In 2025 the Trump administration dismantled the post-Cold War global health architecture by withdrawing from the WHO, freezing most foreign aid, and abolishing USAID's development role. Through its 'America First Global Health Strategy,' the administration created bilateral health compacts requiring partner governments to co-finance HIV, TB, malaria, and outbreak response programs and gradually assume full responsibility.
Kenya signed the first compact on December 4, 2025; Rwanda followed on December 5–6 with a $228 million compact. By early 2026, 15 nations had signed compacts totaling over $16 billion, with the U.S. covering 100% of commodity costs in FY2026 before tapering. These compacts aim to cover all 87 prior recipient countries, though the rollout continues amid USAID shutdown disruptions and WHO withdrawal, which trigger cuts to immunization and other programs.
FY2026 global health funding totals $9.42 billion within a $51.4 billion foreign aid package. Implementation gaps and reversals in health gains could occur, with estimates of over 14 million preventable deaths by 2030 if transitions falter. The strategy leverages aid for geopolitical goals like countering Chinese influence.
15 events
Latest: January 29th, 2026 · 4 months ago
Showing 8 of 15
JK to step
Tap a bar to jump to that date
Jump to
January 2026
FY2026 global health funding passes at $9.42B with PEPFAR preservation
LatestFunding
U.S. foreign aid bill allocates $9.42 billion for global health, including $4.5B for PEPFAR and full FY2026 commodity cost coverage under compacts, as partner countries ramp up co-investments.
15 nations sign America First health compacts totaling $16B+
Agreement
Fifteen countries have executed bilateral Memorandums of Understanding, with implementation planning underway despite concerns over transparency and service delivery details.
December 2025
Fighting resumes in eastern Congo hours after peace ceremony
Security
Within a day of the Washington Accord ceremony, heavy fighting between Congo’s army and Rwanda‑backed M23 rebels flares in eastern DRC, highlighting the fragility of the agreement even as U.S. economic and health partnerships move forward.
U.S. and Rwanda sign $228M bilateral health cooperation MoU
Agreement
In Washington, Rwanda’s foreign minister Olivier Nduhungirehe and U.S. officials sign a five‑year $228M health compact committing up to $158M in U.S. funding and about $70M in increased Rwandan health spending. The deal strengthens HIV, malaria and outbreak programs, embeds U.S. tech firms like Zipline and Ginkgo Bioworks, and is framed as a model America First Global Health compact.
Kenya and U.S. sign first America First health compact
Agreement
Secretary of State Marco Rubio and President William Ruto sign a five‑year health agreement worth at least $1.6–$2.5B, depending on source, marking the first implementation of the America First Global Health Strategy. The deal shifts funding from NGOs to Kenya’s government health system and requires major domestic co‑financing.
Washington Accords for Peace and Prosperity formally ratified
Diplomacy
Presidents Trump, Kagame and Tshisekedi preside over the ceremonial signing of the Washington Accords in Washington, deepening U.S. involvement in Great Lakes security and granting U.S. companies preferential access to DRC’s critical minerals.
November 2025
Health experts warn America First strategy is too narrow and risky
Reaction
Policy analysts and advocacy networks argue the strategy defines global health too narrowly, largely omitting immunization, maternal and child health, nutrition and reproductive health, and warn that bilateral compacts cannot substitute for multilateral cooperation in pandemics.
September 2025
America First Global Health Strategy published; NGOs sidelined
Policy
The administration formally releases its America First Global Health Strategy, which will bypass most NGOs in favor of government‑to‑government compacts, narrow U.S. funding to a few diseases and security functions, and require co‑financing and transition plans to self‑reliance.
House Foreign Affairs advances bill requiring global health compacts
Congress
House Foreign Affairs Committee Chairman Brian Mast announces committee passage of H.R. 5300, mandating that all U.S. global health assistance be delivered through bilateral 'global health compact' agreements under the America First Global Health Strategy.
Senate Foreign Relations Chair backs America First Global Health Strategy
Congress
Senator Jim Risch praises the administration’s new global health strategy for emphasizing outbreak surveillance, 72‑hour response capacity, and co‑investment by partner countries, framing it as a more efficient use of U.S. resources.
July 2025
USAID’s global health supply chain shifts to State; mass cancellations follow
Implementation
Oversight of the Global Health Supply Chain Program and many other USAID initiatives transitions to State. Analyses show more than 80% of USAID global health awards have been terminated or left unobligated, totaling over $12.7B.
June 2025
DRC and Rwanda sign initial U.S.-brokered Washington peace agreement
Diplomacy
Rwandan and Congolese foreign ministers sign a U.S.‑mediated peace deal in Washington aimed at ending fighting in eastern Congo and laying foundations for joint security and economic frameworks, including provisions on public health cooperation.
March 2025
Administration moves to dissolve USAID and fold health into State
Policy
The State Department notifies Congress of plans to permanently dissolve USAID as the main implementing agency for global health and development, transferring remaining programs into a reorganized Bureau of Global Health Security and Diplomacy.
February 2025
Aid freeze strands mpox and other outbreak responses
Investigation
Reporting reveals that USAID’s frozen funds and evacuation of staff from the Democratic Republic of Congo have stalled mpox vaccination, testing and surveillance efforts, foreshadowing broader disruption to global outbreak control.
January 2025
Trump orders WHO withdrawal and 90‑day pause on foreign aid
Executive Action
On his first day of his second term, President Trump signs Executive Order 14155 to withdraw from the World Health Organization and Executive Order 14169 to pause most foreign development assistance pending a review, signaling a fundamental reorientation of U.S. global health engagement.
Historical Context
3 moments from history that rhyme with this story — and how they unfolded.
1 of 3
2003–2023 (initial launch and expansion)
PEPFAR: The 2003–2020s U.S. Global AIDS Initiative
In 2003, President George W. Bush launched the President’s Emergency Plan for AIDS Relief (PEPFAR), a five‑year, $15B initiative targeting heavily affected countries in Africa and the Caribbean, including Kenya, Rwanda, Nigeria and South Africa. The program combined bilateral funding channeled through multiple U.S. agencies, extensive partnerships with NGOs and faith‑based organizations, and support for multilateral efforts like the Global Fund. PEPFAR was reauthorized several times, with cumulative commitments reaching around $120B by 2024 and an estimated 20–25M lives saved through expanded HIV treatment and prevention.
Then
Within its first decade, PEPFAR rapidly scaled access to antiretroviral therapy, reduced mother‑to‑child transmission, and strengthened laboratory and supply‑chain systems in partner countries, while also exporting U.S. influence and soft power.
Now
By the early 2020s, PEPFAR became the flagship example of U.S. leadership in global health, though it also faced criticism and domestic political challenges. Analyses now warn that its abrupt contraction—linked to USAID’s demise and the America First shift—could trigger millions of additional HIV infections and deaths.
Why this matters now
PEPFAR demonstrates both the effectiveness and path dependency of large‑scale U.S. health investments built around NGOs, multilateral coordination and long‑term commitments. The America First Global Health compacts are, in many ways, a repudiation of that model—prioritizing country co‑financing, narrower disease scope, and transactional alignment with U.S. interests. The contrast helps explain why experts fear large reversals in HIV and broader health gains if PEPFAR’s infrastructure is not carefully transitioned rather than abruptly defunded.
2 of 3
2004–present
Millennium Challenge Corporation (MCC) and the Compact Model
Created by Congress in 2004, the Millennium Challenge Corporation provides large, multi‑year 'compacts'—typically $100–700M—to countries that meet strict governance and policy criteria. Eligible countries design programs, often focused on infrastructure and economic reforms, co‑implemented with MCC oversight. The compact approach ties aid disbursement to performance indicators and can be suspended if governance deteriorates. By 2024, MCC had signed 45 compacts worth over $17B, largely in sub‑Saharan Africa, and was credited with helping lift hundreds of millions out of poverty, though some critics argue it can be politically selective and slow to implement.
Then
MCC’s early years showed that well‑designed, performance‑based compacts could attract bipartisan support, encourage policy reforms, and deliver large infrastructure projects in relatively well‑governed countries.
Now
The compact model became a reference point for conditional, country‑ownership‑oriented aid, but its limited country coverage and focus on governance‑qualifying states also highlighted the risk that the poorest and most fragile countries might be left out.
Why this matters now
The America First Global Health Strategy borrows the language and mechanics of MCC‑style compacts—multi‑year agreements, co‑investment, strict metrics—but applies them to essential health services across a far broader and more fragile set of countries. MCC’s history suggests that such compacts can work where institutions are relatively strong, but also warns that tying core services to demanding performance conditions may exclude or destabilize the weakest states.
3 of 3
May 2020–January 2021
Trump’s 2020 Attempted Withdrawal from WHO
During the COVID‑19 pandemic, the Trump administration suspended funding to the World Health Organization, accused it of being 'China‑centric,' and in July 2020 formally notified the UN of U.S. withdrawal, set to take effect in July 2021. Health experts, allies and NGOs widely condemned the move as dangerous and counterproductive, arguing that WHO coordination and data were vital to pandemic response. President Joe Biden reversed the withdrawal on his first day in office in January 2021, keeping the U.S. inside WHO.
Then
The attempted withdrawal sowed uncertainty and temporarily disrupted U.S.–WHO collaboration, but did not fully materialize due to the 2020 election outcome. Critics saw it as a warning about how politicized global health could become.
Now
The episode set a precedent for using WHO membership as a bargaining chip and previewed the 2025 withdrawal order, which now appears more likely to take effect given political alignment in Washington. WHO has since sought to diversify funding in anticipation of a lasting U.S. exit.
Why this matters now
The 2020 WHO withdrawal attempt illustrates both the immediate alarm such moves cause in the global health community and how quickly they can be reversed by political change. It is a key precedent for assessing whether the current combination of WHO exit and bilateral health compacts will be a durable realignment or a transient, contested phase in U.S. global health engagement.
