The administration says the deals protect Americans from disease threats while shifting responsibility to partner governments and safeguarding U.S. taxpayers.
The United States has signed nearly $2.3 billion in new bilateral global health agreements with Botswana, Madagascar, Sierra Leone, and Ethiopia, the State Department said on Dec. 23, advancing the Trump administration’s America First Global Health Strategy and its push to tie foreign health aid to measurable performance and co-investment.
The four memorandums of understanding (MOU), signed on Dec. 22 and 23, commit the United States to almost $1.4 billion in health assistance, while the four African partners will collectively co-invest more than $900 million of their own resources. U.S. officials said the agreements are designed to combat priority infectious disease threats while reducing long-term reliance on American taxpayer funding.
“Each MOU includes clear benchmarks, strict timelines, and consequences for nonperformance—ensuring U.S. assistance delivers results against priority disease threats and reduces long-term dependence on U.S. assistance,” deputy spokesperson Tommy Pigott said in a statement, signaling that future U.S. funding will depend on measurable results and recipient-country commitments.
Shift Toward Greater Self-Reliance
The agreements reflect a broader overhaul of U.S. global health assistance under the America First Global Health Strategy, unveiled in September, which seeks to replace what officials describe as decades of aid-driven dependency with multi-year, incentive-based compacts emphasizing national ownership, co-investment, and accountability.
“With our new America First Global Health Strategy, we will not only save lives and assist countries around the world in developing resilient and durable health systems, but we will also make America safer, stronger, and more prosperous,” the State Department said in a statement. “We will ask governments to coinvest in these efforts and work with the United States to align on performance benchmarks in order to strengthen capacities for countries to become self-reliant.”
U.S. officials have said that while past aid programs saved tens of millions of lives and helped prevent dangerous outbreaks from reaching American shores, they also became inefficient, with a majority of funds absorbed by overhead and technical assistance rather than frontline care.
Beyond inefficiencies, U.S.-commissioned audits conducted from 2020 to 2024 found widespread diversion of donor-funded health commodities, with half of inspected vendors selling stolen supplies, some tied to organized cross-border networks.
“A sizeable minority of the commodities were distributed cross-border, pointing to a level of scale and sophistication indicative of transnational organized crime,” the strategy document states. “It is likely that this diversion is costing U.S. taxpayers millions of dollars each year.”
By Tom Ozimek
