By Felix Litschauer
As we mark the sixth anniversary of the start of the corona pandemic, many people in southern Africa will be remembering the painful lesson that in a crisis, “every man for himself” applies to states too. Back then, South African laboratories were the first to sequence the new Omicron variant and made the data available to the rest of the world. The upshot: flight bans to and from South Africa, with huge economic consequences. And for a long time, the South African population saw little of the vaccines that were quickly adapted to Omicron, as the EU and the US had secured access to the doses. At the same time, the pharmaceutical companies refused to share the technology for developing the vaccines with South African developers. The resulting loss of trust led to a clear stance by many countries in the Global South: never again will we hand over control of our health data without getting anything in return.
This position on data sovereignty is being vehemently defended by the group of African countries in the current negotiations on the Pandemic Treaty. The aim and objective of this treaty is to better prepare the world for future pandemics and ensure equal access to pandemic-related products such as vaccines. As things stand now, all WHO member states apart from the US intend to commit to this. But even as the negotiations on multilateral agreements are underway, they are being undermined: in the last few weeks, 16 African states have signed bilateral health agreements with the US that are in direct contradiction to the principle of an independent health sector. To understand what is going on, you need to take a step back.
Funding gaps and dependencies
With Trump’s renewed decree to initiate withdrawal from the World Health Organisation last year, all of a sudden the latter lost its biggest donor. With the winding up of the US development aid agency USAID and PEPFAR, the programme for funding the global fight against HIV/AIDS, Elon Musk, with the help of DOGE, destroyed longstanding prevention and care structures. This hit many countries in sub-Saharan Africa particularly hard because the US had funded extensive health programmes there with the help of NGOs and private companies, as such effectively massively subsidising the health ministries’ budgets. Countries like Malawi, South Sudan and Somalia suddenly faced funding gaps that in some cases surpassed their entire health budget. In Kenya, one in five healthcare workers was left without pay – previously funded by USAID. Instead of stepping into the breach, many European countries cut their development cooperation funding, leading to development funding for health programmes worldwide being halved in 2025 compared to the previous year.
In August 2025, the ‘Health Sovereignty Summit’ took place in Accra, Ghana. It had already been planned before the US withdrawal from health funding was foreseeable – and with an awareness of a dependency that needed to be rectified. African heads of state proclaimed a new era of ‘health without aid’ and committed to mobilising domestic resources and investing in regional manufacture of medicines, vaccines and other health products. Some governments acted fast to secure important supply structures, like the dispensing of pre-exposure prophylaxis for HIV prevention, or to pay the salaries of community health workers formerly funded by USAID.
Nigeria allocated an additional $200 million in its budget to bridge the gap. The Ghanaian government removed the cap on the proportion of the health budget for health insurance. The Ethiopian parliament doubled the Ministry of Health’s budget. But many of the countries impacted are already so heavily in debt that in the long term they cannot pay the costs without external donors.
Deals, deals, deals
The Trump Administration’s actions are not an impulsive withdrawal from global health policy to please the MAGA base, though. With the “America First Global Health Strategy” published in September, it became a calculated move as part of far more ambitious power politics. The strategy is all about narrowing the global health agenda down to its security aspects: it is about protecting the US from external threats in the form of diseases. Monitoring, reporting outbreaks and establishing supply chains are the priorities. What is more, US international health policy is supposed to “create a favourable environment for American companies so that they can deploy their innovative health products and services worldwide”. The idea is for this new thrust to be implemented by bilateral agreements with dozens of countries; among the first signatories are the governments of Kenya, Uganda, Nigeria and other African states.
The heart of the deals is a pledge to continue funding the partner countries’ health systems, though not indirectly through implementing organisations anymore, but directly from state to state. In return, the countries commit to supporting US firms in accessing new markets in the health sector. And the countries promise to transfer health data and pathogen samples to the US. This is hugely controversial: health data is the rare earths of the data market. Without the genomes of pathogens, there can be no new medicines. Without the sharing of information on disease outbreaks, there can be no predictions about the course of epidemics. Population analyses enriched with health data can provide insights into susceptibility to disease and the probability of outbreaks across entire societies. The data is used to design the supply of medicines and predict demographic and biological trends. But what happens if the data transmitted to US firms is abused? If it is used not only to support healthcare in partner countries, but also as a tool of an authoritarian system? Health data is particularly intimate and can reveal individual characteristics very precisely. It can be used for discrimination, surveillance or coercion.
The US has already used the lever of health funding in the past to export its domestic culture wars. As such, the Trump Administration is admittedly politically aligned with countries like Uganda, where same-sex acts are punishable by death. But the ‘Global Gag Rule’ – a US rule prohibiting foreign NGOs from receiving US development aid if they use their own funds to perform, promote or provide information on abortions – has repeatedly forced partner countries to choose between US funding and women’s reproductive autonomy. The stricter rules now adopted by the Trump Administration are also designed to exclude sexual minorities from healthcare funded by US money. With these bilateral agreements, there is a danger that the US will create a system in which data flows in one direction and ideology in the other. Michel Foucault would probably have described this as a biopolitical dystopia.
Headwinds
This fear is shared by activists from the People’s Health Movement Kenya, a long-standing partner organisation of medico. “The data-sharing agreement contains no data protection guarantees and raises serious security concerns. Direct access to national databases, which may contain personal data, exposes sensitive information to a potential risk of abuse,” they write, together with 60 other civil society organisations, in an urgent letter to the governments of the African Union. And the letter is having an impact. On 19 December 2025, the Supreme Court of Kenya issued an interim injunction prohibiting the implementation of the agreement on data protection grounds. In Zambia, activists are also considering taking legal action against the agreement. But civil society resistance is tricky. Very few agreements are even publicly accessible; as ‘Memoranda of Understanding’ between governments, parliaments are left out in the cold – not to mention poor or rural communities and sexual minorities. “The very communities affected by risks associated with health data are suffering from hunger and debt-induced cutbacks to social spending,” says Dan Owalla of PHM Kenya.
Yet African states have a very clear idea of what data transfer that is not exploitative could look like. They have outlined this in the negotiations on the PABS Annex to the Pandemic Treaty, which is intended to govern the sharing of pathogen data and access to medical products developed from it. Together with a total of 80 countries, representing three-quarters of the world’s population, they are urgently calling for legal treaties: treaties that publicly define the conditions for the use of health information. The agreements with the US government contain nothing of the sort. This does not bode well for the negotiating position towards the European Union. For, just like the US, to protect its own pharmaceutical industry the EU is against any obligations to share vaccines or technology so they can be developed regionally. This means the race for the vaccines for the next pandemic is already over before it has even begun.
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