Devex CheckUp: The Trump insider who will lead Malaria No More in 2026

As the Trump administration rolls out its “America First” global health strategy, U.S. officials are popping up across global health boards and executive teams.

Back in September, Africa CDC chief Jean Kaseya tapped a top State Department official to advise the agency on how it should navigate the new landscape in Washington. And Gavi, the Global Fund, and the Stop TB Partnership also have Trump officials sitting on their boards.

And now William “Bill” Steiger — a former USAID chief of staff — has been picked to lead the U.S. nonprofit Malaria No More starting in January 2026.

Steiger is a longtime Republican global health insider who held major sway at USAID during President Donald Trump’s first term. He’s stepping in just as global health groups are scrambling to stay relevant and influential with the new administration, my colleague Michael Igoe reports.

Steiger, however, doesn’t just bring extensive knowledge of U.S. development assistance and policies. He’s also fully aligned with the Trump administration’s global health vision.

He tells Michael he was impressed by the push for bilateral agreements that require partner governments to put more of their own money into health programs, and he welcomed the focus on working with American companies — pointing to the recent U.S. deal with drone-maker Zipline as an example.

He thinks that partnership can be replicated in the malaria space, where he sees huge opportunities for technology and artificial intelligence to aid in malaria control, as well as in the prevention of theft and counterfeit products.

Read: Malaria No More taps Trump insider for ‘new era’ of global health

ICYMI: State Dept grants $150M to Zipline to triple African drone operations

+ Catch up on our reporting on The future of global health — a new series which explores the consequences of cuts to foreign aid and the search for a new path forward.

And the first ‘America First’ bilateral health deal goes to …

Kenya! U.S. Secretary of State Marco Rubio says the country is the “perfect partner” to serve as a proof of concept for a new era of American health assistance.

The two countries signed a $2.5 billion, five-year bilateral agreement, with the U.S. investing $1.6 billion and Kenya cofinancing with $850 million.

But while Dr. Ouma Oluga, a senior official at Kenya’s Ministry of Health, says the agreement was in the “best interests” of the Kenyan people, others aren’t so sure.

A Kenyan senator has asked the court to suspend and prohibit the implementation of the agreement, arguing it was signed without public participation and parliamentary approval. The senator also raised concerns about potential mismanagement of funds and warned that Kenya’s cofinancing commitment “burdens the national budget.”

Forty-six civil society organizations also published a letter to African leaders this week expressing wide-ranging concern around the ongoing negotiations and noting that the terms are dictated by the U.S. and not by African national or regional interests. They wrote that the agreements have a “rushed timeline and extremely limited inclusion of civil society.”

Another key bone of contention around these agreements is what the deals say about data sharing. During negotiations, a template of the bilateral agreements showed that the U.S. wanted access to specimen data — information that could help American companies develop vaccines and other medical countermeasures — without any clear indication that partner countries would, in turn, gain access to those products.

After the deal was signed, Oluga went on national TV to clarify that Kenya did not sign a specimen-sharing agreement with the U.S. Instead, the two governments agreed to jointly test outbreak specimens as they have existing partnerships, such as with the U.S. Centers for Disease Control and Prevention. If Kenya halted joint testing, he said the Americans would “close shop.” Today, Kenya’s High Court put a temporary stop to the implementation of the agreement, blocking any transfer or sharing of health or personal data for now. A full hearing is expected in early 2026.

Devex obtained a copy of the 37-page Kenya agreement, where much of the language aligned with the other aspects of what the Americans asked for in the template agreement, but it was buttressed with language that noted that areas such as data sharing must comply with Kenyan law.

My colleague Sara Jerving tells me Kenya had a 93-person team at the negotiating table — but it raises a bigger question: What happens to countries without that kind of negotiating power or leverage?

The U.S has now also inked deals with Rwanda, Liberia, and Uganda, and is expected to sign dozens more in the coming weeks.

Read: The US signs first bilateral health deal with Kenya for $1.6 billion

Read more: Kenya limits US access to disease outbreak data in new bilateral deal

Plus: Rapid US health deals spark concerns over lack of public consultation

+ Sara is hosting a Devex Pro Briefing next Tuesday to further unpack these deals with former United States global AIDS coordinator, Mark Dybul, and Aggrey Aluso, executive director at the Resilience Action Network Africa. Save your spot by registering ahead of the event here.

Not a Pro member? You can upgrade or sign up for a free trial when registering for this event.

The other tragedy

As the U.S. government inks deals and puts its global health priorities on display, another major donor is sounding the alarm about how funding cuts — including those from the U.S. — are affecting children’s lives.

The Gates Foundation is concerned that steep cuts to global health funding will lead to an estimated 4.8 million children under the age of 5 dying this year, an increase of over 200,000 from 2024. The foundation fears that the number could rise to 16 million more children dying by 2045 if these funding cuts continue.

Gates Foundation CEO Mark Suzman says, despite the challenges, the budget cuts “should not come at the expense of the world's very poorest and most vulnerable.”

“And no one is poor and more vulnerable than a child who could live and instead dies,” he adds.

Read: Child deaths rise in historic reversal, Gates Foundation reveals

An ounce of optimism

The funding cuts could also result in as many as 10.6 million additional tuberculosis cases, and 2.2 million additional deaths between now and 2030 across 26 countries bearing the highest burden of TB, according to one recent study.

But experts are hopeful that newer, more affordable diagnostic and screening tools could help bring those numbers down. One example is tongue swabs, which make sample collection far easier than coughing up sputum and could help more people get screened and start treatment sooner. There are also portable machines that can test for multiple diseases on the spot.

High-burden TB countries will need to adopt these innovations if they’re going to make real progress against the epidemic.

Countries should also be investing in their own data systems — and making sure they control them — says Dr. Obioma Chijioke-Akaniro, monitoring and evaluation manager at Nigeria’s National Tuberculosis, Leprosy and Buruli Ulcer Control Programme.

Nigeria is a good example of why that matters. The country has diagnosed more people with TB this year than in 2024, despite the U.S. funding cuts. Why? Because it had detailed data on what the U.S. was funding at each health facility. So when the USAID stop-work orders came through, officials were able to quickly analyze the gaps, brief the health minister, secure emergency government funds, and triage the biggest risks. The data also helped them spot fixes using existing resources — including shifting health workers and reallocating funds across states.

Read: How data helped Nigeria mitigate the impact of US cuts on TB

Opinion: Global south's TB diagnostics innovations are key to fight the epidemic

A pound of caution

Some numbers, however, are a lot harder to take in.

Fiji — a Pacific island nation of just under 1 million people — has been grappling with a sharp rise in HIV cases. In 2024, it recorded 1,583 new infections. But in just the first six months of 2025, it had already logged 1,226 new cases.

National data shows the epidemic is hitting young people, Indigenous Fijian communities, and men the hardest. In 2024, 37% of new cases were among 15–24-year-olds. Indigenous Fijians — who make up 62.8% of the population — accounted for 90% of new infections. And 70% of newly diagnosed cases were in males.

A rapid assessment commissioned by the World Health Organization and United Nations Development Programme, at the government’s request, found that people who inject drugs are at increased risk of HIV infection. Interviewees reported reusing needles and syringes, had low awareness of HIV, and faced real barriers to accessing testing and treatment.

The government is now working to introduce a needle and syringe program to curb the cases among people who inject drugs.

But Fiji isn’t alone in the Asia-Pacific. New HIV infections are also on the rise in the Philippines, Papua New Guinea, Afghanistan, Bangladesh, Bhutan, Laos, Sri Lanka, and Timor-Leste.

“While the contexts and dynamics differ across countries, there are shared challenges: failure to reach key populations with enough targeted prevention, late diagnosis, and insufficient treatment coverage. When there are cracks in our response, infections multiply,” write WHO Western Pacific Regional Director Dr. Saia Ma’u Piukala and Eamonn Murphy, who leads UNAIDS' work in Asia-Pacific, Eastern Europe, and Central Asia, in an opinion piece for Devex.

Opinion: HIV is not over in Asia-Pacific — A wake-up call from Fiji

One big number

That’s how many people lived in households that faced financial hardship from paying out of pocket for health care in 2022, according to the latest WHO report on the state of universal health coverage.

This year, the Sustainable Development Goal indicator that tracks financial hardship has been updated to recognize that people already living in poverty can still experience financial strain from health costs — even if they spend less than 10% of their household budget on care.

This means the numbers in the new report can’t be directly compared to those in the 2023 edition. WHO recalculated the indicator all the way back to 2000 — and it still shows that the total number of the population facing this challenge has barely improved.

The agency notes that “due to population growth, there was a net increase in the number of people experiencing financial hardship” — an additional 16.3 million people in 22 years.

So the theme of this year’s Universal Health Coverage Day, which takes place every Dec. 12, seems fitting: “Unaffordable health costs? We’re sick of it!”

What we’re reading

Dr. Doris Macharia took over as the head of the Elizabeth Glaser Pediatric AIDS Foundation amid widespread disruptions to HIV funding. Her response has been to double down on the mission to end pediatric AIDS.  [Devex]

Gavi and the World Bank are deepening their collaboration with plans to mobilize at least $2 billion over the next five years to strengthen financing for immunization and primary health care systems. [Reuters]

WHO has distanced itself from remarks made by its representative in Israel, who accused the U.N. of enabling antisemitism and alleged that famine and genocide in Gaza were products of “statistical and legal manipulations.” [The New Humanitarian]