The America First Global Health Strategy is being questioned as exploitative.

The United States (US) has run into some problems with its America First Global Health Strategy it rolled out in September 2025.

Twenty African nations and four Latin American states have so far signed memoranda of understanding (MOUs) within this strategy. This is partly designed to wean them off non-governmental organisation (NGO) health assistance by providing direct health support from the US government to their governments over five years.

Most of the African countries previously received health grants via the US Agency for International Development, which President Donald Trump terminated, and the decimated US President’s Emergency Fund for AIDS Relief. Much of this aid was channelled through NGOs the Trump administration believed were siphoning off too much in overheads.

Though the amounts the US would invest are substantial, they represent an average 40% decrease in what these countries were receiving in health finance from the US over the past five years. In exchange for the US money, recipient countries commit to taking over the financing of their health functions from the US during the deals’ five years – otherwise the US may withdraw future funding.

The MOU with Kenya, for instance, commits the US to investing about US$1.63-billion and Kenya increasing its health spending by KES115-billion (about US$890-million) in that time. The biggest deal is with Nigeria, which will get US$2.1-billion and must contribute US$3-billion itself.

The big payoff for the US, says Secretary of State Marco Rubio, will be greater security, as America’s health engagement with foreign countries, including access to health data, will let it detect disease outbreaks earlier and counter them before they reach the US. So for instance the MOU with Kenya aims to ensure the country acquires the ability ‘to detect infectious disease outbreaks with epidemic or pandemic potential within seven days of emergence’ and to notify the US within one day.

The aim is also to give US health companies an advantage by providing them with pathogen data they can use to develop vaccines and treatments before their competitors.

The deals do incorporate longstanding and theoretically worthy goals: to get countries to match donor funds, reduce dependency on aid, and eventually pay for their own health systems. But several African countries say the deals are ‘exploitative.’ And so the Zimbabwe-US MOU appears to have collapsed as the US has pulled out because of misgivings expressed by Harare.

‘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, Information, Publicity and Broadcasting Services Secretary.

‘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.’

Kenya’s High Court reportedly halted its MOU as it faces two separate court challenges for giving the US access to patient data and pathogen information. Zambia has also expressed misgivings about a proposed MOU and has requested revisions. According to Health Policy Watch the MOU was due to be signed last December, but it faltered after the US made it conditional on US access to Zambian minerals, particularly copper and cobalt.

The health MOUs with the Democratic Republic of the Congo (DRC) and Guinea were also conditional on signing agreements granting the US access to critical minerals, says Health Policy Watch. A group of lawyers in the DRC is reportedly challenging the minerals deal in court.

As Zimbabwe has suggested, the extraction issue is not so much, or not only, about linking the deals with the mining of minerals, but in a sense about mining health data.

Sophie Harman, International Politics Professor at Queen Mary University of London, wrote in the British Medical Journal that ‘extraction is the core principle of … Trump’s America First global health policy. The current 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.’

Kerry Cullinan, Health Policy Watch Deputy Editor, told ISS Today that bypassing health NGOs would harm vulnerable populations as many NGOs had specialised skills and access. She said the Trump administration was trying to set this strategy up as an alternative to the World Health Organization (WHO), from which it withdrew.

And so one of the obsessions with these MOUs was getting information rapidly about outbreaks of infectious diseases to the US, she said. This was pressuring countries to employ epidemiologists, laboratory technicians, data collectors and the like – whereas poor countries would probably prefer to spend the money on nurses.

Cullinan said multilateral organisations like the WHO and the Africa Centres for Disease Control and Prevention should really be doing that epidemiological work.

Southern Africa Litigation Centre international justice expert Atilla Kisla recently wrote in Daily Maverick that Trump’s WHO withdrawal should not be seen as a retreat from the world. Instead it was a ‘geopolitical pivot’ … ‘an ambitious power play’ through the America First Global Health Strategy to escape the constraints of health multilateralism. It wanted to ‘exercise its power fully and set the rules without international standards, control data flows, bypass multilateral scrutiny and attach ideological conditions to funding.’

The latter refers to MOU clauses forbidding recipient countries from using US financial support for abortion as a family planning method.

He said the access to national disease surveillance systems to genomic sequencing and reproductive health patterns the MOUs gave the US would not only advantage US health companies but also give the US political power over recipient states.

That the Trump administration is demanding a quid pro quo for its health assistance should not come as a surprise – we already knew this was a transactional administration.

African countries should not therefore necessarily reject the strategy out of hand, and should ask themselves: what are the alternatives? Can, for example, a country like Zimbabwe – not the world’s richest – really afford to be so fastidious about its health assistance, especially in a global environment of drastically shrinking foreign aid?

Written by Peter Fabricius, Consultant, ISS Pretoria