Global health, a public good vital to equity and stability, is under strain as U.S. foreign assistance recedes. The withdrawal has disrupted financing and coordination, while health systems and industries face demographic pressures, fragile supply chains, and geopolitical rivalries. Businesses contribute through innovation, foundations, and partnerships with civil society, yet cannot replicate the scale or equity mandate of public aid. The Aspen Institute Germany’s 2025 initiative highlighted that only shared responsibility between governments, business, and multilateral institutions can prevent the erosion of recent progress and sustain a resilient global health order. Germany has a pivotal role to play in this context.
Global health is not a narrow field of specialists; it is a public good that shapes the wellbeing of individuals, societies, and economies alike. It is grounded in the principle of equity, encompassing not only access to medicines and care but also the social, economic and political determinants that shape health outcomes. In this sense, global health has always been more than a question of hospitals or vaccines. It is a collective commitment to stability, security, and fairness in a deeply interconnected world.
That commitment is now under unprecedented strain. For decades, U.S. foreign assistance was the backbone of the global health system, financing HIV and malaria programs, underwriting multilateral initiatives, and shaping the rules of the game through coordination and standard-setting. The retreat of the United States from this role – suspending development aid, stepping back from the World Health Organization, dismantling USAID – has not only reduced resources but also eroded the predictability and structure that once underpinned global health. The effects are cascading: pooled procurement channels are shrinking, multilateral budgets are being cut, and the fragile progress of recent decades risks being reversed.
The geopolitical landscape further complicates this equation. As the United States retreats, China has moved assertively to fill parts of the vacuum, offering bilateral financing, bundled technology, and supply chain dominance in pharmaceuticals and medical equipment. These initiatives provide short- term solutions but risk deepening fragmentation and embedding dependencies. Europe, and Germany in particular, are therefore confronted with a choice: either step into a leadership role by strengthening multilateral institutions and fostering equitable partnerships, or watch as global health governance tilts toward unilateral and transactional models.
This crisis comes at a moment when the health sector itself is already under pressure. Even in wealthy countries, health systems are strained by demographic change, staff shortages, and rising costs. Pharmaceutical and MedTech industries confront shrinking returns on investment, more complex regulatory environments, and fragile supply chains. Trade and tariff disputes add further uncertainty, reshaping cost structures and threatening long-term planning. Large multinational firms, with diversified portfolios and global reach, can absorb some of these shocks by hedging markets or near-shoring production. Small and medium-sized enterprises, by contrast, often lack the buffers to survive regulatory delays, fragmented tenders, or volatile demand. For them, the erosion of donor funding in low- and middle-income countries can mean lost markets altogether. The sector as a whole is therefore caught between systemic fragility and rising expectations.
In this environment, it is tempting to imagine the private sector stepping in to replace U.S. foreign assistance. Businesses are indeed indispensable actors in innovation, manufacturing, and delivery, yet their incentives are not always aligned with the provision of public goods. U.S. aid programs provided multibillion-dollar commitments over decades, anchoring predictable demand and absorbing risk so that others could operate in fragile environments. By contrast, corporate investment depends on market opportunities, shareholder expectations, and time-limited returns. The erosion of the global health infrastructure also complicates the distribution of corporate philanthropic funds, as long-standing implementation partners weaken or disappear. The NGO landscape itself is undergoing restructuring, with con- solidation accelerating and mergers increasingly on the table.
The result is structural: business can complement public funding but cannot replicate its scale, equity orientation, or political legitimacy. Without strong public frameworks, markets will inevitably prioritize profitable segments, leaving behind vulnerable populations and fragile systems.
Still, under the right conditions, companies can make a decisive difference. Predictable procurement and pooled tenders allow firms to leverage manufacturing capacity and lower costs. Risk-sharing instruments enable SMEs to enter difficult markets and withstand payment delays. Harmonized regulation accelerates the scaling of new technologies. Foundations can extend this impact by funding pilot projects, while partnerships with civil society organizations help ensure delivery at the community level. In such contexts, business engagement can shift from charitable add-ons or isolated projects to structural partnerships that stabilize health systems and expand access. The conditions under which companies operate thus determine whether they remain marginal actors or become indispensable pillars of global health.
The tension is clear. Business cannot replace U.S. foreign assistance, but neither can it remain on the sidelines. Without sustained corporate engagement, delivery systems will fragment further, inequities will deepen, and the collective capacity to respond to crises will weaken. Yet, without renewed public leadership, corporate engagement will remain partial, selective, and insufficient. The question is not whether business should fill the gap, but how business, governments, and multilateral institutions can share responsibility in a system where old certainties have collapsed.
It was precisely this dilemma that the Aspen Institute Germany sought to address in its 2025 initiative “Redefining Power and Responsibility: U.S. Foreign Aid, Global Health Leadership, and the Role of the Private Sector.” At a moment of U.S. withdrawal and uncertainty, the project brought together business leaders, policy makers, and civil society from both sides of the Atlantic to explore how responsibility for global health could be shared. The discussions underscored both the indispensability of the private sector and its structural limits, highlighting the need for new forms of collaboration and risk-sharing. What emerged was not a blueprint for substitution, but a recognition of interdependence: business, governments, and multilateral institutions each carry distinct responsibilities, and only together can they prevent the unraveling of global health progress.
This project is supported by the Public Private Strategies Institute.
