Trump Administration Commits $16 Billion to Bilateral Health Deals
A new strategy replaces USAID with direct agreements that experts say trade transparency for speed.
By Eric Collins ·
The U.S. government has committed $16 billion across 36 bilateral health agreements signed since the start of the second Trump administration. This total represents a 34% drop in overall U.S. global health aid compared to previous levels, according to calculations by the Kaiser Family Foundation. The new approach shifts funding away from large international organizations toward direct deals with individual governments, a change officials describe as a move toward partnership rather than charity.
The transition began with the dismantling of the U.S. Agency for International Development in early 2025. President Trump cited alleged fraud, waste, and abuse for the decision. The abrupt end to USAID operations caused immediate disruptions in countries like Zambia, where clinics closed and patients ran out of HIV medication. Janeen Madan Keller, acting co-director of the Global Health Program at the Center for Global Development, described the first half of 2025 as a period of complete upheaval for communities in some of the world’s poorest nations.
By the summer of 2025, the State Department began developing a structured alternative. The resulting America First Global Health Strategy aims to make the country safer and more prosperous through bilateral memorandums of understanding. These agreements often include transactional elements. In Zambia, activists revealed that an initial draft conditioned health funding on access to the country’s copper and rare earth minerals. Although the mineral provision was removed after public outcry, many agreements still require recipient nations to share specific data, such as pathogen information.
Under the new framework, the U.S. expects recipient countries to increase their own financial contributions. In the Zambia agreement, the U.S. pledged $1.5 billion over five years. In return, Zambia committed to raising its domestic health spending by $975 million. Roma Chilengi, the Zambian Health Minister, stated that the country plans to recruit up to 40,000 healthcare workers through this support. Critics argue that the administration is prioritizing the number of signed deals over health outcomes. Asia Russell, executive director of Health GAP, noted that the focus on process indicators rather than impact indicators does not save lives.
Transparency remains a point of contention. The State Department has not publicly released the full text of the agreements, stating that a final determination on broader release will occur after ongoing country negotiations conclude. Jennifer Kates, a senior vice president at KFF, said the agreements are much more opaque than previous programs like PEPFAR, which was known for regular data sharing. The State Department responded that claims of a lack of accountability are unfounded and that every signed memorandum of understanding will be shared with Congress.
The Democratic Party’s majority in the new Congress, which convenes on January 3, is expected to influence the next phase of this policy. Kates predicts that lawmakers will demand immediate access to the memorandums of understanding and implementation plans. She expects the new Congress to first push for more information on what programs are currently supported before considering other actions. Russell argued that Congress needs to halt the process until it receives the necessary accountability and information.
The State Department said most African countries with signed agreements have drawn up implementation plans. It added that U.S. embassies are now focused on operationalizing these plans while recipient governments execute their commitments.
