The new “America First Global Health Strategy” could erode years of progress under PEPFAR

August 8, 2026 - 01:21

A recently unveiled policy framework, dubbed the "America First Global Health Strategy," is drawing sharp concern from public health experts who say it could reverse decades of hard-won gains in the fight against HIV and AIDS. The strategy, which prioritizes narrow U.S. interests over broad international cooperation, is seen as a direct threat to the long-running PEPFAR program, a cornerstone of global HIV relief.

For over two decades, PEPFAR has provided life-saving antiretroviral treatment to millions of people across sub-Saharan Africa. It built clinics, trained local health workers, and created robust supply chains that turned a death sentence into a manageable chronic condition. The new approach, however, shifts funding criteria toward short-term, measurable outcomes that align with immediate American geopolitical goals. This could mean redirecting resources away from the most vulnerable populations, such as pregnant women, orphans, and key at-risk groups, who require sustained, long-term care.

Experts argue that the strategy's emphasis on "America first" undermines the very foundation of PEPFAR's success: trust and partnership. When recipient countries feel that aid is conditional on political loyalty rather than health needs, they are less likely to share sensitive data or cooperate on surveillance. the new policy appears to favor vertical, disease-specific interventions over strengthening entire health systems. This is a dangerous regression, as a weak primary care network cannot maintain the complex follow-up required for HIV patients who must take medication daily for life. If the strategy is fully implemented, experts warn, we could see a resurgence of new infections and a spike in drug-resistant strains, undoing the work of a generation and leaving millions without a safety net. The stakes, they say, have never been higher.