A new report titled A Sovereign Future For Health, released by the Accra Reset—a global health initiative led by Ghana’s President John Dramani Mahama—warns that the United States' reduced involvement in international health aid has created significant challenges for healthcare systems in Africa and other parts of the Global South. The report points to the Trump administration’s cuts to programs like the U.S. Agency for International Development (USAID), along with the impact of the Covid-19 pandemic and rising global living costs, as factors that have made healthcare reform more urgent. These changes have strained health systems and increased the need for sustainable, locally driven solutions. The report highlights that Africa produces less than 1% of its vaccines while shouldering about 25% of the world’s disease burden. It notes that the sudden withdrawal of U.S. funding from global health initiatives has forced many countries in the Global South to restructure their budgets. For example, Nigeria had to absorb 28,000 health workers who were previously employed by USAID, at a cost of $200 million. This shift has placed additional financial pressure on already strained national health systems. According to the report, external financing for health in Africa dropped by nearly 70% between 2021 and 2025. The withdrawal of U.S. funding for South Africa’s HIV treatment program, known as the Emergency Plan for AIDS Relief (PEPFAR), which provided over $400 million annually, led to the closure of HIV clinics across the country. This left 1.4 million people living with HIV uncertain about their treatment. Research presented at a major international AIDS conference described these funding cuts as having “severe and devastating” global consequences. At the World Health Assembly in May, Mahama noted that Ghana lost $78 million after USAID programs were closed, affecting maternal healthcare, malaria treatment, nutrition, and HIV/AIDS interventions. The report also points out that the past few years have undermined global health cooperation, with the pandemic revealing risks from concentrated production and unequal access to essential health products. Rising debt and financial pressures have further constrained national health budgets. Naveen Rao, senior vice-president of the health initiative at the Rockefeller Foundation, emphasized that the Accra Reset does not call for traditional donors to reduce their support for global health but to approach it in a more effective and sustainable way. He argued that donor countries should support the shift toward locally led health solutions while advancing shared health and economic goals. A recent survey commissioned by the Rockefeller Foundation found that 75% of Americans, including more than half of those who primarily support Donald Trump, believe the U.S. should restore aid for disease prevention to help contain the Ebola virus. The survey also showed that 65% of U.S. adults support international cooperation, even if it means sacrificing some national interests, and 64% feel Americans have a shared responsibility to people in other countries, even those they don’t personally know. The report comes as pressure grows on countries to take more ownership of their health systems, as reliance on foreign aid is increasingly seen as unsustainable. The Guardian has reached out to the U.S. Department of Health and Human Services (HHS) for comment.