Africa is proving to be not the easy pushover America had envisaged, even as the ink dried this past week on several new bilateral health Memoranda of Understanding (MOUs) signed between the US and four Latin American countries – the Dominican Republic, El Salvador, Guatemala and Panama – reports Health Policy Watch.
So far, 24 bilateral health MOUs have been signed under Donald Trump’s’ America First Global Health Strategy, but in Africa, the DRC, Kenya as well as Zimbabwe, have shown reluctance to agree to specific “extractive” terms and conditions set forth by Washington.
However, the US State Department described its agreement with Panama, the first MOU signed within Latin America, as “strengthening Western hemisphere health security”, which it added was “a priority”.
The four Latin American agreements involve smaller grants and are almost wholly focused on disease surveillance.
The other 20 bilateral agreements are all with African countries, mostly previous recipients of health grants via the now disbanded US Agency for International Development (USAID), with several of them currently experiencing chronic shortages of medicines for HIV, TB and maternal and child health.
The five-year MOUs are aimed at rapidly transferring financial responsibility for these key health services to countries themselves, as some, like Kenya, Uganda and the Democratic Republic of Congo (DRC), derived more than half their HIV budgets from donors.
Costly terms
The transitional MOU terms include extensive investment in infectious disease surveillance networks that can supply the US with pathogen information within seven days of any outbreak – enabling American firms to have exclusive access to pathogen information, and be able to make vaccines, medicines and diagnostics to combat these.
The US-DRC MOU, signed a week ago, focuses extensively on “strengthening the DRC’s capacity to detect and contain infectious disease outbreaks before they spread internationally”, according to a US State Department statement.
The US will invest up to $900m over five years and the DRC has committed to increasing its health expenditure by $300m.
The bulk of the money will go into “a national integrated surveillance and outbreak response system, including a high-quality laboratory network capable of detecting and investigating infectious disease outbreaks within a week”.
The US held off signing an MOU with the DRC on 5 December, when it signed deals with Rwanda and Kenya on the sidelines of the signing of a Peace Accord between Rwanda and the DRC.
Instead, the US and the DRC signed a “strategic partnership agreement” to “promote secure, reliable, and mutually beneficial critical mineral flows for commercial and defence purposes”.
The DRC is one of the world’s most important sources of rare earth minerals, but China has dominated the purchasing and processing of its minerals. In the past two months, the DRC has opened its rare minerals supply to the US.
In late January, the DRC sent the US a shortlist of state-owned assets involving manganese, copper, cobalt, gold and lithium, for US investors to consider as part of a minerals partnership, Reuters reports.
Meanwhile, the US MOU with Guinea, signed on 27 February, was also preceded by a minerals MOU, signed with the US on 5 February, giving the US access to “critical minerals”.
The health MOU prioritises strengthening the country’s “laboratory networks with biosafety and biosecurity management aligned with international standards by 2027”.
Legal backlash in DRC
But some obstacles are stalling what the US might have perceived as easy access to African minerals – with not all countries on the continent wanting to swop their natural wealth and other assets for aid.
A group of lawyers in the DRC is challenging the minerals MOU in the country’s Constitutional Court, arguing that it violates the Constitution in various ways, including undermining national sovereignty over natural resources.
“…We are assuming our responsibility as Congolese citizens to protect the sovereignty of our country and safeguard our patrimony for future generations,” said Attorney Jean-Marie Kalonji, one of the plaintiffs. The case has yet to be heard.
And Zimbabwe recently backed out of its talks with Washington as it was unhappy with what the US was wanting from it in terms of outbreaks.
“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,” said Nick Mangwana, Secretary for Information, Publicity and Broadcasting Services.
“In essence, our nation would provide the raw materials for scientific discovery without any assurance that the end products would be accessible to our people should a future health crisis emerge. The United States, meanwhile, was not offering reciprocal sharing of its own epidemiological data with our health authorities.”
In the meantime, Kenya’s MOU with the US, the first of the series, has been halted by the country’s High Court as it faces two separate court challenges for giving the US access to patient data and pathogen information.
Last week the Government of Zambia acknowledged that it was unhappy with part of the proposed deal that “does not align with the country’s interests”. It has requested “revisions” to the MOU.
The Zambia-US bilateral health deal was supposed be signed in December, but it faltered after America linked the billion-dollar deal to access to Zambian minerals, particularly copper and cobalt.
Just four days before the pact was due to be signed, the US announced that the two countries had committed to a plan to unlock “a substantial grant package of US support in exchange for collaboration in the mining sector and clear business sector reforms that will drive economic growth and commercial investment that benefit both the United States and Zambia”.
‘Extractive’ policy
Sophie Harman, Professor of International Politics at Queen Mary University of London, argues in last week’s BMJ that “extraction is the core principle of …the America First global health policy”.
“The US administration does not aim to improve health worldwide, instead it intends to make US companies richer and facilitate ‘leveraging US global health leadership to compete with China’,” she wrote.
“Entering a deal with the US Government is a potential lose-lose for states. These countries risk losing resources and opportunities for wealth creation in their own countries, threatening alliances with China for relatively small advances in health, and creating political turmoil in domestic courts.”
See more from MedicalBrief archives:
Zimbabwe rejects $350m US health deal
US seeks Africa data access in new aid agreements
Washington launches billion-dollar health pacts in Africa – with provisos