
This week, we take a look at the details of the https://www.devex.com/news/us-template-for-bilateral-health-deals-bypasses-who-pandemic-negotiations-111285 for bilateral agreements between the United States and partner governments, which sheds light...
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Sarah Jerfing
Foreign.
Ada Saldinger
My name is Rumbi Chakamba and you're listening to this Week in Global Development hosted by myself, Ada Saldinger and David Ainswood. I'm joined by Aina Messi and Sarah Jerfing. And this week we'll be digging into the US's new health strategy as well as the updates from COP30. Hi everyone. Welcome to this week's edition of this Week in Global Development. And we're joined by our reporters Ayamat and Sarah. For this edition. I think I'm just gonna jump straight in and go straight to you, Sarah. So we're finding out a little bit more about the new health strategy. You reported on a template that the US might be using to negotiate bilateral deals with countries. And those bilateral deals have started. Can you take us where we are at right now and what we actually know about these agreements that are being negotiated?
Sarah Jerfing
Yeah, absolutely. So as you mentioned, the US State Department revealed its new America first strategy in September. And within that strategy, the U.S. government is negotiating these overarching bilateral agreements with countries that have a complete package of health programming. And this is different strategy to previous administrations which leaned more heavily on funneling money to implementing partner NGOs. So the Trump administration has been critical of these NGOs and is planning to more heavily on country government faith based organizations in the private sector. So as you mentioned, we reported on a template of these bilateral agreements and that focus on disease areas like hiv, malaria, tuberculosis, colio and measles. It breaks down how funding responsibilities will shift from the US to partner governments and kind of from their own resources. And there's been kind of broadly a lot of optimism around these agreements as kind of a way to better integrate foreign aid international health systems as opposed to creating siloed approaches and parallel systems. But there have been criticisms as well, such as the State Department's capacity after dismantling USAID and laying off a bunch of global health experts. So as you mentioned kind of there's this group of State Department teams moving around, focusing first on 16 African countries. And we just reported on a speech from a conference in Kigali where a State Department official spoke about how American companies are largely absent from African markets and kind of moving forward, African governments won't be aid recipients, but customers. And he referenced two new US deals with American companies, Gilead and Zipline, as kind of ways that how these deals will demonstrate this new approach in action. Also, I attended the African Population and Health Research center symposium in Nairobi today and heard some interesting reactions to the strategy. One of the speakers said that the strategy is more honest than the US has ever been about its intentions towards global health. And that kind of clarity about intentions might help with negotiations. But there was also discussions about imbalances of power where you have these bilateral agreements as opposed to kind of having a continental approach to negotiate.
Ada Saldinger
So one thing that, that's one thing I found really interesting about this approach because one thing that we noted in the template was this thing about pubs, which is the pathogen access, access, benefit sharing thing that's included within the negotiations. So basically, countries are negotiating a pandemic agreement, right? And one of the things that's been contentious within those negotiations is access to pathogen access. And what that means is that if there is any kind of virus or outbreak, countries are supposed to share information about the pathogen that's circulating. And what countries from the global south are saying is that once you've shared that information, if any vaccines or medications are developed because of that, we should have access to that. So that's something they're currently negotiating as part of the pandemic agreement, but it's included within these bilateral negotiations as well. The US is saying that if you do find any outbreak, you need to share this pathogen information with us within five days. And they are not making. And in the template there are no promises of any benefits that they would get from American companies that might develop vaccines, etc for any outbreak that may occur. So for me, I was wondering if that would then ruin the negotiating power for the Africa bloc within the pandemic agree within the pandemic agreement negotiations that are ongoing and if it would also like sort of loosen that resolve because they've been acting as a block throughout the time when they've been negotiating the pandemic agreement. And this kind of. Now if one country's agreeing one thing and another country's agreeing something else, it kind of loosens that combined approach. Are you hearing the same thing and what are people saying about this tactic?
Sarah Jerfing
Yeah, absolutely. And one of the really kind of huge criticisms around this is the timeframe. So the template says 25 years of sharing pathogen data with the United States, but kind of when you look at the template, the rest of the conversation only goes to 2030. So you have kind of this proposition that the US might be asking countries to commit to this for over two decades, which is a very, very long time. So people are saying that this is exploitive and yes, kind of ruins that this, the multilateral approach to kind of reaching common ground that is present in the pandemic negotiations. Right now.
Ada Saldinger
And another thing that I've also noticed, like when we, when we reported on the speech that was made in Rwanda, there was also a lot of talk about bringing in the private sector and African companies. There was a lot of talk about manufacturing medicine and how there's so much so such little manufacturing happening on the continent and how that needs to change. And I think everyone is in agreement, but the continent has been taking a continental approach to this. So it wouldn't be just one country looking at manufacturing, it'll be a country looking at manufacturing for the entire region. And I think when you now make these bilateral deals, I'm not sure if that would be considered as well, that this should be a regional approach and looking at like one country and thinking of if you're going to produce this, we can't ask the next country to do the same. And so this has been happening at a sort of African Union level. And it seems like organizations like the African Union, the Africa cdc, are not being brought into this. But you actually reported on comments that the Africa CDC head, Dr. John Kasseh, also mentioned about these bilateral agreements. And he's asking countries to come forward and basically share what's going on. And he says that's the only way we can sort of be able to negotiate the best kind of deals. Can you take us through what he said? Sure, yeah.
Sarah Jerfing
And I think the comments that we reported on from the State Department official did kind of, it did resonate with what has been kind of talked about on the continent. And they did talk about kind of regional regulatory harmonization and improving pharmaceutical manufacturing. So there could be kind of a State Department support of, you know, the continental mission around that. And the template for the. The bilateral agreements don't kind of dig into the larger kind of manufacturing on the continent. But yeah, so Dr. Kaseya had mentioned that he's just encouraging that ministers to share the information of the bilateral conversations that they're having right now and talked really emphasized that countries and the continent needs to ensure that there's mutually beneficial negotiations and agreements that are reached.
Ada Saldinger
Yeah. So that's definitely something that we'll be on the lookout for. And for anyone who has any information about this, we would love to talk to you. So please do reach out.
David Ainswood
This portion of this week in global development is brought to you by pivotal, which works to accelerate the pace of social progress for women and young people in the US and around the world. We're proud to spotlight pivotal's Action for Women's Health initiative that awards innovators who are shaping the future of women's health from North America to Southern Asia. Hi, I'm here with Sabine Zink Bolognini.
Ada Saldinger
And Adriana Mallet Toeg, co founders of SAS Brazil.
Sarah Jerfing
So Adriana, what first inspired your work.
Ada Saldinger
And what problem were you looking to solve?
Adriana Mallet Toeg
The first thing is the challenge to put innovation for people that most needed it. I think that we have a huge problem with distribution in Brazil. 93% of specialized doctors are in 70% of cities. And we think that real innovation come from three things. First of all, distribution of healthcare in a way that promotes equity. This is the first thing we do and motivate our work. Second, combining existing technologies like mobile health and telehealth with new technologies like AI. So we put these technologies addressing distribution with new technologies like AI and intentionally investing in innovation that improve women's health. So most of health research and innovation is done by men for men. So we face this challenge. So first the key was being to able to orchestrate this intentionally with new technologies and this way to distribute more the healthcare and make it achieve people that usually don't have access.
David Ainswood
And so Sabine, how is your mobile.
Ada Saldinger
Clinic and telehealth model changing access to.
Sarah Jerfing
Care for women in remote areas in particular?
Sabine Zink Bolognini
I think the main thing here, Kate, is to making healthcare easier for women, especially in vulnerable areas. Brazil is a huge country, so patients Travel on average 155km to get to a health specialist. So that's a huge challenge, especially for women because they have to think, who should I leave my children with? Do I need to skip a day of work? So this idea of making health care more accessible where they are, this distribution of health access is something that we innovated and making care easier for women. And this is an important part of our work also this idea of innovating in the way care is delivered. So usually women have to go back and forward to go to the doctor or I'll go to this specialist and I'll take care of my cervical cancer screening. Then the other day I'll go to that doctor to find a breast cancer screening. Then the other day I'll go to another doctor to do my treatment for a dermatology problem. Well, the way we deliver care was also an innovation for these women. So we have this concept of a one stop shop that in the same day women can take care of multiple health demands. And I think this is also something important that we have done in a way that it's innovative, not in the technology itself, but in the way that care is also delivered.
Ada Saldinger
Yeah.
David Ainswood
You were just awarded this Action for Women's Health award. How is this going to help you deepen your impact?
Sabine Zink Bolognini
So for us is speeding up the process of innovation. We believe, and we have partnered through these years and developed our own technologies. I mean, this is something that we are now able to enhance because we believe we need new solutions to tackle this challenge around women's health equity. The second s is the sustainability of our work. So we're aiming at a longer term timeframe in terms of having this long term relationships with the cities that we're currently at and with the partners that we're currently have. So having this long term view, we also believe that is the most effective way to actually implement the change. And the third one is to scale up our impact. Right. So we believe that with this money we can at least double our size of impact every year. But these three assets are the main areas where we are now not only dreaming, but also actually being able to plan and do the work.
Sarah Jerfing
Well, Sabine, Adriana, thank you for sharing more about your work and congratulations on.
David Ainswood
Winning the Action for Women's Health Award.
Ada Saldinger
Another area that Africa definitely took like a continental approach is climate. I know that each time before we have cop, we have like the continent sort of coming together and developing this sort of continental, continental approach to the negotiations. And ironat you are at COP second week there. How's everything going? Actually, maybe I should add to that question, how's everything going and what are some of the big decisions that have come out so far?
David Ainswood
Absolutely great to be here. Week two in Balin. And speaking of Africa, it's really exciting because actually we know that cop 32 is going to be in Africa. It is going to be in Ethiopia, which was announced last week. That was a big outcome and kind of unusual because we actually don't know where Cop31 is going to be because Australia and Turkey are still in, let's say, some major disagreement about that. So we hope to get that idea soon. But we do know it's going to happen in ontus for cop 32. So in terms of the other outcomes, so we have a few, I guess, kind of like three buckets of things that we can talk about. We have some action plans that have happened, some monetary commitments and some innovations. So last week we had some interesting action plans. You know, I cut her food, so I was really interested in the food outcomes. So they had the Berlin Declaration on Pavoli and this was basically an action plan about how countries should tackle under threat Food and poverty. And they're really linking that quite explicitly with climate change, which, you know, food has been, it should have been a conversation in these climate conferences for a long time, but it's only really bought into the forefront in the past couple of years. People really say Sharon Sheikh with ticklers toll it up in three years ago. So this is just really elevating it even more. And we also had the Berlin Health Action Plan. And this is really giving some concrete ways that countries can, can address relating health and climate. And so with both of these decisions, I think it's interesting because you can really see Brazil's flair, like kind of spin that they put on things because Brazil, you know, is this developing country or this, you know, mass and developing country. I don't know if it's actually technically developing country. But you know, it's gone on this, on this big growth trajectory over the past several decades and it really has this kind of social justice of equity bent that it puts on things. So it really makes sense, you know, but it was that we'll be emphasizing things like, like poverty and food as it relates to climate change. And I think those are really interesting things to watch. And I. And it's gotten pretty, it's getting pretty well received, that kind of approach by countries in the African continent, for example. And you know, on the second bucket of things that we had last week, we had several monetary commitments and pledges and announcements. It's always really hard to keep track of these as you could imagine, because everyone is announcing millions and billions of dollars. I always ask myself if I return Nuns money when I would time it at cost because it's hard not to get buried, you know, again since I cover cover food. One really big announcement that was the Gates foundation announced an evil $1 billion that it be to support smallholder farmers in Africa and Asia. And that's specifically addressed the climate change. So that's a really interesting announcement. We also had $300 million from, I think there's 35 organizations working on health. So there have been a lot. And we'll be sifting through all of them to kind of make sense of them. Because of course sometimes it makes it sound like it's a new announcement, but it's actually just kind of an old one that they're retopping, saying we're b sifting through a lot of these advantages and seeing the types show new and important. And also the other thing, the other bucket of things I've been watching and participating in is just conversations about innovations and that's always really interesting. And these tend to happen on the side events and the sidelines. But you know, just for an example of what I'm talking about, I went to one talk of the refugee agency, which you might not necessarily think of as, you know, a top climate actor, but one thing that they're doing is that they launched last week was launching this new REC fund rep. And this is what they're describing as the world's first large scale refugee driven carbon finance initiative. So this is kind of based off of the understanding that, you know, first of all, a lot of refugee camps are really climateable and in kind of unevaluations. So I can know that they unfortunately, because of stresses to the environment that they're in, they tend to have a lot of deforestation and things like that and people have to deal with in clean cooking. So they're wondering how they can kind of maybe earn carbon credits through things like reforestation and clean cooking. So this is just a sort of like an interesting example of the types of initiatives and the innovations that are being reached here.
Ada Saldinger
It's super interesting. I was quite encouraged. We both cover health, so I was quite encouraged by all the things that happened in health. Do you remember the first time there was a help day at cop? I think it seems like the needle has moved quite a bit from that. That announcement that was made, 300 million includes quite some of the big players in philanthropy. Gates Foundation, Rockefeller Foundation. Are you seeing like more happening? Because it usually feels like these discussions around health and climate but not really much action. And this is supposed to be the implementation cop. Are you seeing the same thing that there's more action on this particular cop?
David Ainswood
I'm just mentioning it is the implementation cop. So there is kind of more of an emphasis on these action plans as opposed to new promises. So a lot of it tends, a lot of the documents, when you look at them, they look at kind of concrete ways to do it and concrete ways to measure progress, which I think is interesting, rather than just kind of a blog political document.
Ada Saldinger
And I learned a new word while reading up on your coverage. Mutero. What does that mean? Am I saying it correctly?
David Ainswood
Yes, exactly. That's a word that I learned last week and I've heard a million times ever since. So that means a collective effort in Portuguese. And so this is there, this is coming up a lot because this is going to be. We're waiting on the Mutirao text, which is expected to be kind of the overarching major political text from Kong. And so we have a draft of it already. But of course, as you know, drafts can really change and do change quite often. But we're kind of, you know, I'll take a step back and give you an idea of kind of the contentious issues that have really been at the heart of why there are so many brackets, which means, you know, disagreements and text. So I was down to the four major buckets of, of disagreements between the countries on radio in terms of climate text. So the first one is the fact that if we look at our NDCs, which are the nationally determined contributions, which is basically countries national plans for climate, if you add them all up together, it is not looking like we're a 1.5. Like that is just pretty straight up and pretty obvious. So where a lot of people are trying to figure out how and what we should do about that, how do we address that gap? So that question of how do we do that? Some countries want that in that text and some countries don't. And so this has been a contentious issue.
Ada Saldinger
The second thing, not all countries have submitted. Sorry, I was just going to say not all countries have submitted their ndc.
David Ainswood
Right, exactly, exactly. There's a tracker and it's always ticking up gradually and there is a flood like on the first couple of days of cop, but more than 100. But not all countries have submitted yet. Yeah, so we're still waiting on some. And so the other issue unsurprisingly is of course money and the provision of public finance and specifically adaptation finance, which is how countries adapt to a climate change and which is you know, often harder to capital. Like it's harder to figure out the returns on those investments. Right. So that's not necessarily as benefactor to the private sector. So but in addition there's expectations that countries, especially the Global north, provides concessional financing or grants to the Global south to help adapt to a changing climate. So this is a big question and no one, there's a lot of disagreement about what the approach should be. The third one is Brazil has really been a place where we've seen more conversations related to trade and climate and its impact. So we see things like, you know, if we're looking at Europe, for example, they're, they're increasingly linking things like the import of farmed goods and making sure that that hasn't been farmed on recently deforested land. So there are these like increasing conversations about linking these two and whether or not those should be linked explicitly in the text is something that countries disagree on. And of course there's Some little disagreements about, about transparency, how to report it and how to report on, on climate wellness. So those are the major buckets that we're kind of watching on. One thing that I think is interesting though is that there has been a long movement this year on a fossil fuel phase out roadmap. So like it's not saying that countries, not countries aren end with fossil fuels today obviously, but there's actually over 80 countries they are in support of this road to start phasing it out and having that language inside the text in some way. So it is in the, in the text. And I think that's an interesting and important update that a lot of activists have been pushing for for a while.
Ada Saldinger
Yeah, I remember the story that came out that there are more campaigners or, gosh, I lost the word, people who are from the fossil fuel industry than they are people from the different delegations at Cobb. So I think it'll be interesting to actually see if that makes it in the final document. But that's a lot for us to look forward to and obviously we'll be following your reporting and if you're not already, please sign up for our newswire because you get links to Ayanat and Jesse, our colleague who's also at cop, Davey Reporter's Notebook. They take you really down to the Amazon and kind of show you what's really happening on the ground at cop. And Sarah, I know that you will be following. We also have a colleague who's at the G20 and I know Sarah, you'll be following discussions around the Global Funds replenishment. What can we look forward to from you this towards the end of this week?
Sarah Jerfing
Yeah, so Friday is the Global Fund's highly anticipated replenishment event and it's as you mentioned, kind of hosted on the margins of the G20 summit in Johannesburg. So the Global Fund, as many of us know as the world's largest multilateral funder of global health grants in low and middle income countries focusing on HIV, malaria, tuberculosis. So it's in its eighth replenishment and set a target of 18 billion and that'll be for its work between 2026 and 2029. There have been some early pledges that have come through. The U.K. which is the third largest public donor, committed £850 million, which is a 15% reduction from its previous pledge and the seventh replenishment. And kind of one of the big question marks that we will be following on Friday is what the US government will commit. The US has been the largest donor to the Global Fund since its founding and accounts for 33% of the organization's funding. There is an American law that prevents the US from contributing more than $1, $2 that other donors contribute and kind of when maxed out that that equals that 33%. But earlier this year, the administration, the Trump administration released its fiscal year budget request for next year and that said that it aims to reduce the percentage it contributes as compared to other organizations. But the the US Government has noted it will make a pledge so on Friday. It's unclear if we'll have a final tally during the last replenishment. Pledges continue to take place after the event. So we will see how everything pans out on Friday.
Ada Saldinger
So definitely looking forward to reading that as well. So like I mentioned, we've got a reporter, G20 Ironata Cobb, Sarah, following the Global Fund. So much to look forward to. So I urge you to sign up for our Daily Newswire to get all these stories and more. But thank you guys so much for joining me and yeah, good luck.
This Week in Global Development — November 21, 2025
Hosts: Ada Saldinger, David Ainswood, Rumbi Chakamba
Guests/Reporters: Sarah Jerfing, Ayamat, Sabine Zink Bolognini, Adriana Mallet Toeg
This episode delves into two major topics shaping global development policy and practice:
Highlights:
Key Insights:
“African governments won't be aid recipients, but customers.” — Sarah Jerfing [01:55]
Concerns Raised:
“He’s just encouraging that ministers to share the information of the bilateral conversations… [to] ensure that there's mutually beneficial negotiations and agreements that are reached.” — Sarah Jerfing [06:58]
Pathogen Access Issue (Pathogen Access Benefit Sharing - PABS):
“This is exploitive and… ruins… the multilateral approach to kind of reaching common ground that is present in the pandemic negotiations right now.” — Sarah Jerfing [04:53]
Spotlight: SAS Brazil (Sabine Zink Bolognini & Adriana Mallet Toeg)
“In the same day women can take care of multiple health demands… not in the technology itself, but in the way that care is also delivered.” — Sabine Zink Bolognini [10:40]
Brazil’s Influence:
Brazil’s “social justice and equity bent” is evident in prioritizing poverty and food as part of the climate response.
“If you add [NDCs] all up together, it is not looking like we're at [a safe] 1.5. Like, that is just pretty straight up and pretty obvious.” — David Ainswood [18:13]
“There's been a long movement… on a fossil fuel phase out roadmap… over 80 countries are in support… having that language inside the text.” — David Ainswood [21:16]
On U.S.–Africa Power Dynamics:
“Once you've shared that information, if any vaccines or medications are developed because of that, we should have access to that… [but] in the template there are no promises.”
— Ada Saldinger [03:40]
On Health Equity in Brazil:
“Most health research and innovation is done by men for men. So we face this challenge.”
— Adriana Mallet Toeg [09:04]
On Women’s Healthcare Accessibility:
“Patients travel on average 155km to get to a health specialist. That’s a huge challenge, especially for women because they have to think: who should I leave my children with?”
— Sabine Zink Bolognini [10:00]
On the Rising Action Orientation of This COP:
“Rather than just kind of a blog political document, [these plans] look at concrete ways to do it and measure progress.”
— David Ainswood [17:52]
Explaining “Mutirão”:
“[It] means a collective effort in Portuguese... this is coming up a lot because we’re waiting on the Mutirão text, which is expected to be kind of the overarching major political text from COP.”
— David Ainswood [18:13]
This episode provides nuanced reporting on seismic shifts in global health aid, shining a light on both the opportunities and risks of the U.S.’s new bilateral strategy. Insights from COP30 underscore an increasing convergence between health and climate agendas, with African nations playing central roles. The episode also spotlights innovation in service delivery for women and previews high-stakes funding decisions critical to health in low and middle-income countries.
For full interviews and more details on these topics, subscribe to Devex’s Newswire and follow their on-the-ground reporting.