America First Global Health Strategy: How Trump’s Bilateral Deals Risk African Health Sovereignty

The Trump administration’s approach to global health has shifted dramatically towards bilateral agreements with African countries, with a focus on what the American government can gain rather than what partner nations need. According to commentary published in the British Medical Journal, this represents a fundamental departure from traditional development partnerships and raises serious questions about national sovereignty and data security.

Extraction Over Cooperation

The core principle underlying America’s new global health policy is “extraction,” according to Dr Sophie Harman, a professor of international politics at Queen Mary University of London. Rather than working through multilateral organisations like the World Health Organization or existing international frameworks, the Trump administration is signing direct agreements with individual African governments. Since December 2025, the United States has signed 15 bilateral health agreements with African nations, valued at approximately £13.1 billion, with the explicit aim of advancing American interests alongside stated health goals.

These memorandums of understanding ostensibly focus on established global health priorities including HIV and AIDS treatment, polio eradication, and maternal health. However, critics argue that the language of “local ownership” masks a more transactional approach. The America First Global Health Strategy explicitly states that the United States aims to identify “new markets for US products and services” and to “leverage US global health leadership to compete with China.” This reveals that commercial advantage and geopolitical competition, rather than purely humanitarian motives, drive these agreements.

Concerns About Parliamentary Scrutiny and Data Protection

Kenya’s High Court provided a significant test case when it blocked implementation of a bilateral health agreement between the US and Kenya in December 2025. The court raised concerns about inadequate parliamentary scrutiny of the deal and the absence of clear safeguards governing how personal health data would be used. These concerns reflect broader anxieties across African governments about whether their populations’ sensitive health information would be protected or exploited.

Ebere Okereke, an associate fellow with the global health programme at Chatham House, has warned that whilst these bilateral arrangements offer “greater clarity and speed of implementation,” they create asymmetries of power. African governments must ensure that data governance remains explicit, that co-investment in national health systems is non-negotiable, and that agreements actually enhance their policy autonomy rather than reinforce dependency on external donors.

Shifting Away from Multilateral Support

The broader context makes these bilateral agreements particularly significant. The Trump administration has already withdrawn from the World Health Organization, ended funding to major health initiatives like the Vaccine Alliance (Gavi), and frozen assistance to South Africa over political disagreements. According to analysis of these changes, the cuts to Gavi alone stand to cost 1.2 million children their lives, whilst withdrawals from vaccine programmes could result in 18 million additional malaria infections annually across Africa.

The administration has also rescinded approximately £5.9 billion in foreign health assistance funding, affecting programmes ranging from HIV prevention to maternal health services. More than 9 million Afghans have lost access to reproductive and maternal health services as a result of these policy changes.

What “Local Ownership” Really Means

The stated aim of these bilateral agreements is to reduce African countries’ dependency on aid by requiring them to co-finance health programmes. Kenya’s deal, for example, commits Kenya to providing £630 million alongside £1.2 billion from the United States. Whilst cost-sharing can theoretically improve sustainability, critics warn that this approach may simply shift the financial burden onto countries with limited domestic resources.

African leaders and institutions have begun developing their own response framework, known as the Accra Reset. This approach, articulated at the United Nations General Assembly in September 2025, calls for fewer fragmented external initiatives, stronger country leadership over health priorities, and financing arrangements that strengthen national health systems rather than bypass them. The lesson, according to African health policy analysts, is clear: countries that treat health as a strategic national priority will be less vulnerable to disruption caused by external policy shifts.

The Mineral Connection

A complicating factor is the Trump administration’s demonstrated interest in African mineral resources. The administration brokered a peace deal between the Democratic Republic of Congo and Rwanda in December 2025, following which it has notably not signed bilateral health agreements with the DRC—a country with exceptionally rich mineral reserves. Health assistance, therefore, appears poised to become leverage in negotiations over access to minerals critical for artificial intelligence technologies and other strategic industries.

Key Takeaways

• The Trump administration’s bilateral health agreements with African countries are framed around “America First” principles, prioritising US commercial interests and geopolitical competition with China rather than multilateral cooperation
• Kenya’s High Court blocked a US bilateral health deal over concerns about data protection and lack of parliamentary scrutiny, signalling African governments’ concerns about sovereignty
• The wider defunding of multilateral organisations and programmes is projected to cost millions of lives through loss of vaccine access, HIV treatment programmes, and maternal health services
• African leaders are developing alternative frameworks emphasising national health sovereignty and systems strengthening rather than donor-driven initiatives

What This Means for Kent Residents

Whilst these policy changes occur thousands of miles from Kent, they have implications for British global health engagement and NHS planning. The UK’s position as a committed global health funder through the Department of Health and Social Care means that as the US reduces its multilateral contributions, pressure increases on other donors, including Britain, to fill critical gaps. Emerging infectious diseases spread across borders, so disruptions to vaccination programmes and disease surveillance systems in Africa increase risks of outbreaks affecting UK populations. Additionally, if skilled health professionals in African countries face salary cuts or programme closures, some may seek work opportunities elsewhere, exacerbating existing health workforce shortages that also affect the NHS in the South East. Kent residents relying on NHS services should remain assured that the UK government continues to fund global health initiatives and disease prevention programmes internationally.