The United States has been signing bilateral health deals with African countries, with pacts worth $19.8bn having been negotiated and inked by the end of February. Of this amount, the US has committed $12.2bn and African countries $7.5bn.
Eighteen countries have signed: Botswana, Burkina Faso, Burundi, Cameroon, Côte d’Ivoire, the Democratic Republic of Congo, eSwatini, Ethiopia, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mozambique, Nigeria, Rwanda, Sierra Leone and Uganda.
The Conversation Africa asked Professor Oyewale Tomori, a former World Health Organisation regional virologist, how they should have responded to the US initiative.
Like all funding, conditions have been attached. Which conditions would you consider ‘red flags’?
The most controversial has to be the requirement for countries to rapidly share sensitive health data and precious pathogen samples with the US (sometimes for up to 25 years). Pathogen samples are invaluable assets for public health, clinical management and research. They are useful in identifying diseases, and developing vaccines and treatments.
This is without a corresponding guarantee of access to any resulting medical innovations, such as vaccines and other therapeutics. The potential returns on investment from innovations on one of these pathogens might far exceed the total US contributions to the agreements.
For example, globally, for every dollar invested in Covid-19 vaccine development and delivery, the estimated returns on investment ranged from $42 to to $775.
Moreover, the duration of the initial agreements is five years. Why, then, should African countries sign upfront on sharing data and pathogens for another 20 years? This is regardless of the renewal of the agreements after the first five years.
African countries must not sign away their health data or prodigally release their precious pathogens in a barter exchange for donor funding. Rather, local funding should be mobilised to create and sustain the enabling environment for African healthcare workers to manage data locally, instead of sharing raw data globally.
In addition, locally sourced counterpart funds should be used to create the environment to support and enhance the capacity of local scientists and researchers to develop innovations from indigenous pathogens for global benefits.
Another red flag in the agreements is linked to certain economic, social and political issues that could hamper their implementation. For example, in Zambia, the health agreement has been linked to a separate agreement with the US on “collaboration in the mining sector”.
This has yet to be finalised.
A director of the HIV advocacy organisation Health Gap has already accused the US of “conditioning life-saving health services on plundering the mineral wealth of the country”. He described this as “shameless exploitation, which is immoral”.
A third red flag can be found in Nigeria’s agreement. The US said there would be “a strong emphasis on promoting Christian faith-based healthcare providers”. A major component of the agreement is the inclusion of approximately $200m in dedicated US support for more than 900 Christian faith-based healthcare facilities across Nigeria.
Given Nigeria’s religious diversity, the provision has sparked debate among civil society groups about inclusivity.
In response to the criticisms, the Nigerian Government claimed that the memorandum of understanding was not tied to any religion. The government said that 10% of the US contribution was earmarked for faith-based providers generally, including both Christian and Muslim institutions.
Under the memorandum of understanding, the US will commit nearly $2.1bn to expand essential preventative and curative services for HIV, TB, malaria, maternal and child health and polio. Additionally, Nigeria will increase its domestic health expenditure by nearly $3bn (over 4trn naira).
This is the largest co-investment any country has made to date under the America First Global Health Strategy.
Nigeria’s contribution translates to more than 838bn naira annually. Between 2020 and 2025, the country’s health budget allocation ranged between 4.2% and 5.2% of the national budget. In 2025, it was 2.48trn naira, or 5.18% of the national budget.
The annual anticipated co-financing by Nigeria is nearly 40% of the 2025 health budget allocation. This means that the country’s 2026 health budget must take this into consideration, if it is not to contravene the agreement.
For a country whose health allocation has remained consistently below 6% of the national budget, meeting that part of the agreement is unrealistic. In 2025, Nigeria released only about 36m naira (about $25 797) of the 218bn naira (about $156m) allocated to the Health Ministry for capital projects.
Last, the bilateral agreements seem designed to undermine WHO systems that have been put in place to ensure fairness in any future pandemic response. The “America First Global Health Strategy” focuses on direct bilateral co-operation agreements.
This poses significant risks to the ongoing negotiations on the WHO Pathogen Access and Benefits Sharing mechanism under the Pandemic Agreement adopted in 2025.
African nations should be incredibly careful about what they agree to. In particular, this US agreement has a unilateral termination clause that may leave these countries dangling on the tattered and shredded sovereignty of a beggar nation.
The clause gives America the right to pause or terminate any programmes which do not align with the interests of the US Government and/or the interests of the current administration.
There are always trade-offs in decisions like these: which trade-offs would you consider off limits?
On no account should Africa give raw data or pathogens for any amount of money or donation. We should use our resources to create an enabling environment for our well trained African researchers to function effectively.
Also, these resources should be used to upgrade the capacity of African researchers to locally process our data and analyse our indigenous pathogens. We have a well-trained work force (health research data scientists) who, if given the enabling environment, can process our data and analyse our pathogens, locally.
The reported linkage of health funding agreements with exploitation of mineral and natural resources is evidence enough that the objective is to give Africa cents, while America takes away dollars.
In fairness to the Americans, they stated upfront that this is about putting America FIRST. It is a shame that many African governments are signing these agreements completely deaf to community opinion and disdainful of the inputs of civil society organisations.
If individual countries were thinking right, they would have mandated the African Union and Africa Centres for Disease Control to provide a comprehensive and cohesive guideline on the US agreements.
But that didn’t happen, and what we now have is a host of lop-sided bilateral agreements, designed for the benefit of the donor.
Are there any positives?
Yes, indeed. Each country will receive US funding support to “expand essential preventative and curative services for HIV, TB, malaria, maternal and child health, polio and disease surveillance”. The fund will certainly help them improve services for the prevention and control of these.
Additionally, each agreement has a co-investment requirement. This calls on them to increase their own health spending to replace US investment over a five-year period.
This could have a positive outcome, if successfully implemented, as it would help countries provide adequate funding for healthcare services.
But there are caveats.
First, the clause could force governments to reallocate funds from other essential services.
Second, failure to provide adequate local co-financing might hamper the successful implementation of the agreement.
Third, the expectation that countries will progressively increase domestic funding for health appears unrealistic, and not sustainable. In 2001 African countries agreed to the Abuja Declaration. This committed them to allocating at least 15% of their national annual budget to health.
No country, over these past 25 years, has consistently met this target. But if the clause gets African governments to finally implement the 15% minimum national budget allocation to health, it would obviously be a good outcome of the agreements.
Oyewale Tomori – Fellow, Nigerian Academy of Science
See more from MedicalBrief archives:
US health deals stall in Africa
Zimbabwe rejects $350m US health deal
US seeks Africa data access in new aid agreements