THE FOREIGN SERVICE JOURNAL | JANUARY-FEBRUARY 2026 15 facilitated through USAID and the Centers for Disease Control and Prevention (CDC); Tuberculosis; Maternal and Child Health (MCH); Family Planning/Reproductive Health; Nutrition; Neglected Tropical Diseases; and Global Health Security. But today, if a country indicates that they are seeing better HIV outcomes thanks to decades of PEPFAR support, and their top concerns have shifted to maternal health and malaria, there is an opportunity to turn to other areas of U.S. expertise in which a ministry could most use support. A reframed approach will also open new doors to more patient-centered approaches to health and programmatic efficiencies. If a pregnant woman presents at a clinic feeling ill, instead of offering a diagnostic for one disease, testing could be offered for a suite of diseases or health concerns, to reach a proper diagnosis more efficiently. Though this example appears simplistic, everyone involved in health diplomacy knows such situations are commonplace. Chiefs of mission and their teams talk to many officials across government, and this interaction will benefit from engaging outside the often-siloed development assistance health dialogues. Shifting from health area verticals to bilateral cross-cutting health programming is a big challenge, but it offers an opportunity to reorient to a nimbler approach that is responsive to constantly evolving health priorities and can, perhaps, ultimately drive better health outcomes. Building on Solid Foundations Though some level of reorientation is needed, the State Department should build on the highly effective multisector models for global health already advanced by USAID—for example, the Neglected Tropical Disease (NTD) program. Two decades of U.S. leadership combating 21 NTDs that disproportionately affect the world’s poorest communities through a mass drug administration campaign has achieved remarkable results. More than 54 countries have eliminated at least one NTD, with 600 million people no longer requiring preventive treatment. These efforts have also served as a powerful example of effective public– private collaboration: Only $115 million annually in government funding has leveraged more than $1.1 billion in donated drugs from pharmaceutical companies. Similarly, USAID’s Center for Innovation and Impact spent years developing models of sustainable finance for health and models of data-driven health policy. Let’s not allow that work to get lost but leverage it to ensure that unique American expertise in the fields of health innovation and life sciences, philanthropy, academia, and civil society is engaged. This includes working with the non-health private sector that employs Americans to work in nearly every country in the world and wants to ensure the well-being of their workforces. We have more than 5 million Americans working and living abroad, and improved global health means better access to health care for them as well. Using Comparative Advantage In the consolidation at State, U.S. national interests such as epidemiology and the overall detection, management, and control of various emerging infectious disease threats should remain a priority. Far from being external niche programs, these should become more central and intrinsic to the State Department’s global strategic planning. Part of the United States’ comparative advantage is the ability to rely on the critical interagency expertise that remains following this year’s significant reductions in force. The Centers for Disease Control and Prevention (CDC) plays a vital role in strengthening global health systems through disease surveillance, outbreak response, laboratory capacity building, workforce training, and pandemic preparedness. A notable example of successful interagency collaboration was the response to the Ebola outbreaks in West Africa in 2014, when tens of thousands perished, threatening the globe. The response led to significant investment in national and regional epidemiology, field service capacity strengthening, and creation of the Africa CDC, modeled after the gold-standard U.S. CDC. In 2021, when Ebola reared its ugly head again in a manner similar in scope and distribution to 2014, only a few dozen perished thanks to the new structures the United States created. Looking to Increased Local Capacity Significantly, this increased domestic capacity is applicable to the range of emerging infectious diseases—e.g., mPox, Marburg, Lassa fever, Ebola— protecting not only local communities but the entire globe. We are currently watching a new Ebola outbreak unfold in the Democratic Republic of the Congo with little to no U.S. engagement around the response, which is testing bilateral country ties in new ways. While the United States should maintain some level of bilateral engagement during an emerging infectious disease, increased local capacity aligns with an America First agenda and accesses American comparative advantages.
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