Last year, the U.S. Agency for International Development was absorbed into the Department of State. We assume this isn’t news to any readers. As USAID’s former administrator under the first Trump administration and a former member of the House Appropriations Committee, we understand the importance of these programs and are often asked: Is America really stepping back from global health?
The answer is less obvious: No. You don’t have to take our word for it.
In recent weeks, the State Department has quietly finalized a wave of new bilateral health agreements — strengthening outbreak detection and response in West Africa, reinforcing health sovereignty in Central Africa, deepening infectious-disease cooperation in the Caribbean, and launching a new hemispheric health-security partnership in Panama.
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Far from retreating, the United States is reshaping how it leads with the administration’s America First Global Health Strategy.
As Congress continues to scrutinize foreign assistance throughout the appropriations process and the administration reshapes U.S. engagement abroad, one principle should guide the debate: reform what works — don’t abandon it.
For more than two decades, U.S. leadership in global health has been a pillar of international stability and American influence. Initiatives such as the President’s Emergency Plan for AIDS Relief and the President’s Malaria Initiative did more than save lives: they strengthened public-health institutions, reinforced diplomatic partnerships, and demonstrated that the U.S. can pair moral purpose with strategic discipline.
Today, that legacy is being reshaped and moved forward in the Trump administration’s AFGHS.
The strategy seeks to align health assistance more closely with U.S. national interests while addressing long-standing structural weaknesses in foreign aid. Its core premise — that programs should be accountable, results-oriented, and designed to end dependency rather than perpetuate it — reflects lessons learned across administrations and party lines. America’s global health programs have saved tens of millions of lives, but success should not exempt them from modernization and, yes, reform.
The new approach relies heavily on bilateral agreements that establish clear priorities, timelines, and performance metrics while accelerating the transition of responsibility to partner countries. This is very much in line with what we referred to during the first Trump administration as the “Journey to Self-Reliance.” After all, no partner nation wants to be endlessly dependent upon foreign aid, and taxpayers should expect a credible path toward sustainability.
Reform, however, must be executed carefully.
Negotiating and implementing more than 50 bilateral health agreements is an ambitious undertaking that must be adequately funded and carefully phased to avoid disrupting lifesaving services. Without sufficient staffing and sustained engagement, reform risks becoming rhetoric rather than results.
And while AFGHS rightly targets HIV, malaria, and tuberculosis, its durability will depend on fully integrating maternal and child health, nutrition, and immunization — the very systems that make disease-specific gains sustainable. Nutrition, especially, is a force multiplier. American-made ready-to-use therapeutic foods have saved millions of children from severe acute malnutrition. And because undernourished children are far more likely to die from malaria, tuberculosis, and other infections, weak nutrition systems can undermine nearly every other health investment.
Global health security also deserves continued emphasis. Pandemics do not remain overseas. Early detection, disease surveillance, and rapid outbreak response abroad protect American families, jobs, and supply chains at home. Investing upstream to prevent outbreaks is far less costly — and far less disruptive — than scrambling after a crisis reaches our borders.
Smart partnerships remain essential. Bilateral agreements should complement, not replace, collaboration with proven multilateral institutions such as the Global Fund, the World Bank, Gavi, UNICEF, and the Coalition for Epidemic Preparedness Innovations. These organizations provide scale, burden-sharing, and coordination that bilateral efforts alone cannot replicate. Leveraging them enhances American leadership rather than diluting it.
There are historical lessons here. When President George W. Bush established PMI in 2005, it followed congressional oversight that identified a fragmented and underperforming malaria program. Over nearly two decades, PMI has helped cut malaria mortality nearly in half in priority countries by combining targeted disease control with investments in surveillance, commodity supply chains, and community health delivery. Those gains were not accidental. They rested on predictable funding, clear metrics, and sustained engagement with national health systems.
The same principles should guide current reforms.
Congress has an indispensable role. Bipartisan statutory authorities, appropriations directives, and oversight frameworks have long underpinned the credibility of U.S. global health efforts. Transparency and full reporting on performance outcomes will be especially important as funding models evolve and responsibility shifts toward partner governments. Durable reform requires cooperation between the executive and legislative branches.
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Global health has been one of Washington’s most consistent bipartisan achievements because it aligns American values with American interests. Reforming these programs to be more accountable, more strategic, and more sustainable is prudent. Retreating from them would be shortsighted.
If implemented with discipline, the current modernization effort can preserve what has worked, correct what hasn’t, and ensure that American global health leadership continues to make the world safer — and the U.S. stronger.
Chris Stewart is a former U.S. congressman who represented Utah’s 2nd District.
Mark Green is a former U.S. congressman who represented Wisconsin’s 8th District and also served as USAID administrator.