US Cuts Global Health Funding Amid Strategy Shift

When US President Donald Trump reawakened the ‘America First’ mantra during his second inauguration in January 2025, few could have foreseen the disruptions and chaos that he intended to unleash on the global arena. “During every single day, I will, very simply, put America first,” he said. True to his words, Trump has caused widespread turmoil, with the US global health programmes being among the biggest casualties.

The administration contends that the America First Global Health Strategy (AFGHS) will make the US safer, stronger and more prosperous. Through the strategy, the US intends to pivot away from open-ended aid to a system that puts emphasis on accountability, clear objectives and defined milestones within stipulated timelines.

Disruptions to Global Health Programmes

The dismantling of the US Agency for International Development (USAID) has created widespread and devastating health funding gaps. Nigeria and Botswana are cases in point, with the former left with a whopping $600m hole, while Botswana lost a third of its HIV response funding. Notably, USAID was a key implementing agency of the $110bn President’s Emergency Plan for AIDS Relief (PEPFAR) that has saved over 26 million lives since 2003.

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The decision by the Trump administration to withdraw the US from the World Health Organisation (WHO) sent shockwaves across the global health systems. The US withdrawal was a major blow considering Washington was the top donor providing between 12 and 15 percent of its funding. In 2022–23, the US contributed $1.2bn.

According to Marco Rubio, US Secretary of State, “We must keep what is good about our health foreign assistance programmes while rapidly fixing what is broken. This strategy lays out a plan to do just that.” The administration has built a strong case for AFGHS, citing the need to address inefficiency and wastefulness in the current system.

Of the billions allocated for foreign health assistance annually, less than 40 percent is used for supplies and healthcare workers. The fact that 60 percent is spent on ambiguous expenditures and overhead smacks of wastage. PEPFAR is the poster child of wastage, with $3.1bn of its $4.7bn budget spent on activities such as training, mentorship, supervision, and quality management.

Impact on Global Health

Critics reckon AFGHS is not only exposing the globe to vulnerabilities of outbreaks but is also a clear representation of modern-day biomedical imperialism by the US. Since its launch in September 2025, at least 28 countries have signed memoranda of understandings (MOUs) with the US.

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For the countries that have signed the bilateral agreements, US State Department data show Washington has availed $12.7bn in assistance with partner governments contributing $7.8bn in co-financing commitments. However, most countries are feeling the heavy weight of co-investing, with Nigeria required to raise $3bn, an amount that is close to 40 percent of its 2025 health budget allocation.

The co-investment provisions respond to a longstanding concern across Africa that external aid can create dependency and leave health systems vulnerable when donor funding is withdrawn. However, it is also locking countries into spending commitments that are difficult to meet. The challenge is compounded by the fact that in some of the MOUs, the US is tying financing to sensitive data sharing, such as sharing biological specimens and genetic sequence data of pathogens with epidemic potential.

Zimbabwe is among countries that have turned their backs on the agreements, despite being eligible for $367m in US funding, after it was told to share sensitive data. A near similar situation unfolded in Kenya, the first country to sign the MOUs, with implementation suspended by the High Court over concerns on data protection and the constitutionality of the agreement.

According to Michele Barry, Director of the Centre for Innovation in Global Health and senior associate dean for Global Health at Stanford University, “Global health crises cannot be contained through a patchwork of bilateral agreements.” She adds that outbreaks demand cooperation, coordinated, multilateral responses rooted in trust and shared responsibility.

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The agreements are being termed as ‘patchworks’ because they are time-bound, averaging five years, and contain withdrawal clauses, with any party free to exit upon giving a notice of 180 days. This creates room for abrupt disruptions of programmes, some of which are designed to run for years. The US plans to arm-twist countries and tie funding to access to critical minerals, such as copper, cobalt, and lithium, have ended up backfiring in some cases, such as in Zambia.

The implementation of AFGHS has been met with resistance from several countries, with some refusing to sign the agreements due to concerns over data sharing and sovereignty. In Zambia, the US plans to tie funding to access to critical minerals such as copper, cobalt, and lithium were met with strong opposition, and the deal ultimately fell through. This has raised questions about the effectiveness of the AFGHS in achieving its stated goals, particularly in terms of creating markets for US health innovations and products.

Long-term Consequences

The long-term consequences of AFGHS are still unclear, but it is likely that the strategy will have a significant impact on global health systems. The fact that 28 countries have already signed memoranda of understandings with the US suggests that the strategy is gaining traction, despite the concerns and criticisms. However, the resistance from countries such as Zimbabwe and Zambia, as well as the suspension of the agreement in Kenya, highlights the challenges that the US faces in implementing AFGHS.