In late February, Zimbabwe withdrew from a proposed $367 million U.S. health financing deal over provisions requiring broad access to sensitive U.S. medical data.
This five-year program was presented in support of HIV/AIDS, tuberculosis, malaria, and epidemic preparedness efforts.
However, while the terms required widespread sharing of national health information, including epidemiological surveillance data and pathogen samples, they did not provide binding guarantees that Zimbabwe would have fair access to medical technologies developed therefrom.
Harare called the proposal an “unequal exchange” and warned that Zimbabwe risked supplying “the raw materials for scientific discovery” while the resulting profits could remain concentrated in the United States and global pharmaceutical companies. Critics increasingly describe this pattern as biomedical extractivism, a toxic combination of exploitative research practices and colonial mindsets that reinforce Western domination.
In Lusaka, officials and civil society groups raised concerns about the proposed U.S.-Zambia health partnership worth more than $1 billion over five years. The draft bill would provide Zambia with about $340 million in domestic cofinancing while giving the United States broader access to national health data and pathogen-sharing agreements.
One controversial clause would allow Zambia to terminate the agreement if it fails to reach a separate bilateral agreement with the US government over minerals such as copper and cobalt.
Kenya is showing a third warning sign.
The High Court blocked a similar $2.5 billion deal in December last year after a legal challenge argued that sensitive health data could be compromised without adequate safeguards under Kenya’s data protection laws.
Taken together, the conflicts in Harare, Lusaka and Nairobi point to a broader pattern. These are unfolding against the backdrop of a rapidly expanding network of bilateral global health agreements that Washington is negotiating across Africa under its “America First Global Health Strategy.”
The United States has signed more than 20 memoranda of understanding with African governments, with implementation timelines ranging from 2026 to 2030 and total commitments approaching $20 billion, according to tracking by the Kaiser Family Foundation, an independent U.S.-based health policy research organization.
A significant portion of that funding is expected to come from African governments themselves, allowing the US government to market the model as a partnership while deepening asymmetries, fiscal pressures, and dependence. At least 17 African countries already have similar agreements, many with weak health budgets and little bargaining power.
These agreements will fund programs against HIV/AIDS, tuberculosis, Ebola, and malaria while strengthening disease surveillance systems, testing capacity, and outbreak preparedness.
Nevertheless, they are rapidly shifting bargaining power to Washington’s side. In Nigeria, for example, this funding is conditional on Abuja promising to “prioritize protecting Christians from violence.”
From Zimbabwe to Zambia to Nigeria, disputes center on what the United States expects in return: health data and pathogen samples. In the era of biotechnology and pandemic preparedness, this information feeds the global bioeconomy, powering vaccine platforms, drug patents, and artificial intelligence-driven drug discovery. Biological data has become as strategically valuable as oil, minerals, and rare earths.
Africa’s public health systems may become upstream suppliers of biological information, but downstream interests—intellectual property, drug manufacturing, and commercial interests—remain concentrated in wealthy countries.
These anxieties resonate with Africa’s long history of medicine, which has been closely intertwined with imperial power, racial hierarchies, and foreign domination for more than a century. During the colonial period, European governments frequently waged medical campaigns that combined disease control with surveillance and coercive rule against African populations.
One of the most brutal colonial medical campaigns occurred in French Equatorial Africa from 1921 to 1956 during the Sleeping Sickness Control Program. At the time, colonial authorities rounded up entire villages for compulsory medical testing and treatment. In many cases, people were forcibly tested and injected with experimental drugs intended to combat the spread of disease. Some drugs, including Atoxyl, were later found to cause serious side effects, including blindness and even death.
Skepticism is also shaped by contemporary medical ethics debates involving Western pharmaceutical companies. In 1996, during a meningitis outbreak in Kano, northern Nigeria, Pfizer tested an experimental antibiotic called Trovan on 100 children in a field hospital.
Nigerian law enforcement authorities concluded that the trial was conducted without proper regulatory approval, and a government investigation labeled it an “illegal trial of an unregistered drug.” Facing lawsuits from the Nigerian government and affected families, Pfizer agreed to a $75 million settlement with Kano state in 2009, while continuing to deny wrongdoing.
Public health systems produce test results, epidemiological records, genome sequencing, and biological samples collected during outbreaks. The global biotechnology sector generates more than $1.5 trillion annually and is expected to reach $3.88 trillion by 2030, making genomic data and pathogen samples one of the most valuable scientific resources of the 21st century.
For decades, medical ethics scholars around the world have argued that international medical research must avoid exploitation of people in low- and middle-income countries. In a widely cited 2004 study, bioethicist Ezekiel Emanuel and colleagues argued that ethical research in developing countries requires collaborative partnerships with local researchers, policy makers, and local communities, and fair sharing of benefits.
This principle is conspicuously absent from the structure of U.S. bilateral health care agreements, and the stakes have become even clearer in a post-COVID-19 world. In the early stages of the pandemic, scientists and laboratories around the world relied on the rapid sharing of virus samples and genomic data to track the spread of the virus and develop vaccines.
But once vaccines became available, many African countries were left at the back of the queue while wealthy countries stockpiled them. The World Health Organization’s Pandemic Agreement, adopted in May 2025, aims to address this imbalance through a proposed pathogen access and benefit-sharing system that links pathogen sharing with more equitable access to the resulting technologies.
Bilateral health agreements risk undermining these multilateral efforts. By negotiating directly with countries, powerful countries such as the United States can secure privileged access to pathogen information without being bound by extensive mechanisms designed to ensure fair benefit sharing.
Timely access to pathogen data remains essential for global health cooperation and pandemic preparedness. The controversy is not about sharing itself, but whether countries providing the data will receive open and fair access to the resulting vaccines, diagnostics, and treatments.
African countries therefore face a delicate balance between protecting life-saving health programs while safeguarding data sovereignty, legal oversight, and mutual partnerships. The answer may lie in collective bargaining through institutions such as the African Union and its autonomous health agency, the African Centers for Disease Control and Prevention, rather than unequal and fragmented bilateral agreements.
Although formally voluntary, negotiations between global superpowers and financially constrained health systems are rarely conducted on equal footing. For example, the U.S. government has moved to cut health funding to Zimbabwe after negotiations broke down, highlighting the risks faced by other African countries unwilling to comply with U.S. will.
In the 19th century, as Western countries plundered African societies one after another, colonization progressed through divide-and-conquer tactics. Today, only united action can prevent powerful states from imposing new forms of imperial control through country-specific agreements.
The United States is currently pursuing biological data and pathogen intelligence through policies that risk reproducing the power imbalances of colonial extraction in new scientific forms.
Therefore, our government must protect medical sovereignty with unity and determination.
If Africa shares data and samples, the United States must share African data and samples on equal and transparent terms.
African bodies are not cheap consumables.
The views expressed in this article are the author’s own and do not necessarily reflect the editorial stance of Al Jazeera.
