The United States has encountered setbacks in its implementation of the “America First” Global Health Strategy, a program designed to shift bilateral health assistance away from multilateral organizations and non-governmental organizations (NGOs) and toward direct agreements with foreign governments. Twenty African nations and four Latin American states have signed memoranda of understanding (MOUs) as part of the strategy, but concerns over data access, resource commitments, and potential exploitation are mounting.
Launched in September 2025, the strategy followed the Trump administration’s decisions to dissolve the U.S. Agency for International Development (USAID) and withdraw from the World Health Organization (WHO), accompanied by significant reductions in foreign health assistance. The MOUs aim to transition the U.S. Away from aid and toward jointly financed health agreements, but critics allege the terms are unfavorable to recipient nations.
A central concern is the financial burden placed on partner countries. While the U.S. Pledges substantial investment – $1.63 billion for Kenya and $2.1 billion for Nigeria – these amounts represent an average 40% decrease in overall U.S. Health funding to these countries compared to the previous five years. In exchange, recipient nations are expected to significantly increase their own health spending, with Kenya committing to an additional KES115 billion (approximately $890 million) and Nigeria pledging $3 billion. Failure to meet these cofinancing obligations could jeopardize future funding.
Beyond financial commitments, the MOUs prioritize U.S. Health security interests. Secretary of State Marco Rubio has stated that increased access to health data from partner countries will enable earlier detection and containment of disease outbreaks within the U.S. Specifically, the MOU with Kenya aims for the detection of infectious disease outbreaks with epidemic or pandemic potential within seven days of emergence, with notification to the U.S. Within one day. The agreements likewise seek to provide U.S. Health companies with preferential access to pathogen data for vaccine and treatment development, potentially giving them a competitive edge.
However, the data-sharing provisions have sparked legal challenges and protests. In Zimbabwe, the MOU collapsed after Harare expressed concerns that the U.S. Would gain access to biological resources and data without guaranteeing access to resulting medical innovations for its own population. “Zimbabwe was being asked to share its biological resources and data over an extended period, with no corresponding guarantee of access to any medical innovations – such as vaccines, diagnostics, or treatments – that might result from that shared data,” explained Nick Mangwana, Information, Publicity and Broadcasting Services Secretary.
Kenya’s High Court has halted implementation of its MOU pending the outcome of two court challenges alleging improper access to patient data and pathogen information. Zambia has also voiced misgivings and requested revisions to its proposed MOU, reportedly after the U.S. Conditioned funding on access to Zambian minerals, particularly copper and cobalt. Similar conditions were attached to health MOUs with the Democratic Republic of the Congo (DRC) and Guinea, according to Health Policy Watch, prompting legal challenges in the DRC.
Critics argue the strategy represents a form of “extraction,” prioritizing U.S. Economic and political interests over global health equity. Sophie Harman, an International Politics Professor at Queen Mary University of London, wrote in the British Medical Journal that the Trump administration’s policy aims to enrich U.S. Companies and leverage U.S. Global health leadership in competition with China. Kerry Cullinan, Deputy Editor at Health Policy Watch, warned that bypassing established health NGOs, which possess specialized skills and access to vulnerable populations, could be detrimental.
The MOUs also incorporate ideological conditions, including clauses prohibiting the use of U.S. Funds for abortion as a family planning method. Atilla Kisla, a Southern Africa Litigation Centre international justice expert, characterized the strategy as a “geopolitical pivot” designed to escape the constraints of multilateral health governance and exert greater control over data flows and funding allocation.
The Institute for Health Metrics and Evaluation (IHME) has reported a 21% drop in global health financing from 2024 to 2025, with further reductions expected for multilateral organizations. The future of the “America First” Global Health Strategy remains uncertain as several nations reassess the terms of engagement and legal challenges continue to mount.
