America First Global Health Strategy raises concerns over African sovereignty, data sharing, and health governance

The America First Global Health Strategy (AFGHS), released by the United States in late 2025, has reignited long-standing debates over who truly benefits from global health initiatives. While framed as a partnership-driven approach to disease prevention and health system strengthening, critics argue that the strategy underscores a familiar imbalance in global health governance—one in which a small group of powerful nations and institutions continues to shape health policy in less developed countries.

For decades, global health has been described as a collective responsibility. In practice, analysts say, decision-making authority and agenda-setting power have remained concentrated among donor governments and multilateral financiers, often leaving recipient countries with limited room to define priorities aligned with local needs.

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From Humanitarian Assistance to Foreign Policy Instrument

The AFGHS marks a clear shift away from traditional humanitarian narratives, explicitly positioning global health as a tool of foreign policy and national security under the current U.S. administration. In December 2025, at least 14 African countries signed bilateral agreements linked to the strategy—among them Botswana, Cameroon, Côte d'Ivoire, Eswatini, Ethiopia, Kenya, Lesotho, Liberia, Madagascar, Mozambique, Nigeria, Rwanda, Sierra Leone, and Uganda.

These agreements unlock access to billions of dollars in U.S. health assistance. However, critics warn that the funding is tied to binding conditions that may limit national policy flexibility. They argue that non-compliance could carry diplomatic or financial consequences, potentially weakening sovereign decision-making within African health systems and placing domestic public health priorities at risk.

Washington's Stated Objectives

According to the U.S. State Department, the America First Global Health Strategy is designed to make the United States "safer, stronger, and more prosperous." Its stated goals include preventing infectious disease outbreaks from reaching U.S. shores, strengthening bilateral ties through multi-year co-investment agreements, reducing long-term dependency on foreign assistance, and expanding the global reach of American health innovation.

Supporters describe the model as pragmatic and efficiency-driven. Critics counter that it reframes global health primarily through the lens of U.S. security and economic interests, rather than shared worldwide responsibility and equity.

Data, Pathogen Sharing, and Unequal Obligations

A central pillar of the AFGHS is rapid disease surveillance, including the sharing of outbreak data and pathogen samples—often encompassing genetic information—with U.S. authorities.

While early reporting and sample sharing are standard public health practices, critics caution that bilateral arrangements may create unequal obligations with limited reciprocal benefit. They warn that direct reporting to the United States outside established multilateral processes—such as ongoing negotiations under the World Health Organization—could weaken regional governance structures, erode collective bargaining power, and expose national biological resources to long-term commitments without clearly defined benefit-sharing protections.

Kenya Case Raises Red Flags on Oversight

Kenya became the first African country to sign a Memorandum of Understanding under the AFGHS framework on December 4, 2025, according to SciDev.Net. The agreement includes U.S. support for accelerating Kenya's electronic medical records rollout and enhancing disease surveillance capacity.

However, following legal challenges from civil society groups over transparency and data protection, Kenya's High Court issued a temporary injunction suspending sections of the agreement related to the transfer and exchange of sensitive health information. The case is scheduled to return to court in February 2026. It has amplified broader concerns about oversight, data security, long-term storage, and secondary use of health information once it leaves national jurisdictions.

Public Accountability and Democratic Gaps

The rollout of the agreements has exposed what critics describe as a significant public accountability gap. In many participating African countries, the accords were concluded with limited parliamentary scrutiny and minimal public consultation.

While governments face acute financial and systemic pressure to secure external health funding, civil society organizations argue that economic vulnerability does not absolve political leaders of their responsibility to safeguard citizens' rights, data privacy, and long-term well-being, particularly during public health emergencies.

Aid Conditionalities and Regulatory Influence

U.S. officials maintain that the agreements are intended to promote long-term sustainability, including the gradual transfer of commodity procurement and frontline health workforce financing to partner governments. The strategy also seeks to expand global markets for American health innovation through public-private partnerships.

Critics argue that these arrangements may exert indirect influence on regulatory decision-making in partner countries, encouraging closer alignment with U.S.-approved systems and standards set by agencies such as the Food and Drug Administration—even where such alignment is not explicitly required. Analysts warn that this dynamic could contribute to regulatory capture, reinforce dependence on costly external supply chains, and expose populations to industrial food and pharmaceutical systems that are facing growing scrutiny over long-term health outcomes.

Fragmenting Global Health Governance

African health advocates further caution that the expanding reliance on bilateral agreements outside shared global frameworks—such as the WHO's proposed Pathogen Access and Benefit Sharing (PABS) mechanism, risks fragmenting multilateral health governance.

They warn that such fragmentation could weaken collective outbreak responses and undermine equitable access to vaccines, treatments, and diagnostics developed from shared pathogen data.

As more African countries engage with the America First Global Health Strategy, a central question remains unresolved: whether agreements that explicitly prioritize U.S. interests can adequately protect African public health systems, and the citizens they are meant to serve.