Africa pushes back as Trump's new US health aid comes with strings attached

HARARE — A dramatic shift in United States foreign health policy under President Donald Trump is reshaping Washington's relationship with Africa, with several countries, including Zimbabwe, rejecting new multi-million-dollar health funding agreements over concerns about sovereignty, medical data and national interests.

After dismantling the US Agency for International Development (USAID) last year, the Trump administration has returned with a new model of foreign assistance that replaces traditional aid programmes with bilateral agreements requiring African governments to invest more in their own healthcare systems while advancing American strategic and commercial interests. While Washington says the approach promotes sustainability and self-reliance, critics argue it risks turning health diplomacy into a transactional exercise that could undermine decades of global cooperation.

Zimbabwe is among a handful of African countries, including Ghana and Zambia, that have declined to sign the proposed Memorandums of Understanding (MOUs), citing concerns over the sharing of medical data and biological samples with the United States.

The new policy represents one of the biggest changes in US global health strategy in decades. Instead of funding programmes through international organisations and non-governmental organisations, Washington now wants to work directly with governments while requiring them to shoulder a greater share of healthcare costs. Secretary of State Marco Rubio described the agreements as a new chapter in US foreign policy.

"Our aid to those countries will not just be dollars distributed to an NGO who then will go into the country and impose programmes," Rubio recently told a congressional committee.

The first agreement was signed with Kenya, where the US committed US$1.6 billion while Nairobi pledged US$850 million over five years under a US$2.5 billion partnership. Washington hopes similar arrangements will eventually be concluded across Africa and other developing regions.

Zimbabwe, however, has opted out. Government officials said proposed provisions requiring the sharing of health data and disease-causing pathogens raised concerns over national sovereignty and equitable access to any medicines or vaccines developed using Zimbabwean biological material. Authorities argued that existing World Health Organisation (WHO) mechanisms already provide internationally recognised frameworks for sharing pathogens while ensuring participating countries benefit from future medical breakthroughs.

Officials also questioned whether Zimbabwe would receive guaranteed access to treatments developed by American pharmaceutical companies using locally sourced data. The decision came despite Zimbabwe previously benefiting from major US-funded HIV programmes, including PEPFAR, which supports treatment for more than one million Zimbabweans living with HIV.

Zimbabwe is not alone in its reservations. Ghana also expressed concerns about the scope of health data requested under the agreements. Arnold Kavaarpuo, Executive Director of Ghana's Data Protection Commission, said the proposed arrangement offered little assurance over what would happen once sensitive information left African jurisdictions.

"There were no real reciprocal measures when it comes to the protection of Ghanaian data and Ghanaian sovereignty," he said.

Meanwhile, Zambia resisted linking health assistance to separate negotiations involving critical mineral resources, insisting the two issues should remain independent.

The debate has intensified following a fresh Ebola outbreak in the Democratic Republic of Congo (DRC). The DRC accepted one of Washington's new bilateral agreements and has received US support during the outbreak. However, humanitarian organisations argue that earlier cuts to USAID weakened frontline preparedness by reducing staffing levels, emergency stockpiles and community health programmes before the outbreak emerged.

Former US health officials have also questioned whether dismantling USAID slowed early detection and response efforts. The US disputes those claims, saying it has already committed US$270 million towards combating the Ebola outbreak and maintains that the new bilateral approach delivers more efficient and accountable assistance.

Health governance experts say the controversy reflects a broader debate over Africa's place in global health diplomacy. While many governments agree they should invest more in their own healthcare systems, they are increasingly reluctant to accept agreements they believe compromise sovereignty or primarily serve foreign commercial interests.

As more countries weigh whether to sign Washington's new health partnerships, Zimbabwe's decision underscores a growing insistence that future international cooperation must balance development assistance with national control over strategic resources, public health data and scientific research. Whether the Trump administration's new approach reshapes global health or deepens divisions between donor nations and recipients remains one of the defining questions for Africa's health sector.

Zimbabwe US health aid