Podcast Summary: "Trump’s Approach to Global Health, and the Latest from COP30"

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

Overview

This episode delves into two major topics shaping global development policy and practice:

1. The United States’ shifting strategy on global health under the Trump administration, particularly its move toward bilateral agreements and a “America First” paradigm.
2. Critical developments from the second week of COP30, including new climate action plans, monetary commitments, and innovation highlights, with a particular focus on Africa’s role and the evolving intersection of health and climate policy discussions.

Key Discussion Points and Insights

1. U.S. Global Health Strategy under Trump (00:04–07:29)

Highlights:

• The U.S. State Department unveiled a new “America First” health strategy in September, emphasizing bilateral agreements with partner governments rather than the traditional funding of NGOs.
• Bilateral deals are being negotiated first with 16 African countries, shifting funding responsibilities from the U.S. to these governments and focusing on integration within national health systems rather than creating parallel structures.

Key Insights:

• Increased Reliance on Local Partners: The Trump administration is downplaying traditional NGO-led projects in favor of local government, faith-based groups, and private sector engagement.
• Disease Focus: Bilateral templates prioritize combatting HIV, malaria, TB, polio, and measles.
• “Customer” vs. “Aid Recipient”: A new rhetoric frames African nations as “customers” rather than mere recipients, with the U.S. seeking business engagement through companies like Gilead and Zipline.

“African governments won't be aid recipients, but customers.” — Sarah Jerfing [01:55]

Concerns Raised:

• Power Imbalances: Many worry that bilateral deals fragment Africa’s negotiating power, especially in ongoing pandemic agreement talks.
• Staff Capacity: There is skepticism about the State Department's ability to manage, following the downsizing of USAID and lay-offs of global health experts.
• Transparency: Africa CDC head Dr. John Kaseya urges countries to share bilateral agreement details to negotiate better deals collectively.

“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):

• The template requires partner countries to provide pathogen data within five days of an outbreak, with no guarantee of reciprocal benefits (such as access to developed vaccines).
• The proposed duration (25 years) starkly contrasts with agreements in the pandemic treaty negotiations (to 2030), raising concerns of exploitation and undermining multilateral unity.

“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]

2. Women’s Health Innovation in Brazil (08:06–12:53)

Spotlight: SAS Brazil (Sabine Zink Bolognini & Adriana Mallet Toeg)

• SAS Brazil won the Action for Women’s Health award for addressing health equity for remote women in Brazil via mobile clinics and telehealth.
• The model innovates by bringing a “one-stop shop” for health needs—including cancer screenings and digital dermatology—addressed in a single day at easily accessible locations.

“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]

• The award will help them accelerate innovation, focus on sustainability, and double their impact each year.

3. COP30: Climate Negotiations & African Priorities (12:56–21:32)

Key Developments and Outcomes

• COP32 will be hosted in Ethiopia (Africa) — a major announcement amid uncertainty over COP31’s location.
• Action plans adopted:
  • Berlin Declaration on Poverty and Food: Links food security with climate action, bringing agriculture visibly into climate debates.
  • Berlin Health Action Plan: Concrete steps for integrating health and climate strategies.
• Notable monetary commitments:
  • Gates Foundation: $1 billion to smallholder farmers in Africa & Asia for climate change resilience. [15:48]
  • Additional $300 million from 35 global health organizations, including Rockefeller Foundation.
• Innovations: New carbon finance initiatives, such as a refugee camp-led carbon credit system, show how humanitarian and climate interests are merging.

Brazil’s Influence:
Brazil’s “social justice and equity bent” is evident in prioritizing poverty and food as part of the climate response.

Conflict Areas in Negotiations

• Persistent disagreements on NDCs (national climate pledges) and adequacy.
• Adaptation finance provision remains contentious, particularly how the Global North should fund the South.
• Trade and climate linkages (e.g., farm goods imports tied to deforestation status) see division.
• Transparency and reporting on climate actions.

“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]

Push for Fossil Fuel Phase-Out

• For the first time, over 80 countries support formal language on fossil fuel phase-out in the core agreement text.

“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]

4. Forthcoming: Global Fund Replenishment (22:20–24:01)

Key Context

• The 8th Global Fund replenishment targets $18 billion for 2026–2029 in HIV, TB, and malaria programs.
• Early pledges: U.K. has announced a £850 million pledge (a 15% reduction). The U.S. is expected to make a major announcement but has signaled its intention to reduce its donor share.
• The replenishment event aligns with the G20 summit in Johannesburg.

Notable Quotes & Memorable Moments

• 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]

Timestamps for Important Segments

• 00:04 – 07:29 U.S. health strategy, bilateral deals, Africa CDC response
• 08:06 – 12:53 Women’s health innovation spotlight (SAS Brazil)
• 12:56 – 21:32 COP30 coverage: Africa’s role, major action plans/pledges, negotiation sticking points, and innovations
• 22:20 – 24:01 Preview of the Global Fund replenishment at G20

Conclusion

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.

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