Health Policy Watch | Controversy, secrecy and suffering after year one of the America First Global Health Strategy

Health Policy Watch analysis

Country controversies, secret terms, opaque procurement, and massive unspent Congressional funds have characterised the first year of the America First Global Health Strategy.

“Services are weaker than they were a year ago, HIV testing is down, treatment of children living with HIV is down, and community-based prevention is gutted,” said Emily Bass, expert consultant for Physicians for Human Rights (PHR), about the change in US policy.

Introducing the new strategy a year ago (18 September 2025), United States Secretary of State Marco Rubio pitched it as an antidote to “inefficient and wasteful” past global health programmes.

Since then, 35 countries have signed bilateral memorandums of understanding (MOUs) with the US in terms of this strategy. Two of these, Kenya and the Democratic Republic of Congo (DRC), face legal challenges from civil society groups over the terms.

Three – Ghana, Zimbabwe and Namibia – have refused the terms offered by the US, the main sticking point being US demands for sensitive health data. Zambia is struggling to find a way to secure US aid without having to sell the family silver. Several others, notably the DRC and Guinea, have signed agreements offering the US favourable terms to access their minerals, alongside the health agreements.

The Trump administration has refused any further aid to South Africa, the country with the largest HIV population in the world, primarily over its measures to address apartheid-era racial injustice and its case against Israel at the International Court of Justice.

Read the full analysis here.