A
series
of
bilateral
health
agreements
being
negotiated
between
African
countries
and
the
administration
of
President
Donald
Trump
have
been
labelled
“clearly
lop-sided”
and
“immoral”
amid
growing
outrage
at
US
demands,
including
countries
being
forced
to
share
biological
resources
and
data.
It
emerged
this
week
that Zimbabwe had
halted
negotiations
with
the
US
for
$350m
(£258m)
of
health
funding,
saying
the
proposals
risked
undermining
its
sovereignty
and
independence.
A
letter
sent
by
Albert
Chimbindi,
Zimbabwe’s
secretary
for
foreign
affairs
and
international
trade,
in
December
that was
made
public said
the
president,
Emmerson
Mnangagwa,
“directed
that
Zimbabwe
must
discontinue
any
negotiation,
with
the
USA,
on
the
clearly
lop-sided
MoU
[memorandum
of
understanding]
that
blatantly
compromises
and
undermines
the
sovereignty
and
independence
of
Zimbabwe
as
a
country”.
Meanwhile, a
deal
with
Zambia –
which
has
been
linked
to
a
separate
agreement
with
the
US
on
“collaboration
in
the
mining
sector”
–
has
yet
to
be
finalised,
with
Asia
Russell,
director
of
the
HIV
advocacy
organisation Health
Gap, accusing
the
US of
“conditioning
life-saving
health
services
on
plundering
the
mineral
wealth
of
the
country.
It’s
shameless
exploitation,
which
is
immoral.”
At
least 17
African
countries have
signed
deals
with
the
US,
collectively
securing
$11.3bn
in
health
aid
but
raising
concerns
over
concessions
made
in
return.
Critics
say
there
has
been
a
lack
of
consultation
with
the
community
groups
that
provide
a
lot
of
the
healthcare
in
African
countries,
and
have
raised
concerns
over
data
privacy
–
the
US
requests
patient
record
data
as
part
of
the
deals
–
and
the
prioritisation
of
faith-based
healthcare
providers.
In
Nigeria,
US
statements
suggest
the
funding
is
contingent
on
authorities
tackling
what
the
Trump
administration
refers
to
as the
persecution
of
Christians in
the
country.
The
Trump
administration
is
negotiating
the bilateral
agreements with
countries
as
part
of
its
America
First
global
health
strategy.
The
new
approach
follows
the
US
dismantling
what
had
been
the
flagship
aid
body,
USAID,
and
pulling
back
from
large
multilateral
bodies
such
as
the
World
Health
Organization.
A
10-year-old
girl
is
given
the
HPV
vaccine
at
Budiriro
polyclinic
in
Harare,
Zimbabwe. Photograph:
Aaron
Ufumeli/AP
The
rapid
push
for
deals
is being
seen
as
part
of
US
manoeuvres to
establish
and
entrench
power
on
the
continent.
The
deals
also
commit
African
nations
to
rely
on
US
regulatory
approval
of
new
drugs
and
technologies
before
rolling
them
out.
The US-Rwanda
deal is
explicit
that
it
will
bring
increased
US
private
sector
involvement
in
the
country’s
health
sector.
A Zimbabwean
government
spokesperson
said on
Wednesday
that
the
US
had
asked
for
“sensitive
health
data,
including
pathogen
samples”,
but
without
any
corresponding
guarantee
of
access
to
any
resulting
medical
innovations.
“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,”
he
said.
“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.”
He
said
Zimbabwe
was
also
afraid
bilateral
agreements
would
undermine
WHO
systems
designed
to
ensure
fairness
in
any
future
pandemic
response.
“Development
aid
should
empower
nations,
not
create
dependencies
or
serve
as
a
vehicle
for
strategic
extraction,”
he
said.
“When
financial
assistance
is
contingent
upon
concessions
that
touch
upon
national
security,
data
sovereignty,
or
access
to
strategic
resources,
it
fundamentally
alters
the
nature
of
the
relationship
from
one
of
partnership
to
one
of
unequal
exchange.”
The
US
ambassador
to
Zimbabwe,
Pamela
Tremont, said
on
X she
regretted
the
country’s
decision.
“We
believe
this
collaboration
would
have
delivered
extraordinary
benefits
for
Zimbabwean
communities
–
especially
the
1.2
million
men,
women
and
children
currently
receiving
HIV
treatment
through
US-supported
programmes,”
she
said.
“We
will
now
turn
to
the
difficult
and
regrettable
task
of
winding
down
our
health
assistance
in
Zimbabwe.”
Most
of
the
new
US-African
deals
are
not
publicly
available,
although
the
Guardian
has seen
a
draft
template,
and
a
handful
of
documents
that
appear
to
be
final
agreements
are
in
circulation.
The
five-year
deals
commit
African
countries
to
gradually
provide
a
greater
amount
of
domestic
funding,
including
for
health-worker
salaries
and
equipment
–
replacing
US
investment
which will
decrease
each
year.
If
countries
fail
to
meet
those
commitments,
US
funding
may
be
withdrawn.
US
drafts
also
include
requests
for
access
to
health
data
and
information
on
new
or
emerging
pathogens
for
up
to
25
years,
although
many
countries
appear
to
have
negotiated
shorter
commitments.
In
Kenya,
the
first
country
to
sign
a
deal,
a
court
case
brought
by
campaigners
over
data
sharing
terms
has
put
the
agreement
on
hold.
The
Consumer
Federation
of
Kenya
(Cofek),
one
of
the
groups
bringing
the
case,
said Kenya
risked
“ceding
strategic
control of
its
health
systems
if
pharmaceuticals
for
emerging
diseases
and
digital
infrastructure
(including
cloud-storage
of
raw
data)
are
externally
controlled”.
Uganda’s
attorney
general,
Kiryowa
Kiwanuka,
sought
to
downplay
similar
fears
about
his
country’s
deal
in
an interview
hosted
on
X,
saying
it
was
“not
true”
that
citizens’
health
data
and
privacy
was
at
risk.
“We
have
our
data
protection
and
privacy
law,
and
the
agreement
is
riddled
with
that,”
he
said.
A
headline
reflects
Donald
Trump’s
comments
on
the
persecution
of
Christians
in
Nigeria. Photograph:
Sunday
Alamba/AP
One
reproductive
and
gender
justice
campaigner
in
Uganda
questioned
whether
the
increased
domestic
funding
targets
were
realistic,
given
African
governments’
failure
to
meet
the 2001
Abuja
declaration’s
15%
minimum national
budget
allocation
to
health.
She
said
there
had
been
“no
public
participation”
in
the
negotiation
process,
and
non-governmental
organisations
were
expected
to
be
further
sidelined.
Specialist
clinics
offering
care
to
marginalised
groups
such
as
the
LGBTQ+
community
were
unlikely
to
see
funding
“trickle
down”
to
them,
she
said.
In
Nigeria,
according
to
a US
embassy
statement,
the
agreement
for
$2.1bn
of
US
funding
“places
a
strong
emphasis
on
Christian
faith-based
healthcare
providers”.
US
‘adapt,
shrink
or
die’
terms
for
$2bn
aid
pot
will
mean
UN
bowing
down
to
Washington,
say
experts
Read
more
Fadekemi
Akinfaderin
of
Fòs
Feminista wrote
on
Substack that
“singling
out
one
religious
group
in
a
deeply
plural
country
risks
inflaming
existing
tensions
and
politicising
health”.
She
also
warned
that
“faith-based
facilities
are
less
likely
to
provide
family
planning
services,
STI
prevention
and
some
vaccinations,
due
to
ideological
beliefs”,
urging
Nigeria’s
health
ministry
to
ensure
coverage
gaps
did
not
result
from
the
agreement.
Rachel
Bonnifield,
director
of
global
health
policy
and
senior
fellow
at
the
Center
for
Global
Development
thinktank,
said
that
despite
the
criticisms
there
were
good
reasons
for
countries
to
sign
deals
including
“very
substantial
amounts
of
funding
–
in
some
cases
equivalent
to
50%
or
more
of
governments’
total
domestic
spending
on
health
–
to
support
very
basic
and
much
needed
health
services”.
A
shift
to
government
control
of
health
funds,
rather
than
distribution
through
US
NGOs,
was
also
likely
to
be
attractive,
she
said,
with
the
deals
seen
as
a
chance
to
establish
new,
broader
relationships
with
the
US.
“Even
transactional
negotiations
can
be
seen
as
treating
African
governments
like
peers
and
partners
versus
the
recipients
of
American
charity,”
said
Bonnifield.