A new wave of bilateral health agreements between the United States and African governments is drawing strong scrutiny across the continent. Critics say the deals affect control over health data, pathogen samples and national health priorities. The US State Department says fourteen African countries have signed agreements under the United States’ America First Global Health approach. The State Department named Uganda (US$2.3 billion), Kenya ($2.5 billion), Rwanda ($228 million), Nigeria ($5.1 billion), Eswatini ($242 million), Ethiopia (1.466billion), Mozambique ($1.8 billion), Ivory Coast ($937 million), Cameroon ($850 million), Lesotho ($364 million), Madagascar ($175 million), Sierra Leone ($173 million), Liberia ($176 million) and Botswana ($486 million).
The agreements combine US funding with domestic financing and place conditions on partners: increase health spending, report outbreaks rapidly and expand disease surveillance. In Kenya, which signed a Memorandum of Understanding on 4 December, the High Court has issued an order halting parts of the agreement that involve transfer and sharing of sensitive health data. The court action pauses those provisions until a hearing scheduled for 16 February.
Legal and public-health experts argue that provisions requiring rapid sharing of health data and outbreak information raise questions about governance and safeguards once data leaves national systems. Allan Maleche said, "Health data is a strategic public asset. How it is governed now will shape Africa’s control over public-health policy for decades." The State Department says support will be linked to countries' ability to "meet or exceed key health metrics." Peter Waiswa noted that "most of this funding is performance based and highly conditional."
Another contentious issue is pathogen sharing. Several MOUs require governments to notify the US quickly about outbreaks and share specimens. Aggrey Aluso called this "the most contentious part of the agreements" and warned that "once they leave a country, there are few enforceable guarantees about how they will be used or whether originating countries will benefit." Critics say bilateral reporting to a foreign government can sideline continental systems and weaken regional bargaining power. They call for legislative review, enforceable safeguards, democratic oversight and regional approaches to surveillance so cooperation strengthens, rather than reconfigures, African institutions.
Difficult words
- bilateral — involving two countries or political parties
- scrutiny — close and critical public examination or review
- pathogen — a microorganism that can cause disease in people
- surveillance — systematic monitoring to detect disease or outbreaks
- safeguard — measure or rule that protects rights and safetysafeguards
- memorandum of understanding — a formal nonbinding agreement between two or more parties
- conditional — depending on meeting specific requirements or performance
Tip: hover, focus or tap highlighted words in the article to see quick definitions while you read or listen.
Discussion questions
- What measures would make sharing pathogen samples and health data safer for originating countries? Give reasons.
- Do you think performance-based, conditional funding will support national health priorities? Why or why not?
- How could regional approaches to surveillance strengthen African institutions rather than sideline them?
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