The America First Global Health Strategy (Sept 2025) is the State Department’s roadmap to protect U.S. national security by preventing infectious-disease threats abroad, shift global-health assistance into multi‑year bilateral compacts that require recipient co‑investment, and promote U.S. health innovation and procurement. Its core aims include: strengthening surveillance and outbreak response to ‘‘make America safer,’’ negotiating country-level bilateral MOUs to drive self‑reliance and compete geopolitically (“make America stronger”), and reducing pandemic risk while leveraging U.S. commercial partnerships (“make America more prosperous”).
An MOU is a written, often multi‑year, record of agreed cooperation between governments. Whether an MOU is legally binding depends on its terms and the parties’ intent: the U.S. State Department warns the title alone does not determine binding status and that some U.S. MOUs are treated as binding; the Office of the Legal Adviser/Circular‑175 process determines whether a given document is an international (legally binding) agreement or a political/non‑binding instrument.
Congress enacted FY2026 appropriations (including the NSRP bill that funds State Department global‑health accounts) and the President signed the FY2026 appropriations package in early February 2026. However, the Burundi MOU’s cited “more than $129 million” is described by State as the Department’s intent; appropriations provide funding to State’s Global Health Programs broadly, and Congress did not, in the public record, separately itemize a single $129M line explicitly labeled for the Burundi MOU.
The State Department release says Burundi commits to increase domestic health spending by $26 million over five years but does not publish specific budget line items or a detailed timeline. Public sources so far reference the aggregate co‑investment figure only; implementation details and line‑by‑line Budgets would be set by the Government of Burundi and are not included in the State release.
State’s phrase “treat 97 percent of those living with HIV” most likely refers to treatment coverage (the share of people diagnosed with HIV who are on antiretroviral therapy), not specifically to viral suppression; U.S. global‑health communications commonly report targets as percent on treatment, while viral‑suppression is a separate clinical outcome often reported alongside treatment coverage.
Progress is generally tracked with routine health‑information and surveillance indicators: malaria mortality and under‑five malaria deaths (from national HMIS and civil‑registration/surveys), HIV program indicators (persons on antiretroviral therapy, retention, and viral‑load suppression), and outbreak surveillance metrics (timeliness, detection benchmarks such as 7‑1‑7). The State strategy and related MOU reporting expect country data, integrated service delivery monitoring, and agreed performance benchmarks reported to State and partners.
Implementation typically involves the State Department’s Bureau of Global Health Security and Diplomacy and in‑country U.S. Mission (embassy), in coordination with ministries of health in the recipient country, and implementing partners (national health programs, the Global Fund/PEPFAR partners, CDC technical teams, and NGOs). The Burundi MOU text and State releases indicate Government of Burundi ministries will co‑lead, while State and its implementing U.S. health partners administer funding and technical support on the ground.
State has announced 16 bilateral MOUs under the Strategy representing over $18.3 billion in new health funding (about $11.18 billion U.S. assistance + $7.12 billion recipient co‑investment). Public State releases and the Summary of bilateral MOUs list multiple African countries (examples publicized earlier include Kenya, Malawi, Rwanda, Uganda, Lesotho, Mozambique, Nigeria, Cameroon, C�f4te d�edvoire, Eswatini, Liberia, Madagascar, Sierra Leone, Botswana, Ethiopia, and Burundi). The $18.3B total combines State’s announced U.S. commitments plus the recipient governments’ co‑investment commitments across the MOUs.