The US Government is planning to secure memorandums of understanding (MOU) with African countries that offer limited health aid for five years in exchange for 25 years’ access to countries’ data about “pathogens with epidemic potential”.
But some commentators have described the terms of the bilateral MOUs as “extractive” as they fail to offer African countries access to the health products that might be developed from the pathogen material they share, writes Kerry Cullinan for Health Policy Watch.
Spearheading the process is Brad Smith, formerly one of the leaders of Elon Musk’s Department of Government Efficiency (DOGE), and currently a global health adviser overseeing the reorganisation of the Pepfar and health grants from the now defunct USAID.
He was part of the US delegation that met Kenyan health and finance officials last week to discuss its MOU, with Dr Chris Kiptoo, Kenyan Treasury’s Principal Secretary, later reporting that “both countries are finalising a bilateral agreement aligning Kenya’s health priorities with the United States’ global health objectives, strengthening a partnership that saves lives and builds a more resilient health system”.
Smith also led the US delegation to Zambia on Monday, where he met Zambian Health Minister Dr Elijah Muchima, and Finance Minister Situmbeko Musokotwane, to “chart a new course for US health assistance to Zambia”, according to the US Embassy there.
Extensive access to data
The MOUs include clauses that would give the US extensive access to country health databases and contain punitive measures for any that fail to provide this access or pathogen information, including unspecified “changes in the planned assistance” or total discontinuation of aid.
Conversely, those that meet targets may get unspecified rewards.
While the agreements contain various targets (“outcome metrics”) for reducing HIV, TB, malaria, maternal and under-five mortality, and increasing measles vaccinations, details about how these will be achieved are scanty.
In contrast to the health services section, the “surveillance and outbreak response” section is far more detailed, with budget allocations and staff numbers.
For instance, Zambia is expected to employ “1 723 field epidemiologists” in 2026 at its own expense to meet its outbreak surveillance and pathogen-sharing requirements, according to a draft seen by Health Policy Watch.
The US also notes in the draft Zambian MOU that it is making a $50m cut to its previous commitment of $120m in funding for antiretroviral (ARV) medicine and HIV tests due to “historic theft”. This relates to a 2021 scandal where it emerged that ARVs donated to Zambia were being sold in pharmacies.
Twenty-five years’ access for five-year grants
Countries also have to commit to signing a 25-year “specimen sharing agreement”, although the MOUs only cover a five-year grant period. This agreement will cover “sharing physical specimens and related data, including genetic sequence data, of detected pathogens with epidemic potential for either country within five days of detection”.
An annex that is supposed to set out the “elements” of the agreement is blank, however.
Bizarrely, the MOUs also want governments to commit to a 25-year “data-sharing arrangement” for “exchanging data on the long-term performance of this MOU and for accountability to the United States Congress for appropriated funds”.
Yet the country grants will only run from 1 April 2026 until 2030.
Author Emily Bass published a template for this data-sharing arrangement, saying it “reveals the unprecedentedly extractive nature of these …negotiations”.
The US wants access to a range of data, including electronic medical records, health management and information systems, and outbreak response and surveillance data systems.
The MOUs stress that countries need to provide the US with “any data access or information needed to monitor compliance with applicable legal requirements, including to confirm no US Government funding is being used for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions”.
By placing itself at the centre of rapid information-sharing about dangerous pathogens, the US appears to be attempting to usurp the WHO.
WHO member states are currently negotiating a Pathogen Access and Benefit Sharing (PABS) system that unite countries, pharmaceutical companies and non-profits in a single process aimed at speedily sharing information and developing counter-measures for pathogens that can cause pandemics.
The US and Argentina are the only countries that have opted out of these negotiations.
But if the US is the gatekeeper of pathogen information via these MOUs, this likely to fracture and slow down the global response to pandemics.
In addition, US companies could also get the first shot at developing vaccines, therapeutics and diagnostics for these pathogens.
Aggrey Aluso of Resilience Action Network Africa (RANA) warned that while governments “should explore deals that could benefit the lives of their people and their economy, such deals should not be extractive”.
“Global health security cannot be built on coercive conditionalities,” Aluso told Health Policy Watch.
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