It redefined the field of global health for decades to come, with the US at its centre. The imperative to “vaccinate the world” and play a leadership role in global health security lacked a strong domestic constituency. This history set the stage for the sudden abdication of US global health leadership in early 2025. What can emerge is a new global health compact, in which African governments design robust health systems for themselves and enlist the international community to assist from behind. It means justifying global health in terms that people can relate to and agree with – that is, helping to save lives without taking responsibility for other countries’ health systems.