Robert F. Kennedy Jr.’s confirmation as US secretary of health and human services comes at a critical moment for global health. While the US has long been a leader in global health efforts—gaining strategic, economic, and security benefits from its engagement—progress remains fragile. Hard-won gains against childhood mortality and infectious diseases could be at risk without sustained support. Moreover, the early actions of the Trump administration have raised concerns about the US’s continued commitment to these efforts, making it essential to course correct and reinforce the country’s leadership in global health.
To uphold and strengthen the US role in global health—and safeguard decades of progress while protecting Americans from emerging health threats—Secretary Kennedy should prioritize two key areas: global immunization efforts and the role of US federal agencies in global health security.
Continuing immunization progress
With the deployment of vaccines against common infectious diseases over the past few decades, the world has seen remarkable reductions in child morality and millions of lives saved. Between 2000 and 2023, Gavi, the Vaccine Alliance helped immunize over 1.1 billion children, preventing an estimated 18.8 million future deaths. Today, Gavi supports vaccines against 20 infectious diseases through 53 product presentations.
The US has been a key supporter of Gavi, contributing $300 million in 2024 and committing $5,170 million from 2021 to 2025 in donor contributions and pledges. These contributions enable the delivery of vaccines to the most vulnerable populations, ensuring that children in low-income countries have access to life-saving immunizations.
At the launch of Gavi’s 2026-2030 investment opportunity, the US made a five-year pledge of at least $1.58 billion. Secretary Kennedy should uphold the US legacy and commitment, ensuring continued US support for global immunization efforts. Sustained investment in vaccines is not just about global health—it also protects Americans by reducing the risk of infectious disease outbreaks reaching US shores
The role of US federal agencies in global health security
Amidst global health threats such as Dengue fever in the Americas and Marburg and mpox in Africa, it is in the new administration’s interest to invest in global health security and stop diseases, which do not respect borders.
US federal agencies—including the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC)—play an instrumental role in advancing national and global efforts to prevent and respond to health threats by building the strong partnerships, scientific collaboration, and coordinated response that are vital for global health security. All eyes will be on Secretary Kennedy to ensure that the US federal agencies continue to invest in and prioritize global health security. As Secretary Kennedy considers the global role ahead for US health agencies, two areas stand out for attention:
Enhancing FDA transparency and global access
As a World Health Organization (WHO) Listed Authority, the FDA’s drug and vaccine approvals serve as a benchmark for regulatory decisions worldwide. Many countries with limited regulatory capacity rely on FDA approvals to determine the safety and efficacy of new vaccines and treatments. This global reliance underscores the FDA’s critical role not only in the US but also in shaping market entry and public health outcomes worldwide.
However, this reliance would benefit from a more transparent and accessible FDA. As Secretary Kennedy considers reforming the agency, he should revive recommendations from the FDA’s 2010 Transparency Task Force, which sought to enhance public access to regulatory information. Key reforms—including the publication of clinical trial data summaries, good manufacturing practice inspection reports, and certificates—have been attempted but remain limited. Unlocking this information would not only benefit regulators and people in lower-income settings but also increase public confidence in the FDA’s decision-making processes.
Additionally, Secretary Kennedy should expand the FDA’s successful tentative approval process, which has been instrumental in approving antiretroviral therapies (ARVs) since 2004. This program allows the FDA to authorize medicines that are not eligible for US market approval but are urgently needed for HIV programs in low-income countries. Thanks to this initiative, PEPFAR has provided low-cost, quality-assured, life-saving ARV drugs to nearly 15.7 million people worldwide. Broadening this tentative approval framework to include other essential medicines—such as treatments for tuberculosis, malaria, and maternal health—would significantly improve global health outcomes while reinforcing US leadership in public health.
Ensuring the CDC can continue to prevent and respond to health threats
CDC collaboration and data exchange with the WHO and with other countries through developing and supporting stronger surveillance systems has been vital for responding effectively to emerging outbreaks and global health threats. Direct engagement with international partners ensures that infection prevention and control professions receive critical, real-time updates on disease outbreaks without delays. As Secretary Kennedy takes on his new role, it will be important to maintain and strengthen the CDC’s international disease surveillance efforts, regardless of whether the US remains a member of the WHO. While WHO partnerships provide a streamlined framework for data sharing, the CDC can still collaborate with individual countries, regional networks, and other global health institutions to ensure continued access to essential disease surveillance data.
For example, the CDC’s influenza division has long served as a WHO Collaborating Center for Surveillance, Epidemiology, and Control of Influenza, working with the WHO to monitor and contain flu outbreaks worldwide. With the WHO’s Global Influenza Surveillance Network, the CDC gains access to flu virus samples from other countries, aiding the development of next-season flu vaccines by determining which strains of the virus will be most relevant. Even if the US were to disengage from WHO, bilateral agreements and regional collaborations could maintain this critical exchange of data and samples, ensuring the CDC continues to track influenza evolution and inform vaccine development.
Additionally, Secretary Kennedy has the authority to reshape the CDC’s Advisory Committee of Immunization Practices, which shapes national vaccine policy. It is essential that the committee remains independent, science-driven, and evidence based, maintaining the integrity of vaccine recommendations and the public trust.
Conclusion
Secretary Kennedy’s confirmation and early actions undertaken by the Trump administration have raised questions about the US commitment to global health engagement in some quarters. The stakes couldn’t be higher. Not only are decades of progress in vaccination on the line, but broader work to bolster disease surveillance and strengthen global health security could be reversed if US leadership falters. With threats like bird flu constantly evolving, a retreat from these vital efforts would leave Americans more vulnerable and could deal a serious blow to the US economy. To protect global health gains while safeguarding Americans, Secretary Kennedy should:
- Sustain US support for immunization efforts, particularly through continued investment in Gavi.
- Enhance FDA transparency to ensure global regulators and the public can trust its decision-making.
- Maintain CDC leadership in global disease surveillance, regardless of whether the US withdraws from the WHO.
By prioritizing these three areas, Secretary Kennedy can reaffirm US leadership in global health—not just as a moral imperative, but as a strategic investment in health security, economic stability, and American well-being.
CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise.
CGD is a nonpartisan, independent organization and does not take institutional positions.
