Hopeful signs are emerging from the US global health strategy

Global health has long been at the heart of U.S. soft power. More than 26 million lives have been saved over the past two decades through the President’s Emergency Plan for AIDS Relief, or PEPFAR, demonstrating the generosity of Americans taxpayers, but also an important investment in our economic and national security. It’s only natural, then, that the dismantling of institutions such as the U.S. Agency for International Development, alongside assistance cuts in Europe and elsewhere, have created uncertainty in many parts of the developing world. However, the Trump administration’s emerging global health strategy, with its emphasis on innovation and private sector collaboration, offers both reasons for hope and important new opportunities the development community can’t afford to let slip away. The instinct in Washington has long been to change things gradually — to commission studies, redraw boxes on organizational charts, and rename programs. But that bureaucracy-centric approach will do little to help us respond to urgent needs in many parts of the world, nor will it meet the current administration’s demand for a new model in foreign assistance that puts American leadership and private enterprise front and center. What are some of these hopeful signs? The State Department’s America First Global Health Strategy carries forward a groundbreaking partnership with the drugmaker Gilead to deliver a new HIV prevention medicine lenacapavir to millions. Lenacapavir can replace daily medication with a twice-yearly shot. That’s important because research consistently shows reducing dose frequency is among the most effective ways to increase patient uptake. The State Department has also announced a landmark award for a U.S. robotics company to expand its lifesaving medical drone deliveries in Africa. Zipline has been delivering blood and medicine to hospitals in Africa since 2016, and is credited, among other things, with cutting maternal mortality rates by as much as half in the areas it serves. The Trump administration is now pledging up to $150 million to help Zipline scale up and reach millions of more people by partnering directly with African countries that want American innovation and will pay for ongoing delivery service. Not only do participating governments strengthen their health care networks, but it’s also an economic opportunity for African countries since Zipline hires locally to staff distribution centers and flight operations. These announcements, of course, are not a substitute for a comprehensive plan or a detailed strategy. But they do suggest how the U.S. administration plans to incorporate an emphasis on the power of enterprise-driven diplomacy and development. Specifically, there four strategic directions I see emerging: 1. The Trump administration intends to promote jobs and economic growth. Sustainable progress comes from opportunity and shared economic interests. The Gilead partnership helps open markets for American innovation while strengthening the health systems of partner countries. Zipline’s expansion of its distribution centers and accompanying infrastructure will not only save lives but create thousands of skilled jobs on the ground in Africa and the U.S. 2. The administration wants to protect America’s public health security. COVID-19 demonstrated that an outbreak anywhere can quickly become a threat everywhere. The Gilead partnership extends American breakthroughs in prevention to millions at risk. Zipline cuts delivery times from weeks to minutes so that clinics don’t run out of blood, vaccines, or medicines. 3. The administration intends to invest in innovation and scale what works. The emerging new strategy emphasizes integrating proven solutions into national health systems to deliver faster, more cost-effective results. The Gilead partnership uses America’s market-shaping power to bring cutting-edge science to scale. Zipline’s pay-for-results award ensures that U.S. funding is tied to what African governments want. 4. The administration plans to prioritize results. Gilead’s drug can be over 99% effective in preventing HIV. Zipline’s arrival in a region cut maternal death rates, reduced stockouts by 44% and increased immunization rates by double digits. On my very first day at USAID back in 2017, I reminded our team that, “The purpose of all foreign assistance must be ending its need to exist.” In other words, sustainability and self-reliance should be at the heart of everything we do. While there is obviously much to do before the outline we’ve seen becomes a comprehensive global health framework, harnessing the might of American private enterprise, collaborating with partner countries to strengthen their own public health capacity, and building on what programs such as PEPFAR have already achieved are the right themes to emphasize.