U.S. leadership in global health has long reflected two truths: First, what happens abroad matters here at home, and second, America has both a national security interest and a moral responsibility to act. Investing in the health, safety, and stability of communities around the world not only saves lives but also strengthens American security, prosperity, and global partnerships.
Programs like the President’s Emergency Plan for AIDS Relief, the President’s Malaria Initiative, and the Millennium Challenge Corporation have shown policymakers that protecting national interests and acting with compassion are mutually reinforcing.
You can read my latest article focused on the fundamental place of compassion in the American First global health agenda here.
Bush Institute Insights
Global health funding and programs are sometimes framed as a humanitarian “gift” that only benefits recipients, rather than donor countries. However, decades of progress have shown that global health investment is equally a strategic tool for U.S. national security interests and a humanitarian imperative. In my latest piece titled “Global health should be a foreign policy tool and an act of compassion,” I discuss how American compassion coupled with domestic interest led to PEPFAR’s success, and make the case for why U.S. leadership should build on this foundation in bilateral negotiations under the America First Global Health Strategy.
In 2003, PEPFAR was launched following 9/11, recognizing that instability threatens security at home. By addressing HIV/AIDS at scale, the U.S. helped stabilize economies, strengthen governance, and reduce the conditions that fuel conflict. The results are measurable. PEPFAR has saved more than 26 million lives and helped nearly 5.5 million babies to be born HIV-free. These investments have engendered good will toward the United States and also delivered tangible returns for Americans, from stronger trade relationships to access to emerging markets.
As the George W. Bush Institute has outlined in the PEPFAR Beyond 2030 series, not all countries will be able to immediately assume full responsibility for HIV/AIDS efforts due to differing economic and political challenges. Dr. William Steiger, CEO of Malaria No More, and I have identified specific cases that require a more gradual transition. As the U.S. continues to negotiate bilateral health agreements, maintaining accountability through independently verified, data-driven programming, while accounting for partner countries’ local needs, will be essential to sustain both health gains and national security benefits.
America First Global Health Strategy Update
As of March 19, the U.S. Department of State has signed bilateral health agreements with 27 countries, totaling $20.2 billion in combined health financing from 2026 to 2030. In a recent agreement with Angola, the U.S. committed $71 million, alongside $50 million from Angola, to support global health security, including HIV and malaria mitigation. In Honduras, the U.S. will invest $29.6 million with $16.9 million in domestic co-financing, including support for global health security. In Senegal, $63.1 million in U.S. investment will be paired with $27.3 million in local investment to strengthen HIV and malaria programs, health systems, and digital infrastructure.
In remarks outlining a reset of U.S.-Africa policy, U.S. State Department Senior Bureau Official for Africa Nick Checker emphasized a shift from “aid to trade” and a broader move toward partnerships grounded in mutual economic and security interests. This reset prioritizes commercial diplomacy, including support for major investment deals and critical mineral supply chains, alongside a rethinking of foreign assistance as “strategic capital” tied to accountability and country ownership. This model aligns with ongoing bilateral agreements aimed at transitioning countries toward self-reliance. The remarks also highlight continued U.S. engagement in conflict resolution on the continent where U.S. interests are directly implicated.
Figure of the Week
282 million malaria cases globally in 2024
Malaria remains one of the world’s most persistent and deadly infectious diseases, with an estimated 282 million cases and 610,000 deaths in 2024. The majority of 2024 cases affect children under five in sub-Saharan Africa. While expanded access to prevention and treatment has driven progress over the past two decades, recent gains have stalled due to challenges such as drug and insecticide resistance, climate pressures, and weak health systems.
The U.S. remains the largest government investor in global malaria efforts, investing approximately $1 billion annually into the U.S. President’s Malaria Initiative (PMI) as well as other malaria control efforts and research activities. Under the America First Global Health Strategy, the path forward for PMI remains unclear. Recently, Friends of the Global Fight co-hosted a panel discussion, “Making malaria transitions sustainable: A view from African Communities,” featuring visiting experts, advocates, and faith leaders from Zambia, Mozambique, Senegal, and Kenya, who shared perspectives and learnings on advancing sustainable country-led transitions for malaria.
Ally Updates
The Elizabeth Glaser Pediatric AIDS Foundation released a landscape analysis, Protecting Lives, Sustaining Progress: U.S. Leadership in Global HIV and Maternal and Child Health.
The analysis looks at HIV prevention, diagnosis, and treatment to provide recommendations for U.S. engagement in these areas. Since 1996, due to investments in prevention and treatment of HIV, new HIV infections have declined by 61% and HIV-related deaths by 70%, while maternal and newborn deaths have fallen by roughly 40%. However, major gaps persist. Children represent just 3% of people living with HIV but account for 12% of HIV-related deaths, and global progress to eliminate HIV/AIDS as a public health threat is now stalling.
To sustain gains in maternal and child health, the analysis calls for responsible, well-managed transitions of PEPFAR and global health investment, as well as protection of pediatric HIV programs and greater investment in integrated maternal and newborn care. The analysis also highlights the need to accelerate innovation, such as long-acting HIV prevention tools and new pediatric formulations, and to strengthen accountability in bilateral partnerships through clear targets, transparent reporting, and measurable outcomes.
In the News
- While HIV programs operated under PEPFAR and funded by the U.S. Centers for Disease Control and Prevention (CDC) have been extended through June, they are operating without new funding and instead relying on contingency funds, reports Devex. The U.S. Department of State has transferred less than half of the typical funding to CDC this fiscal year, creating planning challenges and forcing some programs to scale back services. While Congress allocated $4.6 billion to PEPFAR, the funds have not been fully disbursed as the U.S. shifts to bilateral health agreements under the America First Global Health Strategy. Without timely disbursement, these disruptions could undermine the continuity of lifesaving HIV treatment and prevention services.
- In the transit tunnel of the Atlanta airport, a sculpture asks a question that defines the height of the AIDS epidemic: “Who Will Raise the Child?” In the 1990s, millions of children across Africa were orphaned as HIV spread unchecked, leaving families and communities to carry an unimaginable burden. Terry Repak, who lived in Africa during the height of the epidemic, recalls seeing mothers and fathers lost to a disease that was then a death sentence. She also witnessed what happened when that trajectory changed. When effective treatment (ARVs) became available in Africa through the President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. helped save more than 26 million lives and spare tens of millions of children from losing a parent.
- In partnership with the Modernizing Foreign Assistance Network, former USAID officials and a civil society partner produced a road map outlining the principles for effective government-to-government (G2G) assistance under the America First Global Health Strategy. The authors argue that this roadmap will help enable partner governments to better navigate the transition to direct investment. They also suggest that a successful “America First” implementation will require rebuilding the U.S. Department of State’s capacity to negotiate and design programs, strengthening relationships with partner governments, and ensuring meaningful engagement with local institutions and civil society.
- In a blog post for the Center for Global Development (CGD), William Savedoff, a former senior fellow at CGD, argues that middle and small countries must collaborate on vaccine production to ensure timely and equitable access to vaccines, particularly as production remains concentrated in a handful of large countries. These coalitions could create larger markets, strengthen regulatory capacity, and improve resilience, while giving countries a chance to build the infrastructure, skilled workforce, and regulatory systems needed to sustain vaccine production.
- Attacks on healthcare in conflict zones remain at historically high levels, with 2,723 incidents reported globally in 2025. While slightly lower than 2024, the figures indicate a growing “new norm” of violence against medical personnel and facilities. Conflict hotspots, including Ukraine, Gaza, the Democratic Republic of the Congo, Myanmar, and Sudan, continue to see widespread disruption to care. In Sudan, where nearly 12 million people have been displaced, attacks have contributed to the collapse of health infrastructure and rising disease outbreaks.
- A mother dies during childbirth nearly every two minutes in low- and middle-income countries. At the 2026 International Maternal Newborn Health Conference in Kenya, experts discussed this concerning prevalence of preventable maternal and child deaths. While most deaths can be prevented with low-cost interventions that already exist, gaps in access, affordability, and supply chains make scaling access to basic medicines and innovations difficult. Health leaders emphasized the need to ensure essential commodities reach health facilities on time, alongside domestic prioritization for interventions and smarter financing.
