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Bio‑surveillance contractor in Rwanda compact
In 2025 the United States began dismantling its post-Cold War global health architecture: withdrawing from the World Health Organization, freezing most foreign aid, and abolishing USAID’s development role. On this foundation, the Trump administration unveiled an 'America First Global Health Strategy' that replaces large multilateral and NGO-run programs with tightly negotiated bilateral health compacts requiring partner governments to co-finance HIV, TB, malaria and outbreak response programs and gradually assume full responsibility. Kenya signed the first such deal on December 4, 2025, followed by Rwanda on December 5–6 with a $228 million compact; by early 2026, 15 nations had signed agreements committing over $16 billion, with the U.S. covering 100% of commodity costs in FY2026 before tapering support.
Updated Feb 5
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