After the Trump administration shut down the U.S. Agency for International Development (USAID) in 2017, it shifted strategy to offering large, bilateral health packages to African governments, hoping the new framework would build self‑reliant systems and curb traditional donor‑NGO dependencies.
The first of these agreements was signed in 2025 between Kenya’s President William Ruto and Secretary of State Marco Rubio, a $2.5bn deal that includes U.S. contributions of $1.6bn and Kenyan pledges of $850m over five years. But the pledge is tied to Kenya’s investment in U.S. pharmaceuticals, and critics argue that it shifts global health stewardship to a commercial agenda.
Several African states have declined to sign the MOUs for different reasons. Ghana’s Data Protection Commission said the U.S. would demand patient records and pathogen samples – data that would cross Ghanaian borders without reciprocal safeguards. In Zimbabwe, officials overruled a prospective deal after citing the lack of guarantee that any drugs or vaccines developed from shared pathogens would reach local populations.
Zambia’s foreign minister voiced concerns that the U.S. ties the health aid deal to an agreement providing Washington with access to critical minerals, effectively making the health package a strategic instrument rather than altruistic support. The possibility that U.S. interests will dictate the terms of aid has alarmed African leaders who want to preserve sovereignty over public health decisions.
While the U.S. stresses that its new method encourages recipient governments to spend more on health infrastructure, critics warn that the approach may weaken collective global health responses. They note that the 2014 Ebola outbreak in West Africa was largely managed through the USAID network and the World Health Organization – systems that have been threatened by the Trump administration’s cutbacks.
With only a handful of African countries still open to the proposal, the future of U.S. health aid in the region remains uncertain, especially amid concerns over data ownership, commercial influence, and the overall effectiveness of bilateral-only agreements against trans‑national disease threats.
