On 18 September the US government published the America First Global Health Strategy, a major shift in how the country engages with low- and middle-income countries (LMICs). The document frames global health as a tool to advance American safety, prosperity and influence, and it directly criticises existing programmes as "inefficient and wasteful" and as having created a culture of dependency among recipient countries. Key priorities include containing infectious disease outbreaks before they reach US soil, strengthening bilateral relationships, and promoting American health innovation worldwide.
The strategy conditions some funding on LMIC co-investment and meeting performance benchmarks. Policy and health experts say this could encourage accountability and local ownership, but they warn the conditions could become punitive if countries cannot increase domestic spending. Jirair Ratevosian described the policy as "an opportunity and a risk": it could accelerate US strengths such as long-acting prevention, cure research and AI-driven surveillance, yet a too America-centric approach risks sidelining LMIC researchers and missing local epidemic realities. The article cites HIV research as an example: PEPFAR has saved more than 26 million lives since 2003, and lenacapavir trials in Uganda and South Africa helped secure global approval.
Beatriz Grinsztejn, president of the International Aids Society, said the strategy raises major questions about US funding, the future of HIV prevention services, and whether donor countries can increase health budgets. She also warned that the proposed "sunset" of UNAIDS by the end of 2026 underlines the need to protect HIV as a global priority. Earlier actions, including the dismantling of USAID and 90-day funding freezes, were said to have crippled research in some places. In response, the Project Resource Optimization (PRO) Initiative mobilised US$110 million from private donors to keep more than 80 high-impact projects alive; experts say such stopgaps cannot match sustained US assistance. The key questions now are whether LMICs can sustain domestic health financing, whether collaborations will remain science-led, and how donor and multilateral programmes such as PEPFAR and the Global Fund will adapt to the new strategy.
Difficult words
- co-investment — joint financial contribution by two or more parties
- benchmark — standard used to measure performance or progressbenchmarks
- accountability — responsibility to explain actions and accept consequences
- ownership — local control and responsibility for programmes
- punitive — intended to punish or cause penalty
- surveillance — systematic monitoring to detect disease or threats
- mobilise — bring together resources and support quicklymobilised
- sustain — maintain support or activity over a long time
- multilateral — involving multiple countries or international organisations
Tip: hover, focus or tap highlighted words in the article to see quick definitions while you read or listen.
Discussion questions
- How might conditioning funding on co-investment affect local ownership and accountability in LMIC health programmes? Give reasons.
- What are the possible benefits and dangers of a more America-centric global health approach for research and local epidemic responses?
- Do you think LMICs can realistically sustain domestic health financing without sustained donor support? Explain with examples or reasons.
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