America First Global Health

In early 2026, a controversy erupted over a series of bilateral health agreements (BHGAs) between the United States (under the "America First Global Health

" strategy) and various African states. The "America First Global Health" strategy is a Trump administration policy that reorients U.S. healthcare aid, prioritizing national interests. Published in 2025, it shifts the focus from multilateral organizations to bilateral agreements with recipient countries. The strategy is based on three pillars: - America's security through improved disease surveillance and control; - strengthening through time-limited bilateral agreements; and - promoting U.S. healthcare products and containing rivals like China in Africa. Key changes: Aid is concentrated on HIV, tuberculosis, malaria, and polio. Starting in fiscal year 2026, the costs of medical supplies and healthcare personnel will be fully funded, while recipient countries will be required to provide co-financing and transition to self-sufficiency by 2030. Support for international NGOs will be cut, disease programs will be placed under the authority of the Ministry of Foreign Affairs, and the aid will be used as geopolitical leverage. Criticism stems from health experts warning of gaps in care, reduced funding (initially by almost 70%), and risks to global systems due to the circumvention of multilateral organizations such as the WHO. Critics, activists, and some government officials have labeled these agreements "exploitative" or "one-sided" due to strict requirements regarding data sharing, government control, and national financing. By March 2026, at least 17 African countries had signed these agreements, though some have suspended or rejected them due to public protests. Status of the agreements (March 2026) - Kenya was the first country to sign (US$1.6 billion); Currently suspended by the Supreme Court due to privacy concerns and a lack of public participation. - Zimbabwe rejected it. In February 2026, a $367 million deal was scrapped because of objections to "unrestricted access" to health data without any guarantee of the resulting vaccines. - There is resistance in Zambia. Officials are pushing back against a $1 billion deal after leaked information suggested it was linked to US mining interests and would involve hiring 40,000 workers. - Nigeria signed. A $2.1 billion deal was secured; critics complained about the strong preference given to Christian health providers. - Burkina Faso signed. Signed by the government of Ibrahim Traoré in exchange for security and health funding. - Uganda signed. The agreement has been criticized because it reportedly functions as an "appendix" to the national budget, thus circumventing parliamentary oversight. Why the agreements are considered "exploitative." The main criticisms relate to specific clauses in the drafts and signed letters of intent: There's the data sharing. Countries are obligated to share sensitive patient data and "physical samples" (pathogens) with the US within five days of their discovery, often without any guarantee that the African country will benefit from the drugs or vaccines developed based on this data. Then there's sovereignty and budgeting. The agreements often stipulate that African governments rapidly increase their health spending (e.g., Kenya with $850 million) to compensate for declining US aid. If these internal targets are not met, the US can suspend the entire funding package. Regulatory oversight also plays a role. Some agreements obligate African countries to rely solely on US FDA approval for new medicines, which can weaken local and regional health authorities like the Africa CDC. The geopolitical entanglements. In cases like Zambia, there are concerns that health aid is being misused as a “Trojan horse” to secure access to critical minerals for the global energy transition. The reaction of African leaders. The Africa CDC has officially supported countries like Zimbabwe and Zambia in their decision to renegotiate. Director General Jean Kaseya stated: “We want to keep our data in Africa. We want to shape our own future.” Should I examine the specific legal challenges these agreements are currently facing in Kenyan or Zambian courts?