By Gabriel Armas-Cardona, PhD Researcher, University of Groningen & University of Göttingen, g.a.cardona rug.nl

This blog post is part of a series, “Global Health Law in Turbulent Times”.

With the US’s dismantling of its long-lasting foreign policy, including the all-but-eliminated USAID, we’re seeing a dramatic shift in how other actors are responding. The immediate focus is on finding other donors to fill the dire funding gaps, but this stage is temporary. Europe will need to adapt its approach to foreign assistance in light of the changed environment. This post posits that the likely medium-term response will be to develop foreign aid policies focused on regional health security, with sub-Saharan Africa being the key region in mind.

The slashing of USAID has had catastrophic impacts everywhere, but nowhere more than in Africa. In fiscal year 2023, sub-Saharan Africa received the second highest amount of US assistance at $12.1 billion. Europe and Eurasia received more, but the vast majority of that was specifically for Ukraine. That money funded projects like providing water for 250,000 people in displaced camps in DRC, HIV medication for 350,000 people in Lesotho, Tanzania and Eswatini, and Ebola surveillance in Uganda. This aid supported hundreds of thousands of people, significantly reducing health vulnerabilities and fostering stability across entire communities. The withdrawal of this aid not only causes immediate disruption but also sets the stage for long-term increases in health risks and social unrest, undermining the very stability it helped to establish. This instability will lead to more conflict and emigration, including emigration to Europe.

It’s not prescient to say that Europe is currently facing multiple crises. The crises come from all sides, such as US-threatened tariffs, lagging AI development, lack of chip production, sluggish green transition, and Russian sabotage and future military threats. This is ignoring domestic issues of stalling economies, aging demographics, and far-right voices seeking to play spoiler. The common thread among these crises is that addressing or even mitigating them requires substantial financial resources. Europe is going to have to stretch every Euro to cover as many strategic interests as possible. This is where regional health security comes in.

Health security is the application of a security paradigm to health. Health security states that health interventions should be aimed at protecting a population from acute public health threats. It’s pragmatic and concrete. The negative is that it doesn’t produce long-term benefits that other approaches, like health system strengthening, can. However, I see it forming the basis for European health foreign policy in the short- to medium-term.

A health security focus, especially when targeting Africa, provides three key benefits to Europe. First and foremost, it promotes human welfare. Despite everything, we should never forget that the goal is to uplift humanity. Second, health security protects Europe from communicable diseases stemming from Africa. Third, health security can mitigate migration pressure by reducing the push factors at the source. The first benefit is self-evident, fulfilling both Europe’s altruistic goals as well as its obligations of international cooperation. Let me elaborate on the latter two.

Thanks to COVID-19, we recognize that we’re more and more vulnerable to communicable disease epidemics. Thanks to factors like climate change or human encroachment into wild areas, there are more disruptions of natural systems than ever, allowing for new ways for communicable diseases to develop and spread. One response to this rising threat has been the development of a WHO-backed Pandemic Accord. However, with the negotiations stalling, States are looking for regional rather than global solutions. European foreign assistance can focus on communicable diseases, particularly in regions where it’s more likely that the disease could spread to Europe: Africa and the Middle East. Such programs already exist, such as the UK’s Tackling Deadly Diseases in Africa Program. What will change will be programs that are currently globally focused that will reduce their scope. For example, if the US pulls its funding from the GAVI vaccine alliance, then four out of the top five funders will all be European states (the second largest funder is the Bill and Melinda Gates Foundation). It’s likely that global programs like GAVI might either see less money from European states or be pushed to focus their efforts on regions that are relevant to Europe.

Finally, a regional health security focus provides the political benefit of mitigating migration to Europe. Violence, poverty, climate change vulnerability, and social instability are well known push factors for migration. As foreign aid is removed, these factors will increase, leading to more emigration. In 2023, 23% of EU asylum seekers were African, however with the end of the Syrian civil war, that percentage is likely to increase. Politically speaking, migration and asylum concerns remain one of the biggest issues in European countries, with German voters considering migration the largest concern in last month’s election, slightly edging out the economy. Focusing foreign assistance on health security will help stabilize targeted communities, reducing push factors, and provide a talking point that European governments can give to voters to show that they’re taking migration seriously.

The turbulent period we’re experiencing now won’t end with a return to the old order, and key global health actors are waking up to that. Unfortunately, the economic and geopolitical reality of the 1990s, when global concerns were tackled through global cooperation, is gone. Now, systemic global changes combined with disparate interests lead to too few resources for too many needs. European global health actors aren’t exempt from this reality and will be forced, either by choice or by political pressure, to use their limited funds as strategically as possible. The paradigm of regional health security fits those needs and so is likely to become the approach of choice in the near future.