October 1 ushered in a new era in U.S. foreign aid.
asserted
October → usher → aid
Will it work?
asserted
it → work → ?
The Trump administration says that October 1 marks the dawn of a new era in global healthcare.
asserted
October → say → healthcare
And that means rewriting the rules for funding healthcare in low- and middle-income countries.
asserted
that → mean → countries
A key part of the "America First" strategy is the idea that the U.S. should not hand out billions of dollars for health and development programs without reaping concrete benefits — access to local minerals, for example — and without a commitment from governments to spend their own money.
asserted
U.S. → hand → money
To be eligible for U.S. funds, each country is asked to sign a Memorandum of Understanding detailing the amount of money the U.S. will invest as well as the country's financial pledge.
asserted
U.S. → ask → money
The administration says the requirement that countries chip in will make them more self-reliant and eventually less dependent on U.S. assistance.
asserted
them → say → assistance
It's an idea that has merit, according to Jocilyn Estes, a policy analyst at the Center for Global Development, a think tank in Washington, D.C.
uncertain
that → have → Washington
But she wonders if the plan is being rolled out too rapidly.
asserted
plan → wonder → ?
As for the nations involved, reaction has been mixed.
asserted
reaction → involve → nations
Here's a look at how this new arrangement is supposed to work — and what potential obstacles lie ahead.
asserted
obstacles → suppose → ?
Previous administrations viewed global health spending as an important way to build strong relationships and influence with recipient countries and as a key element of U.S. soft power — using donations to incur good will.
asserted
administrations → view → will
"Historically, the focus has been primarily that everybody benefits.
asserted
everybody → benefit → ?
That better health and better development in low and middle-income country regions lifts all boats, and the U.S. benefits from that," says Tom Bollyky, director of the global health program at the Council on Foreign Relations.
asserted
Bollyky → lift → Relations
Here's how the State Department describes the new strategy on its website:
"It will protect the homeland by preventing infectious disease outbreaks from reaching U.S. shores; strengthen our bilateral relationships by entering into multi-year, bilateral agreements that require co-investment from recipient governments, saving millions of lives and moving countries along the path to decreased dependency on foreign assistance; and promote American health innovation around the world."
What's new is what Bollyky calls a more transactional view of health aid.
asserted
Bollyky → describe → aid
"The U.S. wants to be more clear about what U.S. taxpayers receive in return, beyond just countries doing well on their health and development objectives," he says.
asserted
he → want → objectives
That could mean "preferential access to critical minerals," he says — or direct access to patient data from other countries.
uncertain
he → mean → countries
That request for confidential records is perhaps the most controversial part of the administration's approach, he says.
asserted
he → say → approach
According to the Trump administration, the payoff for the U.S. is an enhanced ability to identify outbreaks and protect itself.
uncertain
payoff → accord → itself
Who is participating?
asserted
Who → participate → ?
The U.S. has signed MOUs with 35 countries, committing around $14 billion in health investments over five years.
asserted
U.S. → sign → years
They span the globe and include Nigeria, Rwanda, the Philippines, Tajikistan, Bolivia and El Salvador.
asserted
They → span → Nigeria
In the case of Rwanda, the U.S. will provide $157 million and Rwanda will pitch in $70 million.
asserted
Rwanda → provide → million
In return, Rwanda will share patient data with the United States — and will accept the U.S. Food and Drug Administration's approval of medicines for use during outbreaks without requiring further approval from Rwandan regulators.
asserted
Rwanda → share → regulators
So far three countries have refused to sign MOUs with the U.S., citing sovereignty issues: Ghana, Namibia and Zimbabwe.
asserted
countries → refuse → issues
Negotiations between the U.S. and Zambia stalled for months over provisions for the U.S. to access critical minerals.
asserted
U.S. → stall → minerals
On September 25, during an event at the U.N. General Assembly, Ghana's president John Dramani Mahama said the country rejected the American proposal after seeing the stipulations requiring Ghana to hand over medical records of patients and pathogen data, and accept the FDA as the ultimate drug authority.
asserted
country → say → authority
"It was humiliating," Mahama said.
asserted
Mahama → say → ?
"Ghana is a sovereign nation and we have our processes.
asserted
we → have → processes
He referred to the funding proposition from the U.S. as "a pittance, 100 and something million."
asserted
He → refer → pittance
The consequences for not signing can be quite serious.
asserted
consequences → sign → ?
Also on September 25, U.S. Ambassador to Zimbabwe Pamela Tremont said the U.S. was stopping all global health funding to the country because it declined the agreement for the same reasons as Ghana.
asserted
it → say → Ghana
Instead, she said the U.S. would shift the focus of its relations with Zimbabwe from health to economic investments and trade.
asserted
U.S. → say → investments
Bollyky says the question is whether other countries who refuse will also be totally cut off.
asserted
who → say → ?
With the rollout expected this fall, Bollyky says it's only a matter of time before "we see whether the administration is really willing to follow through with that."
What the experts are saying
Global health specialists interviewed for this story say that American First represents a pragmatic approach to healthcare aid.
"When it comes to public health, it does make sense to actually coordinate closely with governments, and countries should eventually run and pay for their own health systems," says Jocilyn Estes of the Center for Global Development.
asserted
Estes → expect → Development
Yet, she says, "the scope and scale of this pivot is really unprecedented, and the pace that the administration wants to move seems pretty incompatible with the kind of careful planning required when the stakes are this high."
asserted
stakes → say → planning
On the ground implementation of the agreements was originally supposed to have begun in April 2026.
asserted
implementation → suppose → April
When the administration couldn't meet that goal, it extended the start by six months to October 1.
asserted
it → meet → October
But it's not clear yet if the money from the State Department will flow on time.
asserted
money → flow → time
Estes says this rapid-fire rollout is a high-risk moment for the future of U.S. global health assistance.
asserted
rollout → say → assistance
…and 12 more, not listed.
The Aporia
