In late February, Zimbabwe withdrew from a proposed $367 million U.S. health financing deal after objecting to provisions calling for broad U.S. access to sensitive health data.
The five-year program was presented as supporting preparedness efforts for HIV/AIDS, tuberculosis, malaria and epidemics.
However, the terms called for extensive sharing of national health intelligence, including epidemiological surveillance data and pathogen samples, without offering binding guarantees that Zimbabwe would receive equal access to the medical technologies developed from them.
Harare called the proposal an “unequal exchange,” warning that Zimbabwe risked supplying “raw materials for scientific discovery” while the resulting benefits could remain concentrated in the United States and global pharmaceutical companies. Critics increasingly describe this pattern as biomedical extractivism: a toxic combination of exploitative research practices and colonial thinking that reinforces Western dominance.
In Lusaka, officials and civil society organizations have expressed concern over a proposed health partnership between the United States and Zambia valued at more than $1 billion over five years. The draft would require Zambia to contribute approximately $340 million in domestic co-financing while granting the United States broad access to national health data and pathogen-sharing agreements.
A controversial provision would allow the agreement to be terminated if Zambia fails to conclude a separate bilateral pact with Washington on minerals such as copper and cobalt.
Kenya offers a third warning sign.
A similar $2.5 billion deal was suspended by its High Court last December after a legal challenge contending it could expose sensitive health data without adequate safeguards under Kenya’s Data Protection Act.
Taken together, the disputes in Harare, Lusaka and Nairobi point to a broader pattern. They are developing in the context of a rapidly expanding network of bilateral global health agreements that Washington has been negotiating across Africa under its “America First Global Health Strategy.”
According to tracking by the Kaiser Family Foundation, an independent U.S.-based health policy research organization, the United States has signed more than 20 memoranda of understanding with African governments, with implementation timelines ranging from 2026 to 2030 and total commitments approaching $20 billion.
A significant portion of that funding is expected to come from African governments themselves, allowing Washington to market the model as a partnership while deepening asymmetry, fiscal pressure and dependency. At least 17 African countries have already concluded similar agreements, many of them with fragile health budgets and little negotiating capacity.
These compacts fund programs against HIV/AIDS, tuberculosis, Ebola and malaria, while strengthening disease surveillance systems, laboratory capacity and outbreak preparedness.
However, they markedly shift negotiating power towards Washington. In Nigeria, for example, funding depends on Abuja committing to “prioritize the protection of Christian populations from violence.”
From Zimbabwe to Zambia to Nigeria, the central controversy lies in what the United States expects in return: health data and pathogen samples. In the era of biotechnology and pandemic preparedness, this information fuels the global bioeconomy, driving vaccine platforms, pharmaceutical patents, and AI-powered drug discoveries. Biological data has become as strategically valuable as oil, minerals or rare earths.
African public health systems could become providers of biological information, while the downstream benefits (intellectual property, pharmaceutical manufacturing and commercial profits) remain concentrated in the richest countries.
Those anxieties resonate with a longer history in which medicine in Africa has been closely intertwined with imperial power, racial hierarchy, and foreign domination for more than a century. During the colonial period, European administrations often deployed medical campaigns that combined disease control with surveillance and coercive governance over African populations.
One of the most brutal colonial medical campaigns took place during sleeping sickness control programs in French Equatorial Africa between 1921 and 1956. At that time, colonial authorities rounded up entire villages to subject them to mandatory medical inspections and treatments. In many cases, people were forcibly examined and injected with experimental drugs intended to combat the spread of disease. Some drugs, including atoxil, were later found to cause serious side effects, including blindness and, in some cases, death.
Skepticism is also shaped by modern medical ethics controversies involving Western pharmaceutical companies. In 1996, during a meningitis epidemic in Kano, northern Nigeria, Pfizer Inc tested an experimental antibiotic called Trovan on 100 children in a field hospital.
Nigerian investigators concluded it had been carried out without proper regulatory approval and a government investigation described it as an “illegal trial of an unregistered drug.” Pfizer faced lawsuits from the Nigerian government and affected families and agreed to a $75 million settlement with Kano State in 2009, while continuing to deny wrongdoing.
Public health systems produce laboratory results, epidemiological records, genomic sequencing, and biological samples collected during outbreaks. The global biotechnology sector generates more than $1.5 trillion annually and is projected to reach $3.88 trillion by 2030, making genomic data and pathogen samples among the most valuable scientific resources of the 21st century.
For decades, global health ethics scholars have argued that international medical research should avoid exploiting populations in low- and middle-income countries. In a widely cited 2004 study, bioethicist Ezekiel Emanuel and his colleagues argued that ethical research in developing countries requires collaborative partnerships with researchers, policymakers, and local communities, as well as fair sharing of benefits.
That principle is clearly absent from the structure of US bilateral health agreements, and what is at stake is clearer in the post-Covid world. During the early stages of the pandemic, scientists and laboratories around the world relied on the rapid sharing of viral samples and genomic data to track the spread of the virus and develop vaccines.
However, when vaccines became available, many African countries found themselves at the back of the queue as richer countries stockpiled supplies. The World Health Organization’s Pandemic Agreement, adopted in May 2025, seeks to address this imbalance through a proposed pathogen access and benefit-sharing system that links pathogen sharing with fairer access to the resulting technologies.
Bilateral health agreements risk undermining those multilateral efforts. By negotiating directly with individual countries, powerful states like the United States can secure privileged access to pathogen information without being subject to broader mechanisms designed to ensure equitable distribution of benefits.
Timely access to pathogen data remains essential for global health cooperation and pandemic preparedness. The controversy is not about sharing the data itself, but whether countries providing the data receive open and fair access to the resulting vaccines, diagnostics and treatments.
African countries therefore face a delicate balancing act: safeguarding life-saving health programs while upholding data sovereignty, legal oversight and reciprocal partnerships. The answer may lie in collective bargaining through institutions like the African Union and its autonomous health agency, the African Centers for Disease Control and Prevention, rather than unequal and fragmented bilateral pacts.
Although formally voluntary, negotiations between a global superpower and financially constrained health systems rarely occur on a level playing field. Washington, for example, has since moved to reduce its health funding in Zimbabwe following the collapse of negotiations, underscoring the risk faced by other African countries that refuse to bend to its will.
In the 19th century, colonization advanced through divide and rule tactics as Western powers eliminated African societies one by one. Only united action today can prevent powerful states from imposing new forms of imperial control through country-specific agreements.
The United States is now seeking biological data and intelligence on pathogens through policies that risk reproducing the power imbalances of colonial extraction in a new scientific form.
Therefore, our governments must defend medical sovereignty with unity and determination.
If Africa shares its data and samples, the United States must share its on equal and transparent terms.
African bodies are not cheap and expendable products.
The views expressed in this article are those of the author and do not necessarily reflect the editorial position of Al Jazeera.
