A series of bilateral health agreements being negotiated between African countries and the administration of President Donald Trump have been described as “clearly lop-sided” and “immoral” amid growing outrage over US demands, including requests that countries share biological resources and data.
This week Zimbabwe said it had halted negotiations with the US for $350m, arguing the proposals risked undermining its sovereignty. A December letter from Albert Chimbindi, Zimbabwe’s secretary for foreign affairs and international trade, made public on X, said President Emmerson Mnangagwa “directed that Zimbabwe must discontinue any negotiation, with the USA, on the clearly lop-sided MoU [memorandum of understanding] that blatantly compromises and undermines the sovereignty and independence of Zimbabwe as a country”.
A proposed deal with Zambia — linked to a separate US agreement on “collaboration in the mining sector” — remains unfinished. Asia Russell, director of HIV advocacy group Health Gap, accused the US of “conditioning life-saving health services on plundering the mineral wealth of the country. It’s shameless exploitation, which is immoral.”
At least 17 African countries have signed deals with the US, collectively securing $11.3bn in health aid, but critics say the concessions required are worrying. Concerns include a lack of consultation with community health groups, demands for patient record data, and prioritisation of faith-based healthcare providers. In Nigeria, US statements suggest funding is contingent on action over what the administration calls the persecution of Christians.
The bilateral agreements form part of the Trump administration’s America First global health strategy, which follows dismantling of USAID and a US pullback from multilateral bodies such as the World Health Organization. The rapid push for deals is viewed by some as an effort to establish and entrench US influence in Africa. The agreements also tie African nations to rely on US regulatory approval before introducing new drugs and technologies. The US‑Rwanda deal explicitly states it will bring increased US private sector involvement in Rwanda’s health sector.
A Zimbabwean government spokesperson said the US had asked for “sensitive health data, including pathogen samples”, with no guarantee Zimbabwe would get access to any resulting medical innovations. “Zimbabwe was being asked to share its biological resources and data over an extended period, with no corresponding guarantee of access to any medical innovations – such as vaccines, diagnostics or treatments – that might result from that shared data,” he said. He added that Zimbabwe feared bilateral agreements would undermine WHO systems designed to ensure fairness in future pandemic responses and warned that development aid should not create dependencies or become “a vehicle for strategic extraction.”
US ambassador to Zimbabwe Pamela Tremont said on X she regretted the decision, adding the collaboration would have benefited Zimbabwean communities, “especially the 1.2 million men, women and children currently receiving HIV treatment through US-supported programmes,” and that the US would begin winding down its health assistance in Zimbabwe.
Most of the new US‑African deals are not public. The Guardian has seen a draft template and a few documents that appear final. The five‑year deals generally require countries to increase domestic funding — including for health worker salaries and equipment — while US investment decreases annually. If countries fail to meet commitments, US funding may be withdrawn. Drafts also ask for access to health data and information on new or emerging pathogens for up to 25 years, though several countries have negotiated shorter terms.
In Kenya, the first country to sign, a court case by campaigners over data‑sharing terms has put the agreement on hold. The Consumer Federation of Kenya (Cofek), a claimant, 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 externally controlled.” Uganda’s attorney general, Kiryowa Kiwanuka, denied citizens’ health data and privacy were at risk, saying the agreement “is riddled with” data protection and privacy law safeguards.
A reproductive and gender justice campaigner in Uganda questioned whether the higher domestic funding targets were realistic, noting African governments have often failed to meet the 2001 Abuja declaration’s target of allocating 15% of national budgets to health. She said there had been “no public participation” in negotiations and warned NGOs could be sidelined; specialist clinics serving marginalised groups such as LGBTQ+ people were unlikely to see funding “trickle down”.
In Nigeria, a US embassy statement on the $2.1bn package says the agreement “places a strong emphasis on Christian faith‑based healthcare providers”. Fadekemi Akinfaderin of Fòs Feminista warned singling out one religious group in a plural country risks inflaming tensions and politicising health, and noted faith‑based facilities are often less likely to provide family planning, STI prevention and some vaccinations because of ideological beliefs. She urged Nigeria’s health ministry to ensure coverage gaps do not result from the agreement.
Despite criticism, some experts see reasons for African governments to sign. Rachel Bonnifield, director of global health policy and senior fellow at the Center for Global Development, noted the funding can be very substantial — in some cases equal to 50% or more of a government’s domestic health spending — and could support basic, needed services. Shifting control of funds to national governments rather than US NGOs may also be attractive and seen as establishing broader relations with the US. “Even transactional negotiations can be seen as treating African governments like peers and partners versus the recipients of American charity,” she said.
