The US has launched a sweeping overhaul of its foreign health assistance through the America First Global Health Strategy in an approach to African countries, tilting the benefits largely toward Washington.

 

Under this approach, Kenya, Rwanda, Uganda, Lesotho, Liberia and eSwatini have signed bilateral deals that redirect billions of dollars in aid while binding them to long-term medical data and pathogen-sharing obligations.

These frameworks, outlined as efforts to promote self-reliance by 2030, have, however, sparked debate over African health sovereignty as they embed strict conditions tied to US national security and global surveillance priorities.

The new approach shifts from NGO-led funding to direct government-to-government agreements, aiming to eliminate dependency. However, the financial support comes with obligations that extend US influence beyond the funding period.

Rwanda signed a deal worth $228 million, to run over a similar period. Uganda followed with a five-year, nearly $2.3 billion agreement, including $1.7 billion from the US to combat HIV/Aids, TB, malaria, and other diseases. Uganda pledged $500 million in co-investment, with support for digitalisation, faith-based providers, and the military.

Lesotho signed a five-year $364 million MoU, with $232 million from the US and $132 million to be raised locally to strengthen HIV/Aids response, workforce, and surveillance. Liberia entered a $176 million agreement, with $125 million from the US and $51 million from Liberia to build self-reliance in health systems.

Thomas Pigott, Principal Deputy Spokesperson at the US Department of State, said the agreements aim to “advance the America First Global Health Strategy and build resilient, self-reliant, and durable health systems.” He added that more bilateral deals will follow in dozens of countries.

The agreements are designed to transition financial responsibility and technical functions to partner governments. They commit nations to ambitious goals in HIV/Aids, tuberculosis, malaria, and polio, while prioritising maternal and child health, surveillance, and outbreak preparedness.

Host governments must gradually increase domestic spending to take over commodities, laboratories, and salaries, with full ownership by 2030. US funding will expand health data systems, linking financial incentives to performance.

The most contentious element is data access and specimen sharing. While the main frameworks last five years, sister data-sharing agreements extend to seven. US officials say only de-identified, aggregated data—such as numbers on ARVs and infection trends—will be shared.

Earlier drafts, however, included a 25-year “specimen sharing agreement” requiring countries to provide biological samples and genetic data of epidemic pathogens within five days of detection.

Kenya’s Health Cabinet Secretary Aden Duale confirmed a seven-year data agreement, but critics warn that longer-term specimen-sharing undermines World Health Organization (WHO) negotiations on global pathogen-sharing.

The two governments insist data sharing will follow national laws, with Congress receiving only aggregated reports. The US withdrew from the WHO, accusing the body of bias toward China.

The agreements embed operational requirements such as the 7-1-7 Surveillance Model: detect outbreaks within seven days, notify the US within one, and respond within seven. Kenya has also accepted that FDA approval or Emergency Use Authorisation of vaccines and drugs will suffice during outbreaks.

Aggrey Aluso, Africa director at the Pandemic Action Network, criticised the arrangements, saying, “If somebody takes control of genetic sequencing data, they define how you manage or respond to a health emergency. It is not clear what benefits will accrue to those giving their data. There is no guarantee.”The MoUs position the US as a central hub for pathogen intelligence, raising concerns it seeks to undermine WHO authority.

But the Kenyan deal suffered a setback this week after the High Court halted its implementation over concerns on medical data breaches and lack of public participation. The court issued conservatory orders suspending any transfer of sensitive health data.

The Consumers Federation of Kenya (Cofek) and Senator Okiya Omtatah, separately sued government offices, the ministries of Foreign and Diaspora Affairs and Health, the Digital Health Agency, and the Data Protection Commissioner, alongside the National Assembly, Senate, and Attorney-General.

The government must respond by 16 January 2026, with a mention scheduled for 12 February 2026.

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