When the U.S. Department of State released its America First Global Health Strategy this September (1), the policy marked a decisive departure from decades tradition of American foreign aid. Gone is the era when technical assistance, sprawling non-governmental organizations (NGO) infrastructures, and overhead-heavy grants dominated the landscape. Instead, the US government is reframing health aid as an instrument of national interest—prioritizing outbreak surveillance that protects Americans, bilateral deals that serve as counterweights to China and expanded markets for American-made medicines and diagnostics (2). For Africa the strategy carries profound implications for governments, institutions and research across the continent.
At first glance, this pivot looks like a blow to Africa. The old system, under US programs like PEPFAR and USAID, funneled billions into HIV, TB, and malaria programs, funded research networks and built labs and training programs (3). The new strategy does not end that support, but it reshapes it. U.S. support will be tied to direct government-to-government agreements, performance benchmarks and above all, the requirement that funds reach frontline workers and commodities (4).
Embedded in this transactional framework is a paradoxical opportunity. For African nations, the dismantling of health dependency models could mark the beginning of something more profound: an Africa First health paradigm.
From Dependency to Resilience
For too long, health systems across Africa have been shaped by donor priorities—disease-specific programs, parallel reporting structures, and supply chains owned offshore. The new U.S. strategy, by narrowing what it will fund, effectively nudges African governments and institutions towards greater ownership (5). Co-financing requirements, though challenging, create incentives for ministries of health to invest more deeply in their own regulatory systems, supply chains, and data platforms.
This shift could accelerate the development of integrated surveillance networks that serve both infectious diseases and the continent’s growing burden of non-communicable diseases like cancer, cardiovascular diseases and diabetes. Private-sector and faith-based providers already delivering a large share of care in Africa are praised in the U.S strategy for their cost-efficiency (4). Harnessing these networks within national research and delivery systems could build more resilient and self-sustaining health architectures, ones that endure beyond donor cycles.
Building an “Africa First” Health Model
If the U.S. is exporting its innovations abroad, Africa must equally leverage this moment to build indigenous capacity. This means prioritizing the development of robust laboratories and data systems that can support both outbreak detection and long-term health research (6). It also involves establishing domestic financing mechanisms—such as innovative health insurance pools and regional procurement platforms—that reduce reliance on any single donor. Strengthening disease-agnostic trial networks capable of testing new vaccines and therapies across both infectious and non-communicable diseases is essential. Finally, strategic government-to-government agreements should place African ministries of health, rather than foreign funding and partners, at the center of planning, implementation, and accountability (7).
While risks still remain, aid will fluctuate with geopolitical dynamics, and commercial diplomacy may influence priority-setting (8). Africa has demonstrated resilience through past cycles of volatility. By viewing this shift not as an endpoint but as an inflection point, the continent has an opportunity to advance health systems that are increasingly owned, financed, and directed by African institutions. In this model, external partners serve as contributors and collaborators, aligned with and reinforcing African-defined priorities.
The U.S. may have redefined the framework for global health engagement. Africa’s task is to ensure that this shift accelerates, not undermine the continent’s path toward sustainable, resilient, and sovereign health systems. Africa’s moment is now — a resilient, sovereign health future is not only possible, but also within reach.
References
- America First Global Health Strategy [Internet]. United States Department of State. [cited 2025 Oct 3]. Available from: https://www.state.gov/releases/office-of-the-spokesperson/2025/09/america-first-global-health-strategy/
- Think Global Health [Internet]. [cited 2025 Oct 3]. The New America First Global Health Strategy: Four Observations. Available from: https://www.thinkglobalhealth.org/article/the-new-america-first-global-health-strategy-three-observations
- Global Health: Lessons for the Future. Glob Health.
- America First Global Health Strategy.
- Think Global Health [Internet]. [cited 2025 Oct 3]. America First in Global Health: How Africa Should Respond. Available from: https://www.thinkglobalhealth.org/article/america-first-in-global-health-how-africa-should-respond
- Blogs BG. From Aid to Autonomy: How Africa Can Build Resilient Health Systems [Internet]. BMJ Global Health blog. 2025 [cited 2025 Oct 3]. Available from: https://blogs.bmj.com/bmjgh/2025/08/22/from-aid-to-autonomy-how-africa-can-build-resilient-health-systems/
- Africa CDC Hosts the 2nd High-Level Ministers of Health Forum to Strengthen Transformative Health Leadership [Internet]. Africa CDC. [cited 2025 Oct 6]. Available from: https://africacdc.org/news-item/africa-cdc-hosts-the-2nd-high-level-ministers-of-health-forum-to-strengthen-transformative-health-leadership/
- Demeshko A, Drake T, Yakhelef N. A New Era for Global Health: Can African Countries Agree a New Compact with External Donors? 2025 Mar 27 [cited 2025 Oct 6]; Available from: https://www.cgdev.org/publication/new-era-global-health-can-african-countries-agree-new-compact-external-donors