The 39th session of the African Union was hosted in Addis Ababa, Ethiopia from February 14-15. The summit gathered heads of state, ministers, and regional partners to discuss priorities across the continent. This year’s conversations differed from years past as countries across Africa complete bilateral health agreements with the United States under the America First Global Health Strategy.
Africa stands at the precipice of significant change. As outlined in the Bush Institute’s series, Unparalleled Partnerships with Africa, the continent is home to significant opportunities, the youngest population, and some of the world’s fastest growing economies. However, as you’ll see below, my colleagues highlight that this year’s AU summit met at a time when Africa also faces an unprecedented landscape of conflict, human rights challenges, and democratic backsliding.
Many countries across the continent also continue to face the greatest threats to global health – HIV/AIDS, tuberculosis, and malaria. This year’s AU summit emphasized the value that regional agreements, like the Lusaka Agenda, can have in fostering transparency, accountability, and mutual responsibility between country governments, partners like the President’s Emergency Plan for AIDS Relief (PEPFAR), and intergovernmental organizations.
As the United States continues to transition PEPFAR and U.S. global health engagement to bilateral agreements with country governments, the U.S. government must consider extenuating circumstances – like economic, political, and social insecurity – that make the transition to country ownership difficult. They must also consider and support the valuable regional bodies that can foster greater collaboration on the continent.
Figure of the Week
$255 billion return on $46 billion U.S. public investment in global heath research and development (R&D) from 2007-2022.
A study highlighted in a Think Global Health analysis found that U.S. public spending of $46 billion on global health R&D from 2007–2022 yielded a sixfold return on investment for the country, amounting to $255 billion.
This return included 600,000 U.S. jobs, $104 billion in economic activity, and an additional $102 billion in industry investments. The analysis also finds that every dollar invested in neglected disease R&D can generate $405 in social and health returns. Health development investments create economic gains, strengthen global health security, boost trade, and enhance diplomatic influence for donor countries.
The Health Security Policy Academy created an interactive dashboard tracking the annual U.S. commitment to global health from 2017 to 2025. For a more comprehensive understanding of U.S. global health spending, you can view the tracker here.
Ally Updates
Friends of the Global Fight, Malaria No More, and United to Beat Malaria co-published a new report outlining a roadmap for sustainable, country-led malaria control. The report highlights how U.S.-supported innovation and partnerships have helped reduce annual malaria deaths from 864,000 in 2000 to 610,000 in 2024, eliminate malaria in 21 countries, and build surveillance systems that strengthen broader health security.
But the work is not complete. After decades of progress, the global malaria response faces mounting challenges, including drug and insecticide resistance, climate-driven instability, and declining international financing.
To sustain progress under the America First Global Health Strategy, the report calls for strengthening domestic capacity, unlocking innovative financing such as debt swaps and blended finance, and enhancing accountability through public-private and faith-based partnerships to prevent malaria resurgence and protect hard-won gains.
Bush Institute Insights
In light of the 39th African Union Summit, my George W. Bush Institute colleagues, Bradford M. Freeman Managing Director for Global Policy Elizabeth Kennedy Trudeau and Director, Global Policy Natalie Gonnella-Platts, call for pragmatic, accountable leadership to address the continent’s intersecting security and development challenges.
At the Institute, we recognize that PEPFAR’s framework has been focused on effective implementation. Sustained U.S. investment paired with clear targets, local capacity-building, and measurable accountability has led to over 26 million lives saved from HIV/AIDS. This implementation approach offers lessons beyond public health. By prioritizing civilian well-being, strengthening local institutions, and enforcing accountability, African leaders can advance stability and opportunity for the continent’s rapidly growing youth population.
In the News
- Senator Susan Collins, chair of the Senate Appropriations Committee, is advocating to preserve global health investments amid proposed cuts. In an interview with CBN News, she emphasizes PEPFAR’s lifesaving impact and the importance of a responsible, case-by-case transition to country ownership. Sen. Collins adds that a successful transition to self-sustainability under the America First Global Health Strategy will require sustained outreach, education, and partnership between U.S. health care providers and host country staff. The interview also highlights faith-based partners such as Living Hope in South Africa, who credit PEPFAR with transforming HIV treatment and prevention.
- In a recent Health Policy Watch op-ed, African Union Commissioner for Health Amma Twum-Amoah highlights the 2019 African Leadership Meeting (ALM) Declaration as a continent-led framework that strengthens Africa’s health systems following foreign funding disruptions of 2025. The framework positions health spending as a pillar of economic resilience and national security, enhances mutual accountability, and calls for a new partnership between Ministries of Health and Ministries of Finance. With foreign investment accounting for roughly 70% of HIV financing in Africa, Twum-Amoah emphasizes that durable progress toward universal health coverage will require predictable domestic financing, stronger data systems, and country-driven reforms.
- Dr. Manica Balasegaram, executive director of the Global Antibiotic Research and Development Partnership, warns that antimicrobial resistance (AMR) has reached a “dangerous tipping point,” fueled by rising global insecurity. Conflict, climate change, pandemics, and mass migration can strain fragile health systems and accelerate the emergence and spread of drug-resistant infections. Today, nearly 5 million people die each year from drug-resistant infections, and mortality could increase by 70% by 2050 if current trends continue. To counter this risk, health and security leaders must maintain ongoing dialogue on AMR at international forums such as the Munich Security Conference.
- DevEx recently shared the story of nineteen-year-old Sharon Akoth in Kenya, a former beneficiary of PEPFAR’s DREAMS program. Through DREAMS, Sharon received school fees, mentorship, menstrual supplies, and a safe space to learn how to protect herself from HIV and gender-based violence. She was on a path to meet her goals and eventually become a doctor, but those goals significantly changed when the program ended last year.
- Akoth is among millions of girls and young women in sub-Saharan Africa who benefited from prevention programs invested in by the U.S. For more than two decades, PEPFAR and its partners have represented American global health leadership, saving over 26 million lives by pairing lifesaving treatment with smart, community-centered prevention. Sustaining this progress should be top of mind for policymakers, country leaders, and global health partners.
- The Coalition for Epidemic Preparedness Innovations (CEPI) launched “CEPI 3.0,” a five-year strategy to strengthen global defenses against epidemic and pandemic threats. The plan calls for $2.5 billion in new investments to accelerate vaccine development, advance rapid-response platforms, and support global networks capable of delivering vaccines within 100 days of identifying a virus with pandemic potential. Building on lessons from COVID-19, CEPI’s strategy emphasizes equity, regional manufacturing capacity, and regulatory preparedness to ensure faster and fairer access to vaccines.
- The European Commission plans to pledge €700 million to the Global Fund to Fight AIDS, Tuberculosis, and Malaria for 2026–2029, marking a significant decline in annual support compared to previous cycles, reports Health Policy Watch. While the topline figure is similar to the last pledge, extending the commitment over four years instead of three represents an estimated 26.5% annual cut. The move comes amid a broader pullback from major donors, leaving the Global Fund’s eighth replenishment short of its $18 billion target.
