The privatization of American morality

The State Department’s new “America First” Global Health Strategy is a transactional gamble with millions of lives at risk.

By Jeff Nesbit

The destruction of the U.S. Agency for International Development (USAID) at the start of President Donald Trump’s second term was not an act of administrative streamlining; it was an act of demolition.

At the time, the White House framed the move as a blow against the “Deep State,” ignoring warnings that severing the ties between the U.S. and international aid organizations could contribute to 15 million deaths over five years.

Now, with the release of the State Department’s “America First Global Health Strategy” (and a looming deadline to finalize bilateral agreements under the new strategy in the next few weeks), we are finally able to see what they intend to build on the rubble: a global health policy that functions less like humanitarian leadership and more like a hostile corporate takeover.

Photo by Iwaria Inc. on Unsplash

The “America First” health strategy outlines a vision that fundamentally alters the DNA of American foreign assistance.

The Trump administration argues that the old system was defined by “significant inefficiency and waste” and a “culture of dependency.” To fix this, the plan eliminates the traditional network of non-governmental organizations and implementing partners, instead funneling aid through direct, bilateral agreements with foreign governments.

On paper, the strategy claims to prioritize “Frontline Support,” promising that 100% of funding will go to commodities and healthcare workers. This sounds populist and efficient.

In reality, it’s a logistical fantasy. The administration claims that 60% of previous funding went to “technical assistance, program management, and other forms of overhead.” Yet, as experts told CNN recently, dismissing these costs as “waste” betrays a profound ignorance of how health systems function.

A hospital can’t operate with only pills and doctors; it requires training, supply-chain logistics, and management—the very “technical assistance” this administration is cutting. By aggressively removing NGOs, the United States is, in the words of former USAID official Jeremy Konyndyk, “pushing Humpty Dumpty off the wall.”

The pacing of this transition is also reckless. The State Department set a deadline of Dec. 31, 2025, to finalize bilateral agreements with the majority of recipient countries.

This rush to sign complex diplomatic compacts is basically coercion rather than cooperation. Aid workers warn that developing nations are being “backed into a corner,” forced to sign agreements they cannot sustain to keep the lights on in their clinics.

What’s more, the “America First” strategy reveals a cynical pivot toward the same strategy autocratic countries like China have employed for years.

The Trump administration’s global health report explicitly frames foreign aid as a “transactional” tool to “promote American companies” rather than to save lives and reduce human suffering.

It proudly highlights that aid money will be used to procure goods from U.S. corporations, citing more than $120 million in diagnostic tests purchased from American firms in 2024 alone. Last week, the administration underscored this commercial focus by announcing a $150 million deal for an American drone company to deliver medical supplies.

The irony is hard to ignore. The strategy report devotes an entire section to “Leveraging U.S. Global Health Leadership to Compete with China,” criticizing Beijing for its “transactional” foreign assistance.

Yet, the U.S. is now adopting that very same model. The new bilateral agreements require countries to share epidemiological data for up to 25 years - a move experts fear is designed to give American pharmaceutical companies a competitive edge in developing new drugs.

As one senior government official told CNN, “It feels like we’re leaning into the exact self-serving posture ... we once condemned in China.” The United States is no longer a benevolent partner; it’s a vendor demanding data and market share in exchange for penicillin.

Equally dangerous is what the report omits. The strategy focuses almost exclusively on infectious disease outbreaks, HIV/AIDS, malaria, and tuberculosis. There is a deafening silence about maternal and child health, nutrition, and reproductive health.

By narrowing the scope of U.S. aid to only those diseases that threaten “homeland security” or offer commercial upside, the administration is abandoning millions of vulnerable women and children.

This selective definition of “global health” confirms the fears of the bipartisan Modernizing Foreign Assistance Network, which warned that the State Department lacks the systems to manage this portfolio effectively.

The “America First Global Health Strategy” claims it will make America “Safer, Stronger, and More Prosperous.” But safety isn’t achieved by dismantling the surveillance networks that NGOs provided.

You don’t show strength by strong-arming impoverished nations into rushed contracts. And prosperity can’t be bought by transforming humanitarian aid into a subsidy program for American drone manufacturers.

In essence, we are witnessing the privatization of American morality. The administration has replaced the mission of saving lives with the mission of securing contracts.

If the estimates and predicted 15 million deaths come to pass, it won’t be because of natural disasters. It will be the result of a distinctly man-made disaster—a calculated bureaucratic choice to put “America First” by leaving the rest of the world to die.

Jeff Nesbit was the public affairs chief for five Cabinet departments or agencies under four presidents and the communications director for a U.S. vice president.

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