US health strategy aims to position African governments as customers

The United States’ new global health strategy will work to position American companies to lead in African markets — home to the world’s fastest growing populations — with African governments serving as customers of American products. That’s according to Jeff Graham, senior bureau official for the State Department’s Bureau of Global Health Security and Diplomacy. In this vision, the role of donors is to support innovation, he said, as opposed to focusing on responding to emergencies. “American companies are largely absent from the world’s fastest growing consumer market,” Graham said in a speech on Tuesday at the Global Health Supply Chain Summit in Kigali. Graham is part of a team of roving State Department officials traveling across the African continent to negotiate bilateral agreements with countries as part of the new ‘America First’ global health strategy. This strategy marks a shift from previous administrations, which leaned heavily on funneling money to implementing partner NGOs to deliver programming. The Trump administration has criticized these NGOs for having high overhead costs, and is planning to lean heavily on recipient governments, the private sector and faith-based organizations moving forward. “We’re not abandoning global health leadership — we’re transforming it,” Graham said. “The strategy isn’t about withdrawal, it’s about smarter partnerships that leverage American technological leadership to create sustainable health systems while opening markets for innovation.” The U.S. has started its negotiations with 16 African governments. Graham said there are currently two American teams simultaneously negotiating with countries and Rwanda is the third country in his own five-country tour of negotiations. He said two new flagship deals with the private sector “demonstrate this new approach in action.” This includes the U.S.’s new $150 million investment in Zipline — an American company that delivers medical supplies to remote areas by drone. Graham referred to this new investment — which was announced at the Kigali conference — as a “down payment” on the Trump administration’s vision and said that over the next 36 months “you’ll watch American technology deliver life-saving medicines to 130 million people on the continent. You’ll see African governments paying for that service.” “We’'re doing a seed investment, but the actual payment will come from the governments. Those governments won’t be aid recipients, but customers who recognize value,” he said. Graham pointed to another deal that reflects the administration’s new approach: A September agreement with U.S. pharmaceutical company Gilead and the Global Fund to Fight AIDS, Tuberculosis and Malaria to roll out the HIV prevention drug lenacapavir, which he described as an innovative product. The first doses are being delivered this week in Eswatini and Zambia. Graham criticized previous U.S. investment in African health care as having “created dependency, not capacity,” adding that “despite billions in donor funding, we’re still seeing chronic stockouts.” He said for decades the U.S. has “subsidized emergency response.” He criticized the current state of health supply chains as being built for emergency response rather than long-term sustainability, with African companies representing a minuscule portion of the global pharmaceutical market. He said programs such as the U.S. President’s Emergency Plan for AIDS Relief and the U.S. President's Malaria Initiative, as well as organizations such as the Global Fund and Gavi, the Vaccine Alliance, have created fragmentation of different diseases and multiple parallel supply chains. He added that over 80% of essential medicines are secured through international mechanisms, with minimal participation from Africa’s private sector. The Trump administration’s vision is a “significant mindset shift for many of our public health experts on our teams, but one that they’re quite excited about,” he said. Graham outlined a vision where an ever-increasing number of pharmaceutical products are manufactured in Africa, where private sector companies are responsible for most of their distribution rather than governments, and where company-wide supply chains are facilitated by cross-border regulatory harmonization. “We want to leverage America’s unmatched technological advantages in robotics, artificial intelligence, manufacturing, and innovation. We want to create commercial partnerships that survive changes in political leadership on both sides, whether that’s both sides of the aisle in Washington, or both sides of the Atlantic, with our friends here in Africa,” he said. He called upon the supply chain conference attendees to support in designing “the infrastructure that this transformation is going to require.” “Your expertise bridges public health goals and commercial viability,” he said, adding that the Trump administration is serious about making “trade not aid” a reality. The new ‘America First’ strategy has been met with mixed reviews. Some are praising the potential it carries to integrate foreign aid into national health systems as opposed to creating siloed programs and parallel systems. Others have questioned the State Department’s ability to execute it, given the widespread dismantling of the country’s global health expertise and infrastructure, as well as criticized proposed pathogen sharing deals in a template of the bilateral agreements. But Graham is hopeful the changes will pay off. “The next several years of U.S.-Africa health partnerships will look fundamentally different from the last two decades,” he said. “We’re transforming the way the United States does business with Africa and the health sphere, and we feel very confident it’s going to work.”