Devex Pro Insider: 'America First' goes fast and furious on global health

U.S. President Donald Trump dismantled USAID in the blink of an eye. His administration is now going at that same frenetic pace with its “America First” global health strategy, inking a slew of deals with several African nations in rapid-fire succession. And it plans to sign dozens more in the coming weeks. These agreements are critical not only because they dictate the terms of bilateral health relationships between the U.S. and other countries, but also because in many ways, they’re the primary shred of evidence we have of what Trump’s vision for foreign assistance actually looks like — beyond the diminished scope of aid overall. That vision is coming into focus: direct, one-on-one partnerships with governments; no more funneling money through NGOs or big implementing partners; engaging the private sector and faith-based groups; positioning countries as customers instead of aid recipients while promoting American products; leaving technical assistance to individual governments; and forcing them to pony up for their own development if they want to access U.S. funds. Some have expressed relief that at least the development community now knows what it’s facing, along with a wary appreciation of the effort to transition countries to self-reliance. But others are worried about sacrificing quality for speed — with too many strings attached. A prime example of Trump possibly stringing countries along is agreements over sharing sensitive medical data that helps companies develop vaccines and other countermeasures to thwart outbreaks. The administration wants to lock countries into sharing their data for 25 years, an inordinately long time, critics say — triggering concerns that the global south won’t be able to reap the benefits of the data it shares with the United States. For some, it reeks of predatory neocolonialism. Indeed, there’s already been pushback from Kenya, the first country to sign a compact with the State Department. A Kenyan court recently suspended part of the agreement on data-privacy grounds. So what’s next? Aggrey Aluso, executive director of the Resilience Action Network Africa, tells my colleague Sara Jerving that he hopes early signers make the details of their agreements public so that others can use them as a reference point to secure stronger deals for themselves. The stakes are high. Global health makes up nearly two-thirds of the programming that survived USAID’s demolition. U.S. Secretary of State Marco Rubio makes no bones about the speed, scale, and self-interest involved in this historic health overhaul. “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,” he wrote in the global health strategy's introduction, adding that the administration aims to keep what’s “good,” while “rapidly fixing what is broken.” Coming up: Sara delves deeper into the Trump administration’s new global health strategy with Mark Dybul, former U.S. global AIDS coordinator, and Aggrey Aluso in a briefing exclusive to Pro members on Dec. 16. Also, listen to Sara discussing the bilateral health compacts in the latest episode of our podcast, This week in global development. Bits and pieces Healthy compacts. Apparently, health compacts are all the rage, and the World Bank Group is getting in on the action. It’s partnering with 15 countries to prepare National Health Compacts — five-year road maps designed to expand access to quality, affordable health care and create millions of jobs. It’s part of the bank’s larger effort to deliver health services to 1.5 billion people by 2030. “Countries are stepping forward with clear priorities, and we are working alongside them to deliver practical solutions at scale,” World Bank President Ajay Banga said in a statement. “When efforts align behind what works, impact grows.” In related news, the World Bank Group announced it is working with Gavi, the Vaccine Alliance to strengthen financing for immunization and primary health care systems, with a plan to mobilize at least $2 billion over the next five years in joint financing. Washing their hands of it. The U.N. environmental authorities have a new target: paper towels. “As part of UN Headquarters’ continuing efforts to improve the environmental sustainability of facilities operations, the Department of Operational Support will no longer provide paper towels in UNHQ main campus restrooms serving office spaces,” the U.N. Media & Accreditation Unit announced in an email on Wednesday. “The removal of paper towels is expected to generate cost savings of over $100,000 per year,” it stated. It is also “More Sustainable: Electric Hand dryers have one-third the carbon footprint of recycled paper towels.” The action comes in the midst of a persistent and worsening cash crunch, with the U.N. cutting back on everything from air conditioning costs to budgeting for interpreter overtime and travel. The so-called liquidity crisis has been largely fueled by the U.S. failure to pay its dues in full and on time. China, which has emerged as the second largest contributor to the U.N.’s regular and peacekeeping budgets, hasn’t helped — paying its dues late in the year. The paper purge is not absolute. If staff have an urgent need for paper towels, the building pantries will be stocked with paper dispensers. Hand sanitizers will also be available outside the bathrooms, and hand towels will continue to be provided in public restrooms. Another key benefit, the email notes, is “Reduced maintenance: Flushed paper towels remain the primary sources of clogged toilets at UNHQ, which are costly and time-consuming to repair and can result in unsanitary conditions until addressed.” Font fight. Apparently, Rubio thinks Calibri typeface is code for “wasteful” diversity, according to an internal State Department cable seen by Reuters. As The Guardian reported: “Rubio’s predecessor Antony Blinken switched to Calibri in 2023, claiming the modern sans-serif typeface was more accessible for people with disabilities because it did not have the decorative angular features and was the default in Microsoft products.” This apparently rankled Rubio, who ordered diplomats to return to using Times New Roman font in official communications — which a spokesperson said aligns with the president’s “One Voice for America’s Foreign Relations directive” and is “more formal and professional.” Nice to see the State Department has the time to tackle the pressing global issues of the day. Building connections … and controversy. The State Department has also been busy on LinkedIn, where its Office of the Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom recently launched an official page. As of this writing, that post got 215 likes (the page itself has since garnered over 19,000 followers), but not everyone has posted supportive comments. One said that “everyone knows [these rebranding exercises] are but a pale shadow, at best, of what we had before the unconstitutional and profoundly evil destruction of USAID.” Pax AI. To be fair, the State Department has been busy implementing Trump’s foreign policy agenda. Beyond the slew of health compacts, it’s launching an initiative called Pax Silica. According to the department, the international grouping “aims to unite the countries that host the world’s most advanced technology companies to unleash the economic potential of the new AI age.” “This is the first time countries are organizing around compute, silicon, minerals, and energy as shared strategic assets,” a release said. “This is American AI diplomacy at its best: building coalitions, shaping markets, and advancing out national interests.” On Friday, Undersecretary of State for Economic Affairs Jacob Helberg and representatives from Japan, Israel, Australia, Singapore, and South Korea signed the Pax Silica declaration. Scott’s speedy giving spree. Philanthropist MacKenzie Scott has done it again, wasting zero time to give away tons of money — $7.2 billion to be exact. This year’s donation marks her biggest-ever giving announcement. In her blog, Yield Giving — named after a belief in adding value by giving up control — she writes that “our network of staff and advisors has yielded over $26,000,000,000 in 2,700+ gifts to non-profit teams to use as they see fit for the benefit of others.” She’s likely far from done. Scott’s net worth stands at almost $40 billion, according to the Bloomberg Billionaires Index. Lost at sea. IFRC is shutting down its operation supporting people in boats trying to migrate to Europe via the Central Mediterranean due to funding constraints. IFRC says the operation — done in partnership with SOS MEDITERRANEE aboard the Ocean Viking search and rescue vessel — helped save more than 8,600 people, including 2,200 children, over the past four years. “Despite exhaustive efforts, the IFRC has been unable to secure the necessary resources to continue the operation beyond 2025. As a result, IFRC network staff will no longer be present on board the Ocean Viking, and SOS MEDITERRANEE will cover the vessel’s operational costs alone,” a release said. In memoriam The founder and president of Save the Elephants, Iain Douglas-Hamilton, has died at the age of 83. The NGO said he “passed away peacefully as the sun set in Nairobi.” The renowned Scottish zoologist changed the world’s understanding of African elephants, revealing the depth of their intelligence, family bonds, and emotional lives. “At just 23, he pioneered the first scientific study of the social behavior of wild elephants,” Save the Elephants wrote. “When the herds he knew so well started getting killed for their ivory, he turned elephant protector.” “When a new wave of ivory poaching swept across Africa, killing an estimated 100,000 elephants between 2010 and 2012,” the organization wrote, “his science-based advocacy for stronger protections played an important role in the global movement that resulted in the closure of domestic markets around the world, most importantly China’s in 2018.” According to Frank Pope, CEO of Save the Elephants and Douglas-Hamilton’s son-in-law, “He never lost his lifelong curiosity with what was happening inside the minds of one of our planet’s most intriguing creatures.” Daniel Ole Sambu, program coordinator for the Predator Compensation Fund, has died at the age of 51, Kenya’s Big Life Foundation announced on LinkedIn. “We all know who Daniel was—more than a loyal employee, more than a public figure. He was a pillar of Big Life Foundation and a beacon of dedication to the community,” wrote Benson N. Leyian, CEO of Big Life Foundation Kenya. “His tireless work in protecting wildlife and supporting families touched countless lives.” Moving on An update on the restructuring at UNAIDS from my colleague Jenny Lei Ravelo: The number of deputy executive directors has been reduced from two to one, with Angeli Achrekar appointed as the sole deputy executive director and Christine Stegling as director of management and partnerships. Andriy Klepikov has become the president-elect of the International AIDS Society. Klepikov, who is also the executive director at the Alliance for Public Health, wrote on LinkedIn that he is “proud that for the first time a Ukrainian, representative of Eastern Europe and Central Asia, will be at IAS major governance role, bringing strong civil society experience, prioritising communities and key populations, demonstrating resilience of HIV response during the war. I’m committed to do everything to strengthen IAS, to support achieving its new strategy, to contribute to ending AIDS by 2030.” Vasee Moorthy has started a new position at the World Health Organization as senior adviser of science and strategy in the new Science for Health Department. Management Sciences for Health congratulated Justice Nonvignon, who leads its health economics and financing practice area, on his appointment as director for Africa by the International Health Economics Association’s board of directors. Before joining MSH in 2024, Nonvignon served as professor of health economics at the University of Ghana and was the founding head of the Health Economics and Financing Program at the Africa Centres for Disease Control and Prevention, where he spearheaded the development of a comprehensive approach to addressing critical gaps in health economics and financing policy across African Union member states. Kim Pozniak will join InterAction as its new director of communications on Jan. 2. She comes from Catholic Relief Services, one of InterAction’s member organizations, where she spent nearly 20 years leading global communications initiatives. Pozniak has traveled to more than 40 countries, giving her firsthand insight into humanitarian and development work. Coming up The African Development Fund’s 17th replenishment will take place on Dec. 15 and 16 in London. The final pledging meeting is cohosted by the U.K. and Ghana. The African Development Fund is the African Development Bank Group’s concessional window, providing critical resources to 37 low-income African countries. It supports projects that advance climate resilience, regional integration, private sector development, and governance reforms. Building the AI for Good ecosystem: A Devex Pro Briefing with Kanika Bahl will be held on Dec. 15 at 11 a.m.-12 p.m. ET. While frontier AI companies race ahead and global policy debates focus on risk, one critical question remains unanswered: Who is actually building the ecosystem that will ensure AI delivers meaningful benefits for the 3.5 billion people living in poverty? Join Devex Senior Editor Catherine Cheney and Kanika Bahl for an exclusive briefing on what’s next for the AI for Good ecosystem. Register now. Shrinking Gavi to save it: A Pro Briefing with Dr. Sania Nishtar will be held on Dec. 16 at 1-2 p.m. ET. Gavi will be 25% smaller by the year’s end. The organization says it’s consolidating eight grant cycles into one and transferring control over resources to countries. Devex President and Editor-in-Chief Raj Kumar will sit down with Gavi CEO Sania Nishtar to discuss whether the Gavi Leap transformation program offers lessons for the hundreds of organizations now forced into similar decisions without the lead time. Save your spot now. The Millennium Challenge Corporation: New strategies, new metrics, and the road ahead will be held on Dec. 18, at 10-11 a.m. ET. MCC’s model, built on good governance, country ownership, and rigorous data, has been a cornerstone of U.S. foreign assistance for two decades. However, the agency is now navigating a complex landscape of new challenges and adapting after a tumultuous year. Join us as we speak to experts and former officials about the shifting currents inside MCC and what these changes mean for future compact development and the agency’s role in the next generation of U.S. foreign assistance and economic policy. Job of the week Your Devex Pro membership includes access to the world’s largest global development job board. Here’s the latest opportunity: head of project economics at the Asian Infrastructure Investment Bank. Search for more opportunities now.