Human Rights Watch (HRW) reported on Monday that the US entered into bilateral agreements with at least seven African countries to provide healthcare resources in exchange for access to surveillance data and pathogen specimens.
The Memorandums of Understanding (MOUs) with several African governments were signed in 2025 as part of the so-called “America First” Global Health Strategy.
The agreements raise serious concerns about access to people’s private health care data, HRW said.
“The agreements show the US intends to condition vital health assistance for millions of people on acquiescence to troubling conditions,” said Julia Bleckner, senior health researcher at HRW. “After the sudden and devastating pullback from US assistance in 2025, governments are now being pressured to accept agreements with contingencies that jeopardize human rights.”
The US government has not publicly disclosed details of the 31 agreements reportedly signed with African governments. The agreements with Ethiopia, Kenya, Mozambique, Nigeria and Uganda were briefly posted to the US State Department’s Freedom of Information Act Library on March 13, under the Case-Zablocki Act, which requires timely public disclosure of international agreements. They were removed days later, after the New York Times reported that the US had linked a $1 billion health package to access to Zambia’s minerals, with a leaked State Department memo stating that the US would “only secure our priorities by demonstrating willingness to publicly take support away from Zambia on a massive scale.”
Each agreement purports to support the development of the aid-receiving country’s “durable and resilient health system that prevents, detects, and treats diseases.” To this end, they outline six major “Areas of Cooperation” between the parties: (1) Surveillance & Outbreak Response, (2) Laboratory Systems, (3) Commodities, (4) Frontline Healthcare Workers, (5) Data Systems, and (6) Strategic Investment and Technical Assistance. Most agreements, all except Kenya, commenced on April 1, 2026 and are set to continue for five years until December 31, 2030.
The United States’ main role is to provide funding for endeavors such as healthcare data digitization, worker training, building laboratory systems, and conducting assessments and research activities. While the specific responsibilities vary, consistent across each agreement are the aid-receiving country’s obligation to: (1) negotiate specimen sharing agreements to provide the US with “genetic sequence data of detected pathogens with epidemic potential,” (2) commit to using specific technology systems for health care data digitization, (3) agree to tax exemptions on the services funded by US contributions, (4) comply with random audits by providing broad, often unspecified, data access, and (5) comply with the Helms Amendment, which prohibits the use of US funds on abortions.
HRW’s assessment of the agreements provides examples of how these obligations vary from country to country. For example, while Mozambique, Rwanda and Liberia, agree to provide “any data” for audit compliance, Nigeria’s agreement calls for unspecified “regulated data access.” Ethiopia’s preamble reserves a right to personal data protection as protected by domestic laws and Kenya conditions its information sharing on compliance with Kenya regulations. With regard to specimen sharing, Nigeria’s MOU references a future agreement according to an undisclosed Appendix; Kenya’s MOU outlines the right to enter in a specimen agreement that “gives effect to any provisions of this Framework.” These specimen and data sharing requirements are highlighted as crucial components, such that a failure to adhere, after certain curing efforts, leads to a change in funding.
The America First Global Health strategy was purportedly created to make the US “safer, stronger, and more prosperous.” The MOUs outline commitments to reduce the spread of malaria, HIV, and TB while improving maternal and child care health and nutrition outcomes. Many African nations, however, have pushed back on the lack of transparency and autonomy. The Africa Report mentions resistance from activists and government officials, who contend that “African governments are no longer willing to provide data without control, reciprocity, or benefit. This is not simply resistance. It is a renegotiation of the terms of participation in global health.”
