From global solidarity to strategic nationalism? The implications of ‘America First’ global health for low- and middle-income countries

Global health cooperation is undergoing recalibration. The 2025 America First Global Health Strategy does not introduce entirely new governance instruments but more explicitly prioritizes bilateral agreements, co-financing requirements, and performance-based partnerships within global health cooperation. This commentary examines how the strategy formalizes and intensifies existing dynamics of strategic bilateralism and analyses its implications for low- and middle-income countries. We argue that the significance of the strategy lies less in new governance mechanisms than in the scale, visibility, and political framing of existing ones. While this approach may strengthen domestic ownership and programme integration, it may also reshape bargaining dynamics, fiscal responsibilities, and coordination structures within global health systems.