Ghana has become the latest African country to reject the United States’ terms for bilateral health assistance, particularly the requirement to share sensitive health data, according to Reuters.

Late last year, Zimbabwe rejected US terms for health assistance, particularly the demand to share pathogen data without any “corresponding guarantee of access to any medical innovations – such as vaccines, diagnostics, or treatments – that might result from that shared data,” according to government spokesperson Nick Mangwana.

Zambia has until 30 April to decide on whether to avail its minerals – primarily copper, cobalt and lithium –  to US companies in exchange for health assistance.

US aid supported antiretroviral treatment for an estimated 1,3 million Zambians. In the wake of disruptions since President Donald Trump assumed office last January, some Zambian hospitals are seeing an increase in AIDS cases, according to the New York Times. 

Back in December, the US announced Zambia had committed to a plan to unlock “a substantial grant package of US support in exchange for collaboration in the mining sector and clear business sector reforms that will drive economic growth and commercial investment that benefits both the United States and Zambia”.

But this has never materialised amid renewed US pressure on Zambia to open its mineral wealth to the US.

Meanwhile, South Africa has been frozen out of health aid by the Trump administration – in the main, for charging Israel with genocide at the International Criminal Court and for policies aimed at addressing apartheid-era discrimination that the US claims are anti-white.

The loss of US funding has “damaged critical health services, dismantled HIV prevention programs, and disrupted world-class South Africa-U.S. research collaboration,” according to a report published last week by Physicians for Human Rights (PHR), Advocates for the Prevention of HIV in South Africa (APHA), and Emthonjeni Counselling and Training. 

‘Trade over aid’

The terms of the Memorandums of Understanding (MOU) that the US is seeking with key countries, as part of its “America First Global Health Strategy” (AFGHSD), are overwhelmingly transactional.

This week, the US entrenched this approach at the launch of its ‘Trade over Aid’ initiative at the New York Stock Exchange, asserting that the free market is the “surest route to economic prosperity”

Ghana is Africa’s largest gold producer. It is unclear whether the US tried to use its aid offer to extract minerals, as it has in other countries.

However, this is unlikely to have gone down well as Ghana is clamping down on foreign mining operations. In the past few weeks, the country’s Minerals Commission has given three international firms until the end of the year to transfer their gold mining operations to locals.

Ghanaian President John Mahama is also championing the “Accra Reset”, launched last year to encourage African countries to invest more of their domestic budgets in their health and depend less on aid.

At the same time, Ghana is heavily indebted and recently held off paying newly recruited nurses as it lacked the finances.

US role in DRC conflict?

The US held off signing an MOU with the DRC on 5 December, when it signed deals with Rwanda and Kenya on the sidelines of a peace accord between the DRC and Rwanda, allegedly the sponsor of the M23 rebels waging war inside the DRC.

Instead, the US and DRC first signed a “strategic partnership agreement” to  “promote secure, reliable, and mutually beneficial critical mineral flows for commercial and defense purposes”, according to the US State Department. The health MOU followed on 26 February.

The DRC is one of the world’s most important sources of rare earth minerals, but China has dominated the purchasing and processing of its minerals. Following the agreement, the DRC offered US investors stakes in state-owned mineral assets. In late March, a US company, Virtus, bought a cobalt mine.

Recently, it emerged that the DRC has offered mining opportunities to US companies in Rubaya, currently held by M23 rebels, indicating that the US would need to play a role in maintaining peace if it wants access to rare minerals. This week,  the DRC announced the formation of a $100 million initiative to establish “mining guards” to secure mines, with investment from the US and the United Arab Emirates. 

However, lawyers in the DRC have challenged the  MOU in court, while part of Kenya’s MOU has been suspended by a High Court in the face of an ongoing court challenge.

South Africa in the cold

South Africa has the biggest HIV population in the world, and was the largest international recipient of US National Institutes of Health (NIH) research funds, as well as getting funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR). 

“Our report illustrates what an ‘America First’ approach to global health looks like: Lifesaving programs shuttered, world-class research jettisoned, decades of progress against HIV/AIDS jeopardized. All to the harm of, not only South Africans, but to Americans and the global public as well,” said Thomas McHale, director of public health at PHR and a report co-author.

Co-author Emily Bass warned:  “Short-sighted, sudden withdrawal of funds for critical components of the HIV response will cause long-term harm to infants, children, adolescent girls and young women, and other groups at the highest risk of HIV.”  

The report mentions two scientific breakthroughs that came from US-South African research partnerships, namely the clinical trial of lenacapavir, an injectable pre-exposure prophylaxis (PrEP) that is almost 100% effective in preventing HIV, and updated global guidelines for treating drug-resistant tuberculosis (TB).

These breakthroughs “directly benefit Americans”, the authors argue. “By freezing research funding to South Africa, the Trump administration is sabotaging the United States’ own future health and national security.”

The report is based on interviews with South African doctors, researchers, people living with HIV, and others involved in South Africa’s HIV response efforts.

Image Credits: Daniel Torok/ White House , Kerry Cullinan.