The United States (US) aims to compel countries that receive its aid to fight HIV, tuberculosis and malaria to share all information about “pathogens with epidemic potential” in exchange.

This is according to a US government document, the “PEPFAR [US President’s Emergency Plan for AIDS Relief] Memorandum of Understanding (MOU) template”, seen by Health Policy Watch. 

Countries that sign these bilateral MOUs with the US will also be expected to sign a “specimen sharing agreement” committing them to sharing biological material and genetic sequence data of such pathogens with the US within five  days of detection.

This specimen-sharing agreement is envisaged to continue for 25 years although the US aid package only runs from 2026 to 2030. However, the MOU indicates that the specimen-sharing agreement is still being drafted.

Two highly placed and credible sources have confirmed that the US is rolling out these MOUs with African countries.

These bilateral deals will potentially torpedo the Pathogen Access and Benefit Sharing (PABS) system currently being negotiated by World Health Organization (WHO) member states. The US pulled out of the WHO in January, the day Donald Trump became president.

The PABS system is the final outstanding piece of the WHO Pandemic Agreement, adopted in May after three arduous years of negotiations. 

Developing countries feel strongly that they need to benefit from any vaccines, therapeutics or diagnostics that are developed from the pathogen information that they share. The Intergovernmental Working Group (IGWG) charged with developing a PABS system that balances access to pathogen information with benefit-sharing, began text-based negotiations this week.

However, the US bilateral MOU does not make any reference to countries receiving benefits from sharing their pathogen information, although they will get US support to develop disease surveillance and laboratories.

The US commits to funding “an assessment” of individual countries’ “outbreak surveillance system”, including “disease surveillance and safety procedures for pathogen sample collection, transport, storage, testing and disposal.”

The US also commits to assisting with salaries for field epidemiologists – but only for 2026. Thereafter, countries will be expected to assume responsibility for a growing percentage of these salaries over the grant period, which lasts until 2030.

The US will also fund the salaries of some laboratory technicians and 100% of laboratory commodities to identify pathogens in 2026, “subject to the availability of funds”. But funding for these lab technicians and commodities is “expected to decline gradually” after next year, according to the MOU.

Transporting pathogen specimens to labs will become countries’ responsibility after 2026.

Narrow focus

A technical guide accompanying the MOU sets out its purpose as “to establish an understanding between the US  Department of State and partner countries that will advance US interests, save lives, and help countries build resilient and durable health systems”.

The PEPFAR template is narrowly focused on nine outcomes related to HIV testing and antiretroviral treatment; reducing TB deaths and malaria deaths in children under the age of five (U5); improving maternal and U5 mortality and polio and measles vaccinations.

The MOU is heavily skewed towards disease outbreaks, and US donor recipients will be expected to have the capacity to “detect infectious disease outbreaks with epidemic or pandemic potential within seven days of emergence” and notify the US government “within one day of an infectious disease outbreak being detected”.

Once the MOUs are signed, countries can expect funds from April 2026. Several African countries are desperate for funds after their HIV treatment and care programmes were abruptly terminated or disrupted after the US declared a three-month halt to foreign aid in January. Few of these programmes have resumed fully despite US assurances that they are still supporting life-supporting programmes.

‘America first’

In September, the US State Department unveiled its America First Global Health Strategy, committing to resuming funding for HIV, tuberculosis, malaria and polio medicine and the salaries of health workers directly delivering most of these services to patients through bilateral deals with governments and faith-based organisations– at least for the 2026 financial year.

The three pillars underpinning the new strategy are to keep America safe, strong and prosperous. The long-awaited strategy clarifies how the Trump administration aims to restructure PEPFAR and replace functions of the now-defunct US Agency for International Development (USAID). 

US Secretary of State Marco Rubio described the strategy as “a positive vision for a future where we stop outbreaks before they reach our shores, enter strong bilateral agreements that promote our national interests while saving millions of lives, and help promote and export American health innovation around the world”.

Image Credits: UNAIDS.