The United States government is moving rapidly to secure Memorandums of Understanding (MOU) with African countries that offer limited health aid for five years in exchange for 25 years’ access to countries’ data about “pathogens with epidemic potential”.

Some commentators have described the terms of the bilateral MOUs as “extractive” as they fail to offer African countries access to the health products that might be developed from the pathogen material that they share.

The process is being driven by Brad Smith, formerly one of the leaders of Elon Musk’s Department of Government Efficiency (DOGE), who was responsible for implementing deep cuts to the US Health and Human Services (HHS) department. 

Smith is now a global health advisor in the US State Department, overseeing the reorganisation of the US President’s Emergency Plan for AIDS Relief (PEPFAR) and health grants from the now defunct US Agency for International Development (USAID).

He was part of the US delegation that met Kenyan health and finance officials last week to discuss its MOU. So too was Bethany Kozma, a former USAID official during the first Trump administration and a fervent anti-abortion campaigner. She is currently chief advisor for policy and strategy in the HHS Global Affairs Office.

Dr Chris Kiptoo, Kenyan Treasury’s Principal Secretary, reported after last week’s meeting that “both countries are finalising a bilateral agreement that aligns Kenya’s health priorities with the United States’ global health objectives, strengthening a partnership that saves lives and builds a more resilient health system for our nation”.

Meanwhile, Rwandan Health Minister Dr Sabin Nsanzimana met a US delegation headed by Dr Mamadi Yilla, US State Department deputy assistant secretary for health diplomacy, last week to discuss a new MOU.

Smith also led the US delegation to Zambia on Monday (17 November), where he met Zambia’s Health Minister, Dr Elijah Muchima, and Finance Minister Situmbeko Musokotwane.

The meeting aimed to “chart a new course for US health assistance to Zambia”, according to the US Embassy in Zambia.

“The new approach envisions both governments committing to funding levels and health outcome performance objectives in order to accelerate the transition from an aid-dependent health sector to a Zambian government-led health system that is able to sustainably meet the health needs of the Zambian people,” according to the US media release.

Extensive access to data

The MOUs include clauses that would give the US extensive access to country health databases and contain punitive measures for countries that fail to provide this access or pathogen information, including unspecified “changes in the planned assistance” or total discontinuation of aid. Conversely, those that meet targets may get unspecified rewards.

While the agreements contain a list of targets  (“outcome metrics) for reducing HIV, TB, malaria, maternal and under-five mortality, and increasing measles vaccinations, details about how these will be achieved are scanty.

In contrast to the health services section, the “surveillance and outbreak response” section is far more detailed, with budget allocations and staff numbers. 

For instance, Zambia is expected to employ “1,723 field epidemiologists” in 2026 at its own expense to meet its outbreak surveillance and pathogen-sharing requirements, according to a draft seen by Health Policy Watch.

The US also notes that it is making a $50 million cut to its previous commitment of $120 million in funding for antiretroviral medicine and HIV tests due to “historic theft”.

Twenty-five years’ access for five-year grants

Countries also have to commit to signing a 25-year “specimen sharing agreement” although the MOU only covers a five-year grant period. This will cover “sharing physical specimens and related data, including genetic sequence data, of detected pathogens with epidemic potential for either country within five days of detection”. However, an annex that is supposed to set out the “elements” of the agreement is blank.

Bizarrely, the MOUs also want governments to commit to a 25-year “data sharing arrangement” for “exchanging data on the long-term performance of this MOU and for accountability to the United States Congress for appropriated funds”. However, the country grants will only run from 1 April 2026 until 2030. 

Author Emily Bass published a template for this data-sharing arrangement over the weekend, saying that it “reveals the unprecedentedly extractive nature of these ongoing negotiations”.

The US wants access to a range of data, including electronic medical records, health management and information systems, and outbreak response and surveillance data systems.

“This agreement affords the US at-will visibility into digital systems, including those, like electronic medical records, that include personal identifiable information,” Bass notes.

In the audit section, the MOUs stress that countries need to provide the US with “any data access or information needed to monitor compliance with applicable legal requirements, including to confirm no US government funding is being used for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions”.

The MOU concludes by noting that it is not a legally binding document but “a record of the intentions of the parties”.

Bypassing WHO?

By placing itself at the centre of rapid information-sharing about dangerous pathogens, the US appears to be attempting to usurp the World Health Organization (WHO).

WHO member states are currently negotiating a Pathogen Access and Benefit Sharing (PABS) system that unite countries, pharmaceutical companies and non-profits in a single process aimed at speedily sharing information and developing counter-measures for pathogens that can cause pandemics. The US and Argentina are the only countries that have opted out of these negotiations.

However, if the US is the gatekeeper of pathogen information via these MOUs, this likely to fracture and slow down the global response to pandemics.

In addition, US companies could also get the first shot at developing vaccines, therapeutics and diagnostics for these pathogens.

Aggrey Aluso of Resilience Action Network Africa (RANA) warned that while governments “should explore deals that could benefit the lives of their people and their economy, such deals should not be extractive”. 

“Global health security cannot be built on coercive conditionalities,” Aluso told Health Policy Watch.

“True preparedness demands equity, respects data sovereignty, and is grounded in solidarity — not transactions that deepen inequities and silence the voices of those most affected. The current version of the proposed MOUs need an inclusive, equity-centred approach.”