June 18, 2026
What it will take to make Secretary Rubio’s vision for global health aid transition a reality
By Chris Collins
Transitioning U.S. global health assistance to greater country leadership can be a very good thing. Done right, it will center decision making with governments and communities, drive increased domestic health investment and respond to growing calls from African leaders for health sovereignty. Done hastily and without safeguards, it risks backsliding on our 20 years of progress.
Secretary of State Rubio laid out the vision for global health transition earlier this month in hearings on Capitol Hill, stating “…at the core of this arrangement that we’re making with countries is their desire and our goal to ultimately help them build their own national health systems … Some countries, that may take five years; some countries, it may take 15.”
In his remarks, the Secretary is calling out a core element for transition success: calibrating aid transition to fit the dynamics of each country, helping build the primary health care systems needed for success and recognizing that transition will take time.
Rubio also emphasized: “…we don’t want aid to solely be judged by how much you spend; we want it to be judged by what its results are.” That should be the guiding principle of global health aid transition.
But beware the data delay trap. Given the typical lag time in data reporting, potentially exacerbated by the transition of data management, we won’t see comprehensive outcome trends for an extended period, with the impacts on some foundational health services only appearing years later. Doing transition effectively means paying attention at the outset to ensure health systems are being strengthened and programs and policies are setting countries up for success.
Based on the history of highly impactful US global health investments, five priorities are clear:
- Tailor transition to each country’s unique situation and allow the time it requires. Publicly available MOUs include ambitious domestic resource raising targets for many countries, including countries with major malaria epidemics that also face conflict or serious debt distress. A new KFF analysis shows that between 2026 and 2029, relative to prior funding levels, there will be a 24% decline in combined support from the U.S. and the Global Fund. This represents significant fiscal pressure on partners at a time when the World Bank reports global growth is slowing to its weakest pace in nearly 20 years and a quarter of developing economies will end 2026 poorer than before COVID-19. Congress should require frequent mid-course assessments of country fiscal capacity to meet targets, revising targets and timelines as needed.
- Secure data on service levels and outcomes. Reliable data is the only way the U.S. can track progress and make necessary corrections that respond to country realities. As site-level data collection and validation systems that PEPFAR and the Centers for Disease Control (CDC) have long supported are de-commissioned and national government systems become the primary source of data, it is critical that those data streams be vetted for quality and suitability to track disease resurgence. In the midst of transition implementation, vital CDC technical support services are being changed to a fee-for-service model, raising the question whether countries will receive adequate technical supports. Forthcoming country implementation plans should be public so all stakeholders can review the strategy to achieve targets. On service delivery, PEPFAR data from the last quarter of 2025 and other analyses already show a worrisome reduction in services for children, HIV prevention and other areas. Speedy recovery in service delivery will be needed to avoid increased HIV incidence and mortality.
- Scale highly effective innovations. This includes two American-made interventions – lenacapavir for HIV prevention and spatial emanators for mosquito control – for which the administration has wisely set up partnerships with the Global Fund and companies. A clear, ambitious plan for financing and delivering these and other innovations — from home test kits to telehealth to early infant diagnostics – and a defined operational approach for the State Department’s new Innovation Fund is needed to drive the necessary speed and scale.
- Invest in community service systems and protect the most vulnerable. Community service organizations are trusted, front line responders and are particularly important for reaching the most stigmatized, vulnerable populations. Yet many countries do not yet have “social contracting” rules in place that allow them to invest in community systems, and publicly available documents do not detail how community services will be protected. With the significant reduction in PEPFAR’s DREAMS services, it is important that transition plans specify how the multiple needs of adolescent girls and young women, as well as other vulnerable groups, will continue to be met. Country implementation plans should provide clarity on how these services will be financed, delivered, and monitored.
- Coordinate Global Fund and bilateral programming. The Global Fund is the leading edge of aid transition, driving domestic investment, strengthening health systems, engaging multiple in-country stakeholders in decision making and achieving year on year results. Release of all fiscal year 2025 appropriated global health funding will advance responsible aid transition. This includes two billion of “use it or lose it” funding that was appropriated to USAID and has to be obligated by September 30th or returned to the Treasury.
Epidemics are not forgiving. For all its long-term benefits, there’s no question that global health aid transition subjects the delicate gains against AIDS, TB and malaria to considerable risk. As the steward of US leadership against these diseases, Congress needs to be asking questions now and on an ongoing basis about the programmatic and policy measures being implemented that will determine outcomes down the road. Combining Secretary Rubio’s guiding principles with Congressional oversight is how we avoid the very good of aid transition unraveling into the very bad of resurgence of the deadliest epidemics.
Chris Collins is President & CEO of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria