The United States’ (U.S.) new global health strategy aims to position American companies at the forefront of African markets — home to the world’s fastest-growing populations — with African governments serving as clients for U.S. products.
According to Devex, this statement was made by Jeff Graham, senior official at the Office of Global Health Security and Diplomacy at the U.S. State Department. In this vision, donors’ role shifts to supporting innovation rather than focusing solely on emergency responses.
“American companies are largely absent from the fastest-growing consumer market in the world,” Graham said in a speech during the Global Health Supply Chain Summit in Kigali, Rwanda.
Graham is part of a team of State Department officials traveling across Africa to negotiate bilateral agreements with countries under the new “America First” global health strategy.
This strategy marks a departure from previous administrations, which relied heavily on sending funds to partner non-governmental organizations (NGOs) tasked with implementing programs. The Trump administration criticized these NGOs for high operational costs and plans to strongly support beneficiary governments, the private sector, and religious organizations.
“We are not abandoning global health leadership — we are transforming it,” Graham stated, adding that “the strategy is not about withdrawal but about smarter partnerships that leverage American technological leadership to create sustainable health systems while opening markets for innovation.”
The U.S. has begun negotiations with 16 African governments. Graham noted that two American teams are negotiating simultaneously, with Rwanda being the third country on their five-country tour.
He highlighted two new landmark agreements with the private sector that “demonstrate this new approach in action.” One involves a new $150 million U.S. investment in Zipline, an American company delivering medical supplies to remote areas via drones.
Referring to this investment — announced at the Kigali conference — as “a sign of commitment” to the Trump administration’s vision, Graham stated that over the next 36 months, “you will see American technology delivering life-saving medicines to 130 million people across the continent. You will see African governments paying for this service. We are making an initial investment, but the payment will come from governments, who will not be aid recipients but clients who recognize value.”
Critique of the previous model and advocacy for a new paradigm
Graham added that over 80% of essential medicines are procured through international mechanisms, with minimal African private sector participation.
The Trump administration’s vision represents “a significant mindset shift for many of our public health specialists, but a shift they are very excited about,” he emphasized.
Graham outlined a vision in which an increasing number of pharmaceutical products are manufactured in Africa, with private companies handling most distribution — rather than governments — and supply chains facilitated by cross-border regulatory harmonization.
“We want to leverage America’s unmatched technological advantages in robotics, artificial intelligence, manufacturing, and innovation. We want to create commercial partnerships that survive political leadership changes on both sides, whether in Washington or with our friends in Africa,” he said, urging conference participants to help design “the infrastructure this transformation will require.”
He also highlighted another agreement reflecting the administration’s new approach: a September deal with American pharmaceutical company Gilead and the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria to provide the innovative HIV preventive drug Lenacapavir. The first doses were delivered in Eswatini and Zambia.
Dependence vs. capacity: Critiques of previous funding
Graham criticized previous U.S. investment in African health for “creating dependence, not capacity,” adding that “despite billions of dollars in donor funding, we continue to see chronic stockouts. For decades, the U.S. subsidized emergency responses.”
He further criticized current health supply chains for being oriented toward emergency responses rather than long-term sustainability, with African companies representing only a minimal share of the global pharmaceutical market.
According to Graham, programs such as the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative, as well as organizations like the Global Fund and Gavi, created fragmentation between different diseases and multiple parallel supply chains. He reiterated that over 80% of essential medicines are procured via international mechanisms, with little African private sector involvement.
Vision for the future of U.S.–Africa partnerships
The Trump administration’s vision is “a significant mindset shift for many of our public health specialists, but one they are very excited about,” he insisted.
Graham outlined a vision where more pharmaceutical products are manufactured in Africa, the private sector assumes most distribution, and supply chains are integrated through regulatory harmonization across countries.
“We want to leverage America’s unmatched technological advantages (…) and create business partnerships that endure beyond political changes,” he reaffirmed, again urging participants to help build the necessary infrastructure, adding that the Trump administration is committed to making the idea of “trade, not aid” a reality.
The new “America First” strategy has received mixed reactions. Some praise its potential to integrate foreign aid into national health systems rather than creating isolated programs and parallel systems. Others question the State Department’s capacity to execute the strategy, given the significant reduction in its global health staff and expertise, and criticized proposals for pathogen-sharing agreements under bilateral models. Still, Graham remains optimistic.
“The next years of health partnerships between the U.S. and Africa will be fundamentally different from the past two decades,” he said. “We are transforming the way the United States does business with the African continent in the health sector, and we are very confident it will work,” he emphasized.
