A wave of bilateral health agreements being negotiated between a number of African governments and the Trump administration has prompted sharp criticism, with officials and campaigners calling the deals one-sided and ethically questionable because of US requests for biological samples and health data.
This week Zimbabwe announced it had stopped negotiations over a proposed memorandum of understanding worth about $350 million. In a letter made public on X, Albert Chimbindi, Zimbabwe’s secretary for foreign affairs and international trade, said President Emmerson Mnangagwa ordered talks to be halted because the draft MoU would undermine the country’s sovereignty and independence.
A separate proposed arrangement with Zambia, linked to a US mining collaboration, has also stalled. Asia Russell, director of the HIV advocacy group Health Gap, accused the US of leveraging health assistance to secure access to mineral resources, calling it shameless exploitation.
At least 17 African states have reportedly signed similar bilateral accords with Washington, committing a combined $11.3 billion in health aid. But critics say many of the concessions demanded are troubling: limited consultation with community groups, requests for patient-level health records and pathogen samples, long-term rights to emerging-disease data, and a preference for funding faith-based health providers. In Nigeria, observers say US statements imply funding will be linked to actions on what the administration portrays as persecution of Christians.
Observers describe the push for one-to-one deals as part of an America First global health approach that follows moves by the US to reduce its role in multilateral bodies and to reshape development agencies. The rapid rollout of bilateral agreements is seen by some analysts as a way to strengthen US influence on the continent. Drafts indicate signatory countries may be required to seek US regulatory approval for new drugs and technologies; the US-Rwanda agreement explicitly mentions increasing US private sector involvement in Rwanda’s health system.
The Zimbabwean government says the US asked for access to sensitive health information, including pathogen samples, without guaranteeing Zimbabwe would share in any resulting vaccines, diagnostics or treatments. Officials warned that bilateral arrangements could weaken World Health Organization mechanisms designed to ensure equitable access during pandemics and cautioned against development aid becoming a vehicle for strategic extraction.
Washington’s ambassador to Zimbabwe, Pamela Tremont, expressed regret at the decision and argued the partnership would have helped communities, noting roughly 1.2 million people in Zimbabwe receive HIV treatment through US-supported programmes. The ambassador also said the US would begin winding down its health assistance there.
Most of the new US-Africa accords remain unpublished. Reporting has reviewed a draft template and several apparently final documents. Typical five-year deals require countries to increase domestic health spending — for example, salaries and equipment — while US contributions taper each year and can be withdrawn if benchmarks are not met. Some drafts seek access to health data and samples for periods of up to 25 years, though negotiators in several countries have shortened that term.
Legal and civil-society challenges have already affected some agreements. In Kenya, campaigners led by the Consumer Federation of Kenya have secured a court review over data-sharing provisions, arguing the deal risks surrendering strategic control of health systems and outsourcing digital infrastructure and raw data storage. Uganda’s attorney general, Kiryowa Kiwanuka, has countered that the agreement includes data protection and privacy safeguards.
Campaigners for reproductive and gender justice have also raised concerns. They question whether the higher domestic funding targets are realistic given many governments have repeatedly missed the 2001 Abuja target of allocating 15% of national budgets to health. They warn that negotiations have proceeded with little public participation and that NGOs and specialist clinics serving marginalised groups, including LGBTQ+ people, could be sidelined.
In Nigeria, a US embassy statement describing a $2.1 billion package emphasised support for Christian faith-based health providers. Critics, including Fadekemi Akinfaderin of Fòs Feminista, say prioritising one religious group in a diverse country risks politicising health services and creating gaps in areas such as family planning, STI prevention and some vaccinations.
Despite the pushback, some experts acknowledge reasons African governments might accept the offers. Rachel Bonnifield of the Center for Global Development notes the funding can be substantial — in some cases equal to half or more of a country’s domestic health expenditure — and could fund essential services. Transferring control of funds from US NGOs to national authorities may also be politically attractive and signal a more equal relationship with Washington. Even transactional deals can be viewed by some governments as recognition of them as partners rather than merely recipients of aid.