health programs in recent years, which has provided little
incentive to change. The problem is further exacerbated by NGOs who are the recipient of
much of this funding (especially for technical assistance and program management) who
have perverse incentives to self-perpetuate rather than work towards turning functions over
to local governments. As a result, even though the last three presidential administrations
have developed strategies to transition global health programs to increased local ownership,
very little progress has been made. It is time for that to change.
In the following pages, we lay out a positive and forward-looking vision for United States
leadership in global health – an America First Global Health Strategy. We lay out a plan
that will prioritize the interests of Americans and make America safer, stronger, and more
prosperous. And as we do so, we will help save millions of lives around the world and assist
foreign countries in developing resilient and durable health systems.
SAFER. We will keep Americans safe by continuing to support a global surveillance system
that can detect an outbreak within seven days. We will accomplish this through bilateral
relationships with countries that include having a U.S. government staff presence on the
ground where possible, with a larger number of staff dedicated to geographies with the
highest risk of an outbreak. When there is an outbreak, we will be prepared to work with
local governments to respond promptly. We will be prepared to surge resources to ensure
the outbreak is contained, travelers are appropriately screened, and – to the maximum
2025 America First Global Health Strategy | 4
extent possible – the outbreak does not reach American shores or harm Americans living
abroad.
STRONGER. Our global health foreign assistance program is not just aid – it is a strategic
mechanism to further our bilateral interests around the world. Moving forward, we will
utilize our health foreign assistance to advance U.S. priorities and move countries towards
resilient and durable local health systems. We will do this thoughtfully, by entering multi-year
bilateral agreements with recipient countries that lay out clear goals and action plans.
These bilateral agreements will ensure funding for 100% of all frontline commodity
purchases and 100% of all frontline healthcare workers who directly deliver services to
patients. We will also partner with each country to ensure there are data systems in place
that can both monitor potential outbreaks and broader health outcomes. We will ensure
these systems are integrated into the long-term health information systems of a country
so that we can monitor outbreaks and health outcomes well into the future. We will also
work to rapidly transition technical assistance from supporting individual clinical sites
to supporting governments in taking over key functions. This will include more govern-
ment-to-government assistance as well as leveraging the private sector and faith-based
organizations. Finally, we will ask governments to co-invest in these efforts and work with
the United States to align on performance benchmarks that will be required for releasing
future U.S. health foreign assistance funding.
We aim to complete bilateral agreements with recipient countries receiving the vast
majority of U.S. health foreign assistance by December 31, 2025 with the goal of beginning
to implement these new agreements by April 2026.
MORE PROSPEROUS. We will first and foremost make America more prosperous by
helping contain outbreaks at their source, protecting American lives and the American
economy. We will also leverage our foreign assistance to promote American companies
and American innovations abroad, including continuing to procure goods from American
companies as part of our foreign assistance programs. We will also leverage our bilateral
relationships with countries to promote American health innovations and products more
broadly globally, helping ensure that American innovation becomes a cornerstone of health
systems around the world.