The US launched the America First Global Health Strategy, which transforms global health toward national security and bilateral influence instead of universalist principles.[1][2] Previous programs, such as the President's Emergency AIDS Relief Plan, combined expertise with solidarity and saved millions of lives.[1] The new strategy prioritizes control of supply chains and US interests through multi-year bilateral agreements with clear objectives.[1][3] The Covid-19 pandemic exposed the fragility of multilateral coordination as countries applied export restrictions and stockpiled in their own interests.[1] Multilateral institutions serve as negotiation arenas rather than engines of solidarity.[1] Strategic pillars include strengthening global surveillance to detect outbreaks within seven days, building government capacity, and supporting American health innovation.[1] Fragmentation opens up space for new leadership, such as an African public health order coordinated by the African Centers for Disease Control and Prevention.[1]