The Trump administration is overhauling America’s approach to global health aid, shifting away from large-scale foreign assistance programs toward negotiated bilateral agreements with recipient nations. The State Department outlined the strategy on Thursday, describing it as a way to cut inefficiencies while ensuring U.S. taxpayers see tangible benefits.
“We must keep what is good about our health foreign assistance programs while rapidly fixing what is broken,” Secretary of State Marco Rubio wrote in a letter announcing the change. “We will continue to be the world’s health leader and the most generous nation in the world, but we will do so in a way that directly benefits the American people and directly promotes our national interest.”
The new framework reflects President Donald Trump’s transactional view of foreign policy, which emphasizes direct bargaining with governments to advance U.S. objectives. Supporters of the old model argued that traditional aid helped secure American interests by fostering stability and alliances abroad, but the administration has steadily moved away from that approach.
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Trump has long criticized foreign aid as misaligned with U.S. values and priorities. His team dismantled the U.S. Agency for International Development, cut billions of dollars in congressionally approved assistance, and temporarily froze funding earlier this year for programs such as the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). That initiative has been credited with saving more than 26 million lives.
Under the revised plan, countries will be asked to assume greater responsibility for managing their health programs, with U.S. dollars directed more narrowly toward critical supplies like medicines, testing kits, and frontline workers. A senior administration official, speaking anonymously ahead of the rollout, said the goal is to give partners more “skin in the game” while encouraging them to eventually operate without American aid.
A State Department overview accompanying the plan argued that many existing global health initiatives “have become inefficient and wasteful.” It said the U.S. will gradually transfer costs for program management and technical expertise to foreign governments while continuing to fully cover direct patient care and frontline operations.
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Negotiations with individual countries are expected to begin in the coming months, with the administration aiming to finalize new agreements by spring 2026.
Officials also signaled a shift in focus, continued support for regions still battling HIV, particularly in Africa, but a redirection of more funding toward nations in the Western Hemisphere and the Asia-Pacific. At the same time, money will move away from nongovernmental organizations the administration considers fiscally irresponsible.
The strategy document acknowledged PEPFAR’s lifesaving achievements while contending that its budget structure wastes too much on overhead. It further highlighted global disease surveillance as a top priority and promised to expand the U.S. government’s presence in areas deemed most vulnerable to future outbreaks.
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