A wave of resistance is growing across Africa as the US pushes forward with a series of bilateral health agreements under its America First Global Health initiative. With 14 African countries already signing on, including Uganda, Kenya, and Nigeria, critics are raising significant concerns about how the deals reconfigure control over health data, pathogen samples, and the ability of African nations to set their own public health priorities.
The deals, which combine US funding with domestic financing, require African countries to increase their health spending, report disease outbreaks rapidly, and expand disease surveillance. The agreements link continued support to meeting performance benchmarks, but critics argue this model could constrain national decision-making and risk undermining local sovereignty.
Key Concerns: Health Data and Pathogen Sharing
Central to the debate is how the agreements govern health data and pathogen samples—critical assets in the global health security and biomedical research landscape. Several agreements require governments to report outbreaks to the US government within a short time frame and to share pathogen specimens for analysis. While early reporting and surveillance are vital, African experts argue that the structure of these deals may shift authority away from African-led health systems to external control.
Aggrey Aluso, executive director of the Resilience Action Network Africa, called pathogen sharing the “most contentious” part of the agreements. She highlighted that pathogen specimens are incredibly valuable in the pharmaceutical ecosystem, and once shared with the US, it’s unclear whether African nations will see any benefits from the resulting products.
Furthermore, the requirement for countries to report directly to the US government rather than through multilateral channels could alter the balance of global health governance, critics say. Aggrey Aluso expressed concern that these arrangements could sideline African institutions meant to protect the continent’s collective interests.
Governance and Oversight Issues
The Kenya case has brought attention to the governance concerns raised by the new deals. Kenya became the first African country to sign a Memorandum of Understanding (MOU) with the US in December 2025, which included support to accelerate the rollout of Kenya’s electronic medical record systems. However, the Kenya High Court has since intervened, halting certain aspects of the deal related to the transfer and sharing of sensitive health data. The case is set to be heard in February 2026, and it has raised broader concerns about the oversight and safeguards in these agreements.
Allan Maleche, executive director of Justice for Health in Kenya, emphasized that health data is a strategic public asset and that how it is governed will shape Africa’s future control over public-health policy. He argued that international health cooperation agreements must not dilute state responsibility and that governments should remain accountable for protecting human rights and ensuring health outcomes, even when donors provide funding and design the systems.
Conditional Financing and National Priorities
Critics also point out the highly conditional nature of the US’s financial support. Under these agreements, the funding is tied to African governments’ ability to meet certain health metrics, which could limit their ability to address emerging health challenges like neglected tropical diseases or non-communicable diseases. According to Peter Waiswa, associate professor at Makerere University School of Public Health in Uganda, this model could constrain national policy choices and limit governments’ flexibility to tackle local health priorities.
He further warned that locking large portions of national budgets into externally defined frameworks could weaken regional coordination and leave countries vulnerable to external pressures. Waiswa questioned whether other international partners, such as China or the UK, would continue to provide support if the terms of the agreements shift the balance of control away from African nations.
Moving Forward: The Need for Regional Coordination
Despite the resistance, Aluso stresses that there is a real opportunity to improve disease surveillance and laboratory capacity in Africa through these agreements. However, she emphasized that any cooperation must strengthen African institutions rather than undermine them.
She and other critics argue for greater democratic oversight, enforceable safeguards, and regional coordination to ensure that African countries retain control over their health systems and benefit from international partnerships on their own terms. Without these safeguards, Africa risks becoming dependent on external actors for health system governance—a model that could weaken the continent’s collective bargaining power in the long term.
