A series of bilateral health deals being negotiated between African countries and President Donald Trump’s administration have been called “clearly unbalanced” and “immoral” amid growing outrage over US demands, including requiring countries to share resources and biological data.
This week it emerged that Zimbabwe had suspended negotiations with the United States for $350m (£258m) in health funding, saying the proposals risked undermining its sovereignty and independence.
A letter sent in December by Albert Chimbindi, Zimbabwe’s foreign affairs and international trade secretary and made public, said President Emmerson Mnangagwa “ordered that Zimbabwe must discontinue any negotiations with the United States on the clearly unbalanced MoU (memorandum of understanding) that blatantly compromises and undermines the sovereignty and independence of Zimbabwe as a country.”
Meanwhile, a deal has yet to be finalized with Zambia, which has been linked to a separate agreement with the United States on “collaboration in the mining sector,” and Asia Russell, director of the HIV advocacy organization Health Gap, accusing the United States of “conditioning life-saving health services on the plundering of the country’s mineral wealth. It is blatant exploitation, which is immoral.”
At least 17 African countries have signed deals with the United States, collectively securing $11.3 billion in health aid but raising concerns about concessions made in return.
Critics say there has been a lack of consultation with community groups that provide much of the health care in African countries and have raised concerns about data privacy (the United States requests data from patient records as part of the agreements) and the prioritization of religious health care providers.
In Nigeria, statements from the United States suggest that funding depends on authorities addressing what the Trump administration calls the persecution of Christians in the country.
The Trump administration is negotiating bilateral deals with countries as part of its America First global health strategy. The new approach comes after the United States dismantled what had been the main aid agency, USAID, and withdrew from large multilateral organizations such as the World Health Organization.
The rapid push for deals is seen as part of US moves to establish and entrench power on the continent. The agreements also commit African nations to relying on U.S. regulatory approval of new drugs and technologies before deploying them.
The agreement between the United States and Rwanda is explicit that it will bring greater participation of the American private sector in the country’s health sector.
A Zimbabwean government spokesperson said Wednesday that the United States had requested “sensitive health data, including pathogen samples,” but without any corresponding guarantee of access to the resulting medical innovations.
“Zimbabwe was asked to share its biological resources and data over an extended period, without a corresponding guarantee of access to medical innovations – such as vaccines, diagnostics or treatments – that might result from those shared data,” he said. “In essence, our nation would provide the raw materials for scientific discovery without any guarantee that the final products would be accessible to our people should a future health crisis arise.”
He said Zimbabwe also feared that bilateral agreements would undermine WHO systems designed to ensure equity in any future pandemic response.
“Development aid should empower nations, not create dependencies or serve as a vehicle for strategic extraction,” he said. “When financial assistance depends on trade-offs affecting national security, data sovereignty, or access to strategic resources, it fundamentally alters the nature of the relationship from one of partnership to one of unequal exchange.”
The US ambassador to Zimbabwe, Pamela Tremont, said on X that she regretted the country’s decision.
“We believe this collaboration would have brought extraordinary benefits to communities in Zimbabwe, especially the 1.2 million men, women and children currently receiving HIV treatment through US-supported programs,” he said. “We will now address the difficult and regrettable task of reducing our healthcare in Zimbabwe.”
Most of the new agreements between the United States and Africa are not publicly available, although The Guardian has seen a draft model and a handful of documents that appear to be final agreements are in circulation.
The five-year agreements commit African countries to gradually provide more domestic financing, including for health workers’ salaries and equipment, replacing U.S. investment that will decline each year. If countries do not meet those commitments, U.S. funding can be withdrawn.
The US drafts also include requests for access to health data and information on new or emerging pathogens for up to 25 years, although many countries appear to have negotiated shorter commitments.
In Kenya, the first country to sign an agreement, a court case brought by activists over data-sharing conditions has left the agreement on hold. The Consumer Federation of Kenya (Cofek), one of the groups that brought the case, said Kenya risked “ceding strategic control of its health systems if pharmaceuticals for emerging diseases and digital infrastructure (including cloud storage of raw data) are controlled externally.”
Ugandan Attorney General Kiryowa Kiwanuka attempted to downplay similar fears about her country’s deal in an interview featured on X, saying it was “not true” that citizens’ health data and privacy were at risk.
“We have our privacy and data protection law, and the agreement is rife with that,” he said.
A reproductive and gender justice activist in Uganda questioned whether targets for increased domestic funding were realistic, given the failure of African governments to meet the minimum allocation of 15% of the national budget for health set out in the 2001 Abuja Declaration.
He said there had been “no public participation” in the negotiation process and that non-governmental organizations were expected to be further marginalized. Specialty clinics that offer care to marginalized groups, such as the LGBTQ+ community, are unlikely to receive funding, she said.
In Nigeria, according to a US embassy statement, the deal for $2.1 billion in US funding “places a strong emphasis on Christian healthcare providers.”
Fadekemi Akinfaderin of Fòs Feminista wrote on Substack that “singling out a religious group in a deeply plural country risks inflaming existing tensions and politicizing health.” It also warned that “religious centers are less likely to provide family planning services, STI prevention and some vaccines, due to ideological beliefs,” and urged Nigeria’s Health Ministry to ensure the agreement does not lead to coverage gaps.
Rachel Bonnifield, director of global health policy and senior fellow at the Center for Global Development think tank, said that despite criticism, there were good reasons for countries to sign agreements that included “very substantial amounts of funding – in some cases equivalent to 50% or more of governments’ total domestic spending on health – to support very basic and much-needed health services.”
He said a shift toward government control of health funds, rather than their distribution through American NGOs, would also be attractive, and that the agreements would be seen as an opportunity to establish new and broader relationships with the United States.
“Even transactional negotiations can be seen as treating African governments as peers and partners vis-à-vis recipients of American charity,” Bonnifield said.
