The United States has expanded its global health efforts through a series of strategic initiatives under the America First Global Health Strategy, including a new five-year partnership with the Kingdom of Eswatini. The Memorandum of Understanding (MOU) signed by both governments outlines $242 million in combined U.S. and domestic investments aimed at improving public health systems, modernizing disease surveillance, and expanding access to HIV prevention and treatment.
The MOU specifies that the U.S. will contribute up to $205 million to support health data infrastructure, outbreak response technology, and antiretroviral access, while Eswatini is committed to increasing domestic health expenditures by $37 million over the agreement period. These measures are designed to foster sustainable, efficient healthcare delivery and safeguard health gains in the country.
A key component of the partnership involves the delivery of lenacapavir, a twice-yearly injectable HIV prevention drug developed by U.S. company Gilead Sciences. The first doses have arrived in Eswatini and Zambia, as part of a broader market-shaping effort by the President’s Emergency Plan for AIDS Relief (PEPFAR) to supply at least two million doses across ten high-burden countries. Clinical trials indicate the drug prevented HIV infection in more than 99% of participants, and it is expected to provide added protection for pregnant and breastfeeding mothers.
The new bilateral agreements, part of a series with dozens of recipient countries, aim to gradually transition financial and operational responsibilities to local governments while incentivizing co-investment. Officials noted that the approach seeks to strengthen health systems, save millions of lives, and enhance long-term sustainability, reflecting a coordinated effort to combine U.S. expertise, technology, and strategic funding in global health.
