US–Africa health agreements draw scrutiny ^{CEFR B1}

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 America First Global Health approach.

The agreements combine US funding with domestic financing and require partner states to increase health spending, report outbreaks rapidly and expand disease surveillance. The State Department named Uganda, Kenya, Rwanda, Nigeria, Eswatini, Ethiopia, Mozambique, Ivory Coast, Cameroon, Lesotho, Madagascar, Sierra Leone, Liberia and Botswana as partners.

Kenya was the first to sign a Memorandum of Understanding on 4 December. The High Court has halted parts of the agreement that involve transfer and sharing of sensitive health data until a hearing on 16 February. Legal and public-health experts say rapid sharing raises governance and safeguard questions once data leaves national systems. Allan Maleche said, "Health data is a strategic public asset."

Experts also warn that most funding is performance-based and conditional. Peter Waiswa said support is linked to countries meeting key health metrics. Aggrey Aluso called the rules on pathogen sharing "the most contentious part" and warned there are few guarantees about how specimens will be used. Critics want legislative review, enforceable safeguards and regional approaches to surveillance.