Just days into his second term starting January 2025, Donald Trump launched a sweeping review of US foreign aid and began dismantling USAID, the country’s foreign assistance machine, describing the majority of its programs as not being aligned with American interests.
The State Department is unequivocal: the era of large-scale, open-ended foreign aid is over. In its place is trade and investment, structured primarily to advance American strategic and commercial interests. Rather than grants and development assistance as the core tool of engagement, the focus is ‘mutually beneficial’ deals, market access and partnerships that bolster US interests.
It is within this realignment of American foreign policy that Washington’s controversial health memoranda of understanding now being advanced across Africa must be understood.
The America First Global Health Strategy 2025 is anchored on three pillars – making America safer, making America stronger and making America more prosperous.
It is blunt in its ambition: “Our global health foreign assistance program is not just aid – it is a strategic mechanism to further our bilateral interests around the world.”
But if the strategy is ambitious, the accompanying MoUs are even more audacious. They go beyond conventional health cooperation by requiring partner countries to provide detailed epidemiological data of citizens, in some cases up to 25 years. This insistence on direct access to sensitive national health data is precisely what has raised concerns among some African governments, public health experts and international observers, highlighting the transactional, America-first logic underpinning this new approach to global health.
So far 18 African countries – Botswana, Burkina Faso, Burundi, Cameroon, Democratic Republic of Congo, Eswatini Ethiopia, Ivory Coast, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mozambique, Nigeria, Rwanda, Sierra Leone and Uganda – have signed the MoUs with the US, offering funding, technical support and public-health partnerships in exchange for expanded access to epidemiological data.
This is a struggle over data, power, sovereignty and the future architecture of global health governance.
“There are huge concerns regarding data, regarding pathogen sharing,” Dr Jean Kaseya, Director-General of the Africa Centre for Disease Control and Prevention, a specialised agency of the African Union, said recently.
Some governments have pushed back, framing the agreements as “asymmetrical” and warning against externalisation and control of sensitive national datasets.
Zimbabwe has outrightly terminated talks with the US, after which Washington announced it was ending all health funding. Zambia and other countries that have expressed concern with the conditions and haven’t signed, have up to 1st April 2026 to decide if it will go ahead and on what terms.
Historically, public health data sharing has been coordinated through the Geneva-based 194-member World Health Organisation, a multilateral system designed to ensure transparency and cooperation among members. But for the second time, Trump has withdrawn the US from the UN agency.
In place of multilateral cooperation, Washington has introduced bilateral agreements where the balance of power is unequal and where American interests dominate, undermining the spirit of shared global health governance.
In its Health Strategy, the US argues that data sharing accelerates outbreak detection, strengthens preparedness and integrates health systems into global early-warning networks. In principle, this aligns with the goals of global disease surveillance that the WHO champions.
But that is only part of the story. There are two things that remain unstated.
First, the health data to be accessed will feed directly into commercial pipelines of the US pharmaceutical industry, providing valuable genetic and epidemiological information that helps guide research, patents and product development.
Secondly, there are separate MoUs to be signed on critical minerals but tied to health financing, hence the recent ministerial meeting in Washington, where 54 African countries attended.
Taken together, these arrangements risk reproducing an extractive pattern, this time involving both biological data and natural resources for the benefit of US commercial and geopolitical interests.
But Africa seems to be finally reading the times correctly. As these MoUs were being crafted, the Africa Centres for Disease Control and Prevention in November 2025 unveiled Africa’s Health Security and Sovereignty (AHSS) Agenda to safeguard the continent against rising health threats while reducing dependency on external systems, manufacturing, procurement, supply chains and financing.
At their recent annual summit in Addis Ababa in February, African Heads of State endorsed the AHSS as “the guiding continental framework for long-term health sovereignty, resilience and self-reliance”.
The AHSS should be viewed as a steppingstone towards Africa building and financing its own resilient health systems. If the continent can mobilise the resources to sustain its own healthcare, it will no longer be forced into lopsided deals that compromise its autonomy.
Self-financing would allow African governments to set their own priorities, invest in domestic research and pharmaceutical capacity and retain control over health data and biological resources, ultimately serving African interests first.
Dennis Mulilo writes on business and politics.