14 JANUARY-FEBRUARY 2026 | THE FOREIGN SERVICE JOURNAL SPEAKING OUT Troy Fitrell retired in September 2025 after 30 years in the U.S. Foreign Service. He led the Bureau of African Affairs through the changes reflected in this article and earlier served as ambassador to the Republic of Guinea, in addition to assignments in Africa, Europe, and Latin America. Jamie Bay Nishi is the chief executive officer of the American Society of Tropical Medicine and Hygiene, the largest international scientific organization of experts dedicated to reducing the worldwide burden of tropical infectious diseases and improving global health. As a Foreign Service dependent, she grew up in Saudi Arabia, Egypt, France, and Germany between postings back to Washington, D.C. A “tumultuous” year doesn’t begin to describe the impact on lives, livelihoods, and global health initiatives of the dismantling of USAID, the pulling back from multilateral partnerships, and budget cuts across public health and research. The global health community’s cry that these disruptions have cost lives and set back health initiatives for years is not an understatement: We cannot easily replace USAID’s expertise or that of the global health implementer community. It is not enough to simply shift the burden onto fragile countries themselves or pass the responsibility solely to international and regional organizations. If we cannot do things as we did, we must plan to conduct health diplomacy in a new way. Even with decreased U.S. funding, the State Department must protect and advance the gains already achieved in global health while implementing the administration’s policies. State’s Bureau of Global Health Security and Diplomacy recently released its strategy for the new era of U.S. contributions to global health programming, which is intended to empower partner country governments, improve health outcomes, and promote durability and self-reliance in local health systems while ensuring U.S. health security. We appreciate our colleagues’ efforts, noting—as they did on the release of the strategy—that there is much left to do to implement the broad strategic approach. We hope our suggestions in this piece will complement the strategy and keep us all directed toward better global health outcomes. An Opportunity for Health Diplomacy Going forward, chiefs of mission and their country teams will need greater understanding of the complexities of health challenges in the countries where they serve as they inherit the responsibility to engage continually on health, a task previously owned by USAID counterparts. They must advance bilateral conversations with significantly diminished resident expertise. Further, the State Department will need to quickly acquire the know-how for contract and grant authority to fill gaps that are deemed priorities in terms of U.S. strategic interests. There is appropriate concern within the global health community about State Department generalists’ ability to absorb global health programmatic activities, but there is a difference between implementing health programming and integrating global health into the overall conduct of diplomacy. The State Department will not be able to advance its work without engaging technical health expertise, but at the same time the department has a fresh opportunity to collaborate with partner countries to consider health activities within a broader socioeconomic context. Within the health arena, State can now reshape activities formerly undertaken by USAID’s Global Health Bureau and consider health impact outside siloed efforts run largely through diseasespecific vertical programs. Integrated Approaches vs. Silos For years, and across political administrations, global health stakeholders have noted the need for integrated approaches to delivering health outcomes but often felt constrained by longestablished programs aligned to specific appropriated funding lines. Traditionally, there were eight health-area silos: HIV/AIDS, largely facilitated through PEPFAR; the President’s Malaria Initiative (PMI), jointly State’s Opportunity Ahead for Global Health BY TROY FITRELL AND JAMIE BAY NISHI
RkJQdWJsaXNoZXIy ODIyMDU=