The US is reshaping its engagement with Africa’s health sector through a controversial new policy – the America First Global Health Strategy. This marks a departure from decades of NGO-driven aid, replacing it with direct, bilateral agreements between Washington and African governments.
Since its launch in September 2025, around 20 African countries have signed on to these agreements, potentially unlocking billions of dollars in funding. Yet it is a highly transactional model, requiring African governments to share real-time health data and biological samples in exchange for financial resources.
Framed as a move towards efficiency and sustainability, the strategy is instead raising questions across the continent: in a data-driven world, what is the true cost of such health partnerships?
America first at the expense of…
“This is very much in continuation with the current policy of putting American interests before anything else,” said Dr Zulfika Bhutta, founding director of the Institute for Global Health and Development at the Aga Khan University. He describes it as “a significant transactional arrangement with return of materials which also makes data and biological materials freely accessible to US based scientific institutions”.
Africa’s growing population represents a vast source of health data that is valuable in shaping economic decisions in health, including where pharmaceutical companies focus on diseases and epidemics.
“This is data mining,” warned Tinashe Mundawarara, an advocate at the Health and Policy Consortium in Zimbabwe. “They want to own the data as the only remaining frontier and will definitely be using this to leverage their foreign policy and investments.”
“For the average African, their interests do not appear anywhere in the picture; the value is yet to be seen,” said Mundawarara.
Legal debate on health data
Zimbabwe has already rejected the deal outright, citing sovereignty concerns. In Kenya, the high court suspended implementation of a similar agreement, following legal challenges over data privacy and public participation.
At the heart of the debate is a fundamental question: who owns national data?
“Ordinarily a government should be able to hold the data of its citizens in a safe and secure database,” said Allan Maleche, executive director of the Kenya Legal and Ethical Issues Network on HIV and AIDS, KELIN. “But the difficulty we face is weak data infrastructure.”
The agreements also raise complex legal questions. If conflicts arise between national privacy laws and US demands for data access, which framework prevails?
Maleche is clear: “Citizens are governed by their constitution and the subsidiary laws that support that constitution. International law does not gain precedence at the national level.”
Yet in practice, enforcing these protections may prove challenging. Critics warn that without strong safeguards, such arrangements could expose African populations to exploitation, particularly in pharmaceutical research and development.
A funding dilemma
Another pillar of the strategy is a push for African governments to significantly increase domestic health spending, even as US contributions decline over time. While this is framed as a pathway to self-reliance, many experts see it as unrealistic.
“Definitely not realistic,” said Mundawarara. “There are always competing interests. I do not see African governments being able to meet that expectation.”
In fact, many countries have struggled for years to meet the Abuja Declaration target of allocating 15% of national budgets to health. Increasing that commitment by an additional 40%, as some agreements require, could strain already fragile economies.
Beyond national concerns, the strategy may also reshape global health governance. By prioritising bilateral deals, the US risks undermining multilateral institutions such as the World Health Organisation (WHO).
“Fragmentation absolutely weakens (multilateralism),” said Dr Bhutta. “It doesn’t help anybody so this is not even in the US interest.”
Africa’s strategic response
As the continent grapples with these challenges, a common theme is emerging: the need for unity. Experts are calling on the African Union and national governments to adopt a coordinated negotiating position that prioritises sovereignty, equity, and long-term development.
“This is not the same as agreements that come with global compact and global understanding. So, this is where the African Union needs to stand together,” Dr Bhutta remarked.
In his view, health data and biological samples can be shared in collective actions under the auspices of WHO. But if the US wants to reduce global health to trade deals, then countries must make sure they benefit from the research based on their own health data, not just short-term funding for health programmes.
In the end, the continent’s response may determine whether this new era of health cooperation becomes a pathway to empowerment, or a new era of inequalities.
- The US has introduced the America First Global Health Strategy, shifting from NGO-driven aid to direct bilateral agreements with African governments, requiring sharing of health data and biological samples for funding.
- About 20 African countries have signed these agreements since September 2025, but concerns arise over data sovereignty, exploitation risks, and the true cost of these partnerships.
- Zimbabwe rejected the deal over sovereignty, and Kenya suspended a similar agreement due to legal challenges on data privacy and national data ownership conflicts.
- The strategy pushes African governments to increase domestic health spending as US aid declines, a move criticized as unrealistic given economic strains and historical difficulties meeting health budget targets.
- African experts urge the continent to form a unified negotiating front via the African Union to protect sovereignty and equity, and caution that prioritizing bilateral U.S. deals risks weakening global multilateral health institutions like WHO.
