Promise and gaps in America First strategy for global health

Plans are based on credibility the Trump administration does not have Just before the 2025 UN General Assembly, US secretary of state Marco Rubio released the America First Global Health Strategy .1 The title openly clashes with long established global health values of multilateralism and international cooperation. But it is also a pivot away from the widespread chaos caused by the Trump administration’s swift and brutal actions, including disrupting the President’s Emergency Plan For AIDS Relief (PEPFAR), America’s signature foreign policy achievement, withdrawing from the World Health Organization, dismantling USAID, ending funding for the Gavi vaccine alliance, and slashing the leadership, staff, and budget of the US Centers for Disease Control and Prevention (CDC).2345 It seems to be a call for a return to order. While the first reaction might be scepticism, the new strategy launches a foreign assistance model based on reforms that experts have pushed for years—with little action and woeful political will. It comprises five key elements. First, it calls for negotiated partner country agreements (“compacts”) that specify upfront co-financing with timelines for transition to self-reliance and are reliably enforced. African and other leaders are already embracing “health sovereignty,” moving from acute dependence on western aid to resilient national health systems.67 That …