The Trump administration is launching an unprecedented, $11 billion soft-power effort to remake foreign health assistance after its controversial decision to gut USAID.
Why it matters: Called the America First Global Health Strategy, the program aims to boost U.S. influence and interests in developing nations —especially those in Africa — while bypassing non-government organizations (NGOs) that delivered services through USAID.
- The program would send billions of dollars directly to needy foreign governments, health care organizations and drug manufacturers over the next five years — a plan that critics worry could be a recipe for corruption and "catastrophic" failures.
Zoom in: So far, Secretary of State Marco Rubio has signed 15 agreements with African countries aimed at improving their health systems with an emphasis on HIV/AIDS, malaria, tuberculosis and maternal health.
- The U.S. has committed $11.1 billion over five years to the countries, which have pledged $12.2 billion in matching funds and promised to meet performance goals.
- The State Department aims to have agreements with 50 countries in a few months.
Zoom out: The initiative is the administration's answer to critics who accused Trump of deadly, dangerous and self-defeating isolationism when the administration scuttled USAID at the start of his second term.
- Rubio said the system replaces the "NGO industrial complex" that siphoned 70% of U.S. money to middlemen and bureaucrats based in the D.C. area. Former USAID officials dispute that characterization.
- "They built parallel health care, flying a bunch of American workers out there to treat people," said Jeremy P. Lewin, undersecretary of state for foreign assistance.
- "Yes, you made progress, but it stalled and you never built durability or self-reliance in these African governments because they had this parallel system."
Between the lines: Adopting a criticism from the left, Lewin said USAID fostered a "neo-colonial mindset" of "The white man has to do it." The new plan will do more to help developing nations build their health care capacity, Lewin said.
- "We're going to give you access to innovative American drugs. We're going to give you access to commodities, antiretroviral drugs, diagnostic kits [and] malaria nets at scale through pool procurement," he said.
- Lewin said third-party auditors will track data and money to spot and eliminate fraud and waste.
The other side: Former USAID officials and global health specialists, however, say the administration's new system will be crippled by graft on the ground and inaccurate data collection.
- "The capacity is not there, and the level of corruption is so high that money is going to disappear," said Andrew Natsios, a Republican who led USAID under President George W. Bush.
- Natsios sneered at Lewin's use of the term "neo-colonialism," saying many countries don't know how to prevent "catastrophic failure."
- "I suggest that this 'neo-colonial' model is the only one that is acceptable to the U.S. Congress" and inspectors' general tracking federal payments, he said.
Since Trump began dismantling USAID, foreign aid specialists have made dire predictions about the impact. One epidemiologist estimated that up to 750,000 people have died because aid was shut off, a figure the State Department disputes.
- Atul Gawande, former USAID assistant administrator under President Biden, detailed the problems in November in a New Yorker piece and documentary that focused on Kenya.
The following month, Rubio announced a health agreement with Kenyan President William Ruto, who praised the initiative.
- Cameroon, Eswatini, Lesotho, Liberia, Mozambique, Nigeria, Rwanda, Uganda, Madagascar, Sierra Leone, Botswana, Ethiopia, Malawi and Côte d'Ivoire also have signed aid agreements with the U.S.
- Panama, the first non-African nation to be involved, will join later this week.
The big picture: Trump's "America First" mantra means just that. So the aid packages have U.S. strategic and business interests in mind.
- In Zambia, the U.S. ambassador last month linked a pending health care agreement with U.S. access to mining opportunities.
- U.S.-based ExxonMobil has one of the largest liquefied natural gas facilities in Mozambique. It's among the world's poorest countries and has one of the globe's highest HIV/AIDS rates: 11.5% of people aged 15-49.
- Rwanda's deal was hammered out amid talks over access to critical minerals. The agreement helps the country expand its use of medicine-carrying drones from the American company Zipline.
To try to block the spread of HIV, Gilead Pharmaceuticals has agreed to provide its injectable preventative drug lenacapavir through the program.
- The U.S. government also is paying for Starlink, the satellite-based internet company owned by Elon Musk, to help connect health clinics to the web.
- Lewin said the free wifi draws people to the clinics, where they get care at the same time.
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