The Trump administration’s “America First Global Health Strategy” has damaged efforts to respond to the most urgent public health crises facing the world, Physicians for Human Rights (PHR) said today.
September 18, 2026 marks one year since the launch of the America First Global Health Strategy, which represented a new approach to U.S. global health focused on American economic and security interests. The “America First” strategy was introduced nine months after the Trump administration triggered a series of seismic shocks to U.S. foreign aid for global health and research, including stop-work orders, the shuttering of USAID, and cuts to the National Institutes of Health (NIH) disrupting clinical trials in progress. While advocates have long called for reforms to the global health funding system to ensure sustainability and uphold human rights, the “America First” strategy has made U.S. global health policy more transactional, exploitative, and short-sighted.
“The architects of the America First strategy make claims about the efficiency and impact of their approach that aren’t backed up by evidence. Data from PHR and other independent groups clearly show that services are weaker than they were a year ago, HIV testing is down, treatment of children living with HIV is down, and community-based prevention is gutted,” said Emily Bass, expert consultant for Physicians for Human Rights and co-author of two reports on the impacts of foreign aid disruption in South Africa, Tanzania, and Uganda.
Since March 2025, Physicians for Human Rights has gathered evidence and documented the consequences of United States foreign aid transition, including the disruption of health services, the waste of U.S. investments in research and innovation, and the abandoned commitments to the most vulnerable segments of society.
Secretary of State Marco Rubio has asserted that no one has died due to cuts to U.S. foreign assistance, but investigations by journalists, including NPR and The New Yorker, have documented deaths following the abrupt withdrawal of U.S.-funded health services. Health workers in Ethiopia also reported to PHR deaths after aid cuts disrupted access to essential care, including a pregnant woman.
“Work under the America First Global Health Strategy has been slow to start,” said Bass. “Countries are still waiting for final work plans and funding. Planning has happened with unprecedented secrecy. Neither the U.S. Congress nor leaders in co-signatory countries know what is being paid for, who will benefit, and who will be left behind.”
“The administration has framed the America First Global Health Strategy as a transition toward stronger, more self-reliant health systems. But in this past year, we have documented all the ways that the United States has set countries up to fail,” said Thomas McHale, SM, public health director at Physicians for Human Rights. “An aid transition is not successful if clinics lose essential staff, prevention programs disappear, health data systems deteriorate, and people who already face barriers to care are pushed even further away from services. That is retrenchment, not ‘sustainability.’”
In South Africa, PHR documented the consequences of the “America First” approach across the HIV response. Through interviews with clinicians, researchers, people living with HIV, and advocates, PHR found that U.S. funding cuts contributed to the loss of community-based testing and prevention services, health worker layoffs, longer waits at clinics, weakened patient follow-up, and deteriorating health data systems. Services designed to reach adolescent girls and young women, sex workers, and other key populations were among those disrupted, showing how abrupt cuts fall hardest on people who already face stigma, discrimination, poverty, or other barriers to care. Through interviews with clinicians, researchers, people living with HIV, and advocates, PHR found that U.S. funding cuts contributed to the loss of community-based testing and prevention services, health worker layoffs, longer waits at clinics, weakened patient follow-up, and deteriorating health data systems.
While South Africa already financed most of its HIV response, PHR’s research shows that the removal of targeted U.S. investments still dismantled critical services, weakened the broader public health ecosystem, and squandered decades of U.S. investment.
The “America First” strategy’s next phase raises a different but equally serious concern. The United States is now shifting more of its resources into government-to-government awards and awards to private sector industry partners, with little attention to benchmarks, transparency, accountability, or the rights of patients or civil society in the countries where the money will be spent.
“One year in, the question is no longer whether the America First Global Health Strategy works on paper,” said McHale. “The question is whether it is improving health and strengthening health systems. The available evidence collected by PHR and partners around the world demonstrates that the answer is a resounding ‘no.’”
Global health strategies must protect the people most vulnerable to losing access to care, including communities already marginalized by discrimination, poverty, conflict, or exclusion from health systems. They must also include meaningful accountability mechanisms to track where funds are going, how they are being used, and whether the governments receiving them are protecting health workers, facilities, and the people those systems are meant to serve.
PHR calls on the U.S. government to protect continuity of care during funding transitions by phasing changes responsibly, conducting impact assessments before and during cuts or transitions, and ensuring that essential services do not disappear when funding shifts. Financing for key and marginalized populations should be predictable, multi-year, and designed to protect specialized services for people who already face the greatest barriers to care, without shifting costs onto survivors or communities.
Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.