16 JANUARY-FEBRUARY 2026 | THE FOREIGN SERVICE JOURNAL Decades of U.S. contributions to health implementation programs, public health, and health research have strengthened the capabilities of most countries to facilitate more of this work, and we are at a point where the United States should robustly engage on health diplomacy to have more nuanced dialogue around what will make individual countries and the United States safer, healthier, and economically more secure. Recommendations As we consult with countries to design and implement the way forward, based on the administration’s new strategy, we submit the following recommendations to State leadership: 1. Empower and resource posts. Ambassadors and their country teams must absorb the responsibility to map the priorities, integrate the capabilities, and convene and advise stakeholders in host countries. We must recognize that posts do not have this capacity currently and need both the instruction and investment to make it a reality. 2. Have the right operational tools. In the short term, State must rapidly build its contracting authority to be able to issue contracts and grants to support direct global health programmatic work moving forward and, ideally, assign contracting authority to posts. Even with a smaller budget, this capacity is critical. 3. Build on success. Recognizing the essential contributions and successes of PEPFAR, PMI, and the USAID Global Health Bureau, as well as the fact that the world has continued to evolve with new enduring and emerging health challenges, programs should now build on that proven infrastructure and consider multiple health areas concurrently. 4. Persevere with multisector engagement. The State Department and missions should encourage all sectors the United States represents, including the private sector, nongovernmental organizations, academia, and civil society, to advise them on how to drive the best return on investment working with more limited public sector funding, prioritizing capabilities the U.S. can uniquely offer to fill gaps and improve health outcomes. 5. Rely on whole-of-government expertise. The State Department does not have, and never will have, deep technical expertise related to global health. It is imperative that the department reinstate interagency agreements, in particular with the CDC, to have the ability to deploy the best in the U.S. government’s capacities to tackle health challenges. This is specifically the role of diplomacy versus subject matter expertise. Underpinning any recommendations to the State Department, congressional appropriators must recognize the new responsibilities and requirements and fund them appropriately. This means preserving and building on PEPFAR’s capacities while concurrently supporting a shift away from siloed funding and offering flexible health funding to achieve maximum impact. The newly reorganized Bureau of Global Health Security and Diplomacy faces countless challenges. If successful in adopting refreshed and collaborative approaches, we may see strengthened bilateral relationships and improved health outcomes globally. n Speaking Out is the Journal’s opinion forum, a place for lively discussion of issues affecting the U.S. Foreign Service and American diplomacy. The views expressed are those of the author; their publication here does not imply endorsement by the American Foreign Service Association. Responses are welcome; send them to journal@afsa.org.
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