Once the data left the Ghanaian borders, we had no control over what becomes of it.
In the wake of dismantling its longstanding foreign aid apparatus, the United States has begun offering African nations bilateral health agreements that tie medical funding to American commercial, pharmaceutical, and strategic interests — a departure from the multilateral frameworks that once, however imperfectly, distributed power more broadly. Countries like Ghana, Zimbabwe, and Zambia have pushed back, invoking sovereignty over their data, their pathogens, and their mineral wealth, while the Ebola outbreak in the Democratic Republic of Congo offers an early and sobering measure of what is lost when global health infrastructure is treated as leverage rather than shared necessity. The question being asked across the continent is an old one dressed in new terms: what is the true cost of aid that arrives with conditions, and who ultimately pays it?
- The Trump administration replaced USAID with bilateral health deals explicitly designed to advance American commercial and strategic interests, leaving dozens of nations to negotiate alone against a superpower with clear leverage.
- Ghana, Zimbabwe, and Zambia each refused to sign, citing loss of control over medical data, no guarantees that drugs developed from shared pathogens would return to their people, and the alarming linkage of health aid to critical minerals access.
- Kenya's deal — the flagship agreement worth $2.5 billion — was suspended by a court over patient privacy concerns before cabinet ministers eventually pushed it through, signaling the legal and political turbulence these agreements are generating.
- In the DRC, the cost of dismantled infrastructure became concrete: an Ebola outbreak met a gutted response network, missing stockpiles, and a ten-day delay that former USAID officials say would not have happened under the old system.
- As of late July, adoption across Africa remains uneven and contested, with the full shape of America's restructured global health strategy still unresolved and its consequences still accumulating.
When Marco Rubio signed a $2.5 billion health agreement with Kenya last December, he predicted dozens more would follow. By mid-May, thirty-two countries had accepted similar deals. But the story behind those numbers is more complicated than a new chapter in American generosity.
With USAID dismantled, the Trump administration replaced multilateral health cooperation with bilateral agreements tied explicitly to US commercial and strategic interests. Recipient nations were required to increase their own health spending and prioritize American pharmaceutical companies. A State Department spokesperson was direct: this was not charity, but strategic capital invested to advance US interests.
The resistance came quickly. Ghana's Data Protection Commission objected that medical data generated by Ghanaians would flow to US authorities with no reciprocal protections — once it crossed the border, Ghana had no say over its use. Zimbabwe declined after receiving no guarantees that vaccines developed from shared pathogens would ever reach its own people. Zambia's foreign minister revealed that Washington had insisted on bundling the health agreement with a separate deal granting access to critical minerals — a linkage Zambia refused to accept.
South Africa's health minister captured the broader unease: no self-respecting nation should accept terms where the US gains perpetual access to pathogens and genetic data in exchange for only five years of funding.
The stakes became viscerally clear in the Democratic Republic of Congo. Already among the first to sign a new bilateral deal, the DRC faced an Ebola outbreak in recent weeks — but the infrastructure to respond had been hollowed out. One humanitarian director had lost a third of his staff to USAID cuts. Emergency stockpiles were gone. Personal protective equipment was not prepositioned. Ten critical days were lost at the outbreak's start. A former USAID official who led the 2014 West Africa Ebola response said the outbreak would not have spread undetected had the old network still been intact.
The US pointed to $270 million donated to the Ebola response as evidence of continued commitment. But former CDC director Kevin DeCock warned that bilateral relationships are structurally incapable of addressing transnational crises — global health, by its nature, crosses borders and demands global approaches. As Tanzania signed on and others continued to decline, the reshaping of America's role in global health remained unfinished, its costs still being counted.
When Marco Rubio signed the first bilateral health agreement with Kenya last December, he spoke with the confidence of a man launching a new era. The deal was worth $2.5 billion, and the Secretary of State predicted many more would follow—thirty, forty, fifty, he mused. He was right about the momentum, if not the reception. By mid-May, thirty-two countries had accepted similar health agreements. But the story of how those deals came together reveals something more complicated than a simple expansion of American generosity.
The Trump administration had dismantled USAID, the main vehicle for US foreign assistance, shortly after taking office. In its place came a new strategy: bilateral health agreements with individual nations, each one tied explicitly to American commercial and strategic interests. The State Department was blunt about the philosophy. "US foreign assistance is not charity," a spokesperson told the BBC. "Rather it is strategic capital to be wisely invested to advance US interests." The deals required recipient countries to increase their own health spending and to prioritize American pharmaceuticals and medical companies. On the surface, this sounded reasonable—building local capacity, reducing dependency, encouraging self-reliance. But the fine print told a different story.
Kenya's agreement, despite Rubio's optimism, faced legal challenges from activists concerned about patient privacy. A Kenyan court initially suspended the deal. Cabinet ministers eventually approved it, but only after months of delay. The resistance in Kenya was a preview of what would come elsewhere. Ghana's Data Protection Commission objected to the terms, citing concerns about the scope of medical information being requested. Arnold Kavaarpuo, the commission's executive director, explained the problem plainly: Ghana would generate the data and pass it to US authorities, but there were no reciprocal protections for Ghanaian sovereignty. "Once the data left the Ghanaian borders, we had no control over what becomes of it," he said. Zimbabwe rejected a deal for similar reasons, noting that there were no guarantees that drugs or vaccines developed from shared pathogens would be available to its own people.
Zambia's resistance revealed another layer of the problem. Foreign Minister Mulambo Haimbe told the BBC that the US had insisted on linking the health agreement to a separate deal giving Washington access to critical minerals. The Americans wanted the two negotiated as a package; Zambia wanted to discuss them on their own merits. When the State Department was asked about this linkage, it stopped short of confirming it directly but doubled down on the transactional logic: America First, and allies should take American priorities seriously.
The shift away from the World Health Organization—which the US had withdrawn from earlier in the year—meant that African nations could no longer rely on a multilateral framework that had at least theoretically balanced the interests of many countries. Instead, they faced bilateral negotiations with a superpower that was explicit about viewing health aid as leverage. South Africa's Health Minister Aaron Motsoaledi put it bluntly: no self-respecting nation should accept terms where the US got access to pathogens and genetic information in perpetuity while committing only five years of funding.
The consequences of this shift became visible almost immediately. The Democratic Republic of Congo, one of the first countries to accept the new American health deal, faced an Ebola outbreak in recent weeks. But the infrastructure to respond had been gutted. Amadou Bocoum, the country director for the humanitarian organization Care, had been forced to lay off thirty-six workers—a third of his staff—after USAID cuts. When the Ebola outbreak emerged, the staffing was not there. The emergency stockpiles were not there. Critical supplies like personal protective equipment were not prepositioned. Bocoum lost ten days at the start of the response, days that mattered in containing a viral hemorrhagic fever. Jeremy Konyndyk, who led the USAID response to the 2014 Ebola epidemic in West Africa, said he could not imagine the outbreak spreading undetected if the full network of US-funded health partners had still been in place.
The US argued that its new bilateral approach was more aligned and effective, and pointed to the $270 million it had donated to the Ebola response. But critics, including former CDC director Kevin DeCock, warned that bilateral relationships could not address transnational health crises. "Global health, by definition, is transnational, crosses borders, does not concern just one country," DeCock said. "Global health problems require global approaches, and no country can go it alone." As of late July, adoption of the bilateral agreements in Africa remained patchy and controversial. Tanzania had just signed up. Several other nations had declined. The reshaping of America's global health strategy was still very much in motion, and its ultimate reach remained uncertain.
Citas Notables
Once the data left the Ghanaian borders, we had no control over what becomes of it.— Arnold Kavaarpuo, executive director of Ghana's Data Protection Commission
Global health problems require global approaches, and no country can go it alone.— Dr Kevin DeCock, former CDC director
When this new Ebola came, the staffing was not there, and the emergency stock that we also used to have was also not there.— Amadou Bocoum, DR Congo country director for Care
La Conversación del Hearth Otra perspectiva de la historia
Why are African countries so concerned about sharing health data with the US? Isn't that how disease surveillance works?
It does, but the context has changed. Before, sharing data through USAID or the WHO felt like part of a collective effort to protect everyone. Now it feels transactional—the US gets the data and the genetic information, but there's no guarantee African countries will benefit from any drugs or vaccines developed from it. And the US is explicit that it's doing this to advance American interests.
But the US says it's the same aggregated, de-identified data they've always used.
That's technically true, but it misses the point. Ghana's data protection chief said it clearly: once the data leaves their borders, they have no control over what happens to it. And when the US links health deals to access to critical minerals, or conditions them on buying American pharmaceuticals, it stops feeling like cooperation and starts feeling like extraction.
What about the argument that this encourages countries to spend more on their own health systems?
That's the stated goal, and it sounds good. But it's also convenient for the US—it reduces American spending while maintaining American influence. And when you cut USAID staff in the middle of an Ebola outbreak, as happened in Congo, you're not building capacity. You're creating a vacuum.
So the Ebola outbreak is connected to these policy changes?
Directly. The same country that just signed the new bilateral deal had to lay off a third of its health workers because USAID was dismantled. When the outbreak came, the early warning systems weren't there. The stockpiles weren't there. People who could have mobilized the community weren't there. That's not abstract policy—that's real consequences.
Is there any argument in favor of this new approach?
Some analysts say the US should be given a chance to prove that conditional engagement and results-driven partnerships work better than deference to multilateral organizations. But the evidence so far—the resistance from multiple African nations, the weakened response to Ebola—suggests the risks are real and immediate.