oluwatosin oyeniyi After dismantling the main US body for delivering foreign assistance last year, the Trump administration is again offering hundreds of millions of dollars to African countries to support their healthcare structures and help fight disease. However, the new deals come with stringent conditions attached, sparking resistance from several African governments who view the terms as an infringement on their sovereignty and a threat to their national interests.
The Shift from USAID to Transactional Bilateral Deals
When the initial agreement was signed by Kenya’s President William Ruto in Washington last December, US Secretary of State Marco Rubio expressed optimism that it would be the first of many. “We hope to sign, I don’t know, 30, 40, how many? Fifty? Well, this is number one. We’ll always remember this one… and we think we’ve picked the perfect partner,” Rubio declared.
Yet, even this landmark deal with Kenya, worth $2.5 billion, has faced significant hurdles. Activists went to court to block it over data privacy concerns, although cabinet ministers eventually approved it last month. The resistance in Kenya is emblematic of a broader pushback across the continent against the Trump administration’s “America First” Global Health Strategy (AFGHS).
Shortly after taking office for his second term, President Donald Trump ordered the closure of the US Agency for International Development (USAID) amid accusations of wastefulness. This move decimated health programs in some African countries that relied heavily on American funding. The dismantling of USAID was part of a broader freeze on all US foreign aid for a 90-day review, fundamentally altering the landscape of global health assistance.
The State Department’s new global health strategy requires recipient governments to share responsibility by increasing their own health spending, with the goal of building durable systems that can eventually be self-reliant. For example, the US is contributing $1.6 billion to the overall deal with Kenya, with the East African nation pledging $850 million over five years.
The Trump administration hopes that partnering directly with national leaderships will improve upon traditional donor-NGO relationships, which it argues created dependency, led to parallel delivery arrangements, and consumed aid dollars in overhead costs. “Our aid to those countries will not just be dollars distributed to an NGO who then will go into the country and impose programmes,” Rubio told a congressional committee last month. “Not only are we treating the acute situations on the ground of people that are sick, we are helping them build the capacity and the capability to do this for themselves.”
However, this approach represents a significant shift away from a model of global cooperation anchored in the World Health Organization (WHO), from which the US withdrew early this year, to direct agreements tied explicitly to US strategic and commercial interests.
The “America First” Conditions and Continental Resistance
The American bilateral deals come with an explicit promise to prioritize US pharmaceuticals and medical firms to develop and deliver treatments. “Our global health foreign assistance programme is not just aid – it is a strategic mechanism to further our bilateral interests around the world,” states the policy document.
By mid-May, 32 countries had accepted the health Memorandums of Understanding (MOU), including at least 20 in Africa. However, several nations, including Ghana, Zimbabwe, Zambia, South Africa, Tanzania, and the Democratic Republic of Congo (DRC), have resisted signing up or have been excluded due to political disputes.
Zambia: The Minerals-for-Aid Dispute
In Zambia, Foreign Minister Mulambo Haimbe criticized what he described as an American effort to link health funding to US economic interests by connecting the deal to a separate agreement giving Washington access to critical minerals. “Our [US] colleagues looked at it from the perspective that [the two deals] must be taken as a package to be negotiated and concluded at one particular time,” he told the BBC, emphasizing that the Zambian government wanted to discuss them separately on their own merits.
“The US felt that there is need for there to be a preferential treatment in the use of critical minerals. And the framework was to reflect that,” Haimbe added.
The State Department stopped short of explicitly linking the two but offered a robust “America First” response. “The Trump administration has made clear, US foreign assistance is not charity – rather it is strategic capital to be wisely invested to advance US interests – and we expect all of our allies and recipient nations to take seriously American strategic and commercial priorities,” a department spokesperson said.
South Africa and Tanzania: Political Exclusions
Last month provided further evidence of the readiness to tie health financing to American priorities with the announcement that the US would withdraw completely from funding HIV/Aids programs in South Africa. An administration official connected the move to Pretoria’s “failure to make demonstrable progress on policy requests,” including the treatment of the white-minority Afrikaner community—a claim of “white genocide” that has been widely discredited.
Similarly, the US stated it is “reconsidering ties” with Tanzania due to the government’s “ongoing repression of religious freedom and free speech, the presence of persistent obstacles to US investment, and disturbing violence against civilians” following the country’s elections.
Ghana, Zimbabwe, and Kenya: Data Sovereignty Concerns
For some African countries negotiating the bilateral MOUs, concerns over US access to health data set alarm bells ringing. This included patients’ information as well as biological resources known as pathogens—organisms that cause disease such as viruses, bacteria, and parasites.
Arnold Kavaarpuo, executive director of Ghana’s Data Protection Commission, stated that the government in Accra objected to the deal due to the scope and breadth of data required. “It was us generating data and passing it on to the US authorities, and there were no real reciprocal measures when it comes to the protection of Ghanaian data and Ghanaian sovereignty,” he said. “Once the data left the Ghanaian borders, we had no control over what becomes of it.”
Zimbabwe also cited concerns about requests for medical data, presumably to be shared with US pharmaceutical companies, as the reason it rejected a deal. A government spokesman pointed out that there were no guarantees that drugs or vaccines developed from the pathogens would be available to its people, noting that the WHO already had a system for members to share data and benefit from future treatments.
In Kenya, the High Court temporarily suspended the country’s deal after legal challenges demanding the protection of patient privacy. The data sharing agreement institutionalizes foreign access to Kenyan health data and biological materials, raising significant implications for data governance, national control, and benefit sharing.
“Frankly speaking, no nation on Earth that respects itself should accede to [two requests],” South Africa’s Health Minister Dr. Aaron Motsoaledi told the BBC. “That [the US] will get their pathogen if there’s any pandemic or epidemic in their area. And they’ll also provide them with a genome for life. But the US is going to give them money for five years.”
The Impact on the Ground: The DRC Ebola Outbreak
The debate over health diplomacy has been thrown into sharper relief following the spread of a new outbreak of Ebola in the Democratic Republic of Congo (DRC). While the DRC was one of the first countries to accept the new American health deals, humanitarian workers and former US health officials argue that sweeping US aid cuts to the DRC and the WHO seriously weakened the front-line response.
Amadou Bocoum, the DRC country director for the international humanitarian organization Care, reported having to lay off a third of his staff after USAID cuts. “When this new Ebola came, the staffing was not there, and the emergency stock that we also used to have was also not there,” he said. “With proper funding, we would have had prepositioned stock and begun distributing critical supplies like PPE from day one, but instead, we started with nothing and lost 10 days.”
Critics describe the dismantling of USAID as a blow to the speed of detecting the Ebola outbreak and the scale of the response, emphasizing that the humanitarian agency was crucial to organizing logistics, supplies, and local outreach.
A New Era of Transactional Leverage
The US insists that the sharing of data and specimens is key to continuing scientific development and mutual cooperation, arguing that the material requested is the same aggregated and de-identified data used for years in the fight against infectious diseases.
However, the context has fundamentally changed. “It was an unequal relationship, but it was quite tolerable politically,” says Nelson Aghogho Evaborhene, a PhD fellow in global health governance at Roskilde University in Denmark. “Because you could sell it to the domestic population as an altruistic need to improve health service. But now it has changed significantly, because it’s more about very transactional leverage.”
Many African nations have drawn lessons from the Covid-19 pandemic, where the race to find a vaccine proved the value of pathogen data but left the continent struggling to secure doses for its people. As Aggrey Aluso, the executive director of Resilience Action Network Africa (Rana), notes, “I think one of our biggest opportunities as Africa is the fact that we have important information that can help build the global health security ecosystem.”
As the Trump administration continues to push its “America First” Global Health Strategy, African nations are increasingly weighing the immediate benefits of financial aid against the long-term costs to their sovereignty, data privacy, and economic independence.
