In 1889, as European powers busily divided up Africa into colonial holdings, the British did something that might seem unusual in this day and age, when the profit motive and geopolitics aren’t always so neatly tied together. Instead of sending in British troops and officials, Britain outsourced the work of colonialism to Cecil Rhodes and his British South Africa Company (BSAC). By granting BSAC a charter, Britain could gain land and power without the direct financial risk of doing the colonizing themselves. Much like a national government, BSAC raised an army, invaded territories, and signed a raft of suspect treaties with local rulers, gaining access to mines and land. It was also listed on the London Stock Exchange.
Today, we know BSAC’s former holdings in Southern Africa as Zimbabwe and Zambia, each having gained independence from the company and Britain. Yet, more than a century after the “Scramble for Africa,” experts and government leaders are alleging that a foreign power is again coercively seeking to extract minerals and other resources from Africa with the help of private companies.
This time, it’s not the Europeans and outfits like the British South Africa Company. It’s the United States and its private sector. Deals under the auspices of President Trump’s America First Global Health Strategy are offering countries in Africa and elsewhere a progressively diminishing amount of critical health funding—revokable at any time—in return for granting the United States expansive and continuing access to an array of resources ranging from minerals to valuable health data, experts and officials say. The deals aren’t coercion at colonial gunpoint, exactly, but they’re still life or death propositions for the countries involved.
Nelson Evaborhene, a doctoral fellow at Denmark’s Roskilde University, said the leaders of the African countries are making these agreements for domestic reasons. “They are looking at the next electoral cycle,” he says. “Many of them, they’re clearly going to pick the US funding.”
Upon taking office in 2025, Trump famously paused foreign aid, disrupting the distribution medicines for HIV and other disease. The administration pulled out of the World Health Organization (WHO) and dismantled the US government’s principal vehicle for aid provision, USAID. Current and former nonprofit and government officials partly blame the cuts for the slow public health response to a large Ebola outbreak centered in the Democratic Republic of Congo, which has seen US support fall from $1.4 billion in 2024 to $21 million allocated for this fiscal year. Health workers say they lack the supplies and training to deal effectively with the outbreak, which has seen 600 suspected cases and 139 deaths so far.
In place of a system that funneled US aid through global agencies or according to need-based considerations, the Trump administration has been seeking to sign individual deals with aid recipients that some see as having a quid pro quo component. So far 30 agreements have been announced, mostly with countries in Africa.
“From my research trying to track down this America First [strategy], what we are seeing are very transactional relationships,” Evaborhene says. A US embassy press release about funding for Zambia, for example, trumpeted US access to mineral rights there. In another case, the small country of Eswatini finalized a deal a month after accepting deportees caught up in US immigration sweeps. Though US officials have denied that some concessions to the United States, like access to minerals, are linked to the health compacts, the “timing and the sequencing is very telling,” Evaborhene says.
Ownership. One complaint about US global health programs is that they operated outside national health systems, making them particularly susceptible to the kind of disruption that occurred when Trump paused funding early in his term.
Under the America First deals, the United States will progressively decrease health aid, theoretically giving time for recipients to increase their own public health capabilities a commensurate amount. Then they’ll have “ownership” of their health programs, the US thinking goes. It’s a sales pitch that doesn’t reassure Evaborhene. As US funding decreases, countries will have buy their own health care products with money that Evaborhene worries won’t be spent fostering domestic industry. Indeed, documentation for the America First Global Health Strategy says that the United States will “leverage our foreign assistance to promote American companies and American innovations abroad, including continuing to procure goods from American companies.” That’s “not really like ownership,” Evaborhene says. The strategy document imagines an expansive role for the private sector in delivering services and producing goods. Africa, it notes, will have $250 billion health care market by 2030, and that there is an opportunity for “access for US company-produced pharmaceuticals in emerging markets.”
Evaborhene is also concerned that the health agreements will leave countries at the mercy of US political considerations. Those that don’t hew closely to perceived US interests could lose funding at any time, he says.
The deals “are embedding some form of conditionalities, which exposes health systems to geopolitical ruptures and fractures,” Evaborhene says. He cites the example of Nigeria, where laws require the government to take a neutral stance. The $2.1 billion America First agreement announced in December prioritizes Christian providers. The “government then has to choose between its constitutional principles of neutrality and receiving funding,” Evaborhene says.
South Africa, a country with 8.3 million people living with HIV, offers an illustration of how politics within the United States might hold sway over health aid decisions under the deals.
Last year, with his South-Africa-born billionaire backer Elon Musk at his side, Trump famously confronted South Africa’s president about supposedly widespread murders of whites. Musk has long made debunked claims of a “white genocide” in the country best-known for decades of brutal white-minority rule during the Apartheid Era. Of course, South Africa’s 2023 accusation in international court that Israel was committing genocide in Gaza further dented its reputation with Trump. The Trump administration has severely curtailed health support for South Africa. “Political alignment now overrides epidemiological logic,” Evaborhene wrote in a recent piece in The Lancet Global Health.
The United States doesn’t have an America First health deal with South Africa, where aid, mostly health related, totaled $581 million in the 2024 fiscal year. That figure could come in precipitously lower in the future.
Extraction. It’s no surprise that European colonialists in Africa sought to capitalize on mining during the late 19th century. Back then, diamonds and gold were the motivation. Now observers point to a new scramble for resources, this time for Africa’s plentiful deposits of minerals, including cobalt and copper, that are critical to modern technologies. China and European nations are also zealously investing.
A December press release from the US Embassy in Zambia referenced “a five-year partnership on public health” while also announcing that Zambia had “committed to a plan that aims to unlock a substantial grant package of U.S. support in exchange for collaboration in the mining sector and clear business sector reforms.” The former US ambassador to Zambia denied linking the mining concessions to health aid, but a leaked US memo drafted for Secretary of State Marco Rubio called for cutting funding for the 1.3 million Zambians who rely on US-provided HIV medicine unless Zambia agreed to a five-year health deal, mining access for US businesses, and regulatory reforms in mining and other sectors.
The Zambian government released a statement earlier this month saying that it objected to the “coupling” of various agreements with the United States such that the “conclusion of the critical minerals agreement is made conditional to the conclusion of the Health [agreement].”
Already there are signs of that cases of AIDS are on the rise in Zambia, after disruptions of US aid early in the Trump administration.
Data. Zambia pointed to another reason why negotiations with the United States have gone sideways: US demands for health data.
The United States has reportedly asked for up to 25 years of health data from countries while pitching agreements under which US funding for public health taps out after only five. By now a handful of countries have rejected or paused the deals over concerns related to data sharing. Zimbabwe turned one such deal down earlier this month. A government spokesman said the decision related to “comprehensive access to Zimbabwe’s sensitive health data, including virus samples and epidemiological information from our citizens,” without corresponding guarantees that Zimbabwe would benefit from vaccines or products developed from that access. Ghana rejected an agreement over similar concerns. In Kenya, the first country to ink an America First health deal, a court has put the compact on hold while it weighs whether an agreement would violate domestic data laws.
The process of sharing health data has been fraught for decades. Wealthy countries that can manufacture vaccines and therapies stand to benefit from sharing arrangements, while developing countries that provide pathogen samples may not. That dynamic played out, for example, when Indonesia refused to share virus samples with the WHO in 2007 amid growing concern over a potential H5N1 pandemic. The COVID pandemic further underscored the problem, with people in poorer countries waiting for first vaccine doses while those in wealthier ones were receiving boosters.
“The danger of a repetition of the COVID-19 saga, when Africa was ‘last in line’ to receive medical tools developed from African data, is real,” 50 non-governmental organizations said in a letter about the America First agreements last year. “This runs directly counter to Africa’s push for regional manufacturing and deeper self-reliance. It also risks locking African producers out of value chains built on African data.”
Disease surveillance data, like virus genomes, would be useful for developing “next level” treatments, says Jane Munga, who is a researcher at the Carnegie Endowment for International Peace and a former economic advisor to the Kenyan government. Munga has written about the data sharing provisions of the America First agreements. The deals are coming at a time when health data might also serve another purpose, she says. It could be used for lucrative AI development. “If you can get a large data set that provides you millions of data points for Africans, how they respond to medicine and so forth, you can train a new large language model. You can train a health model.”
Some researchers say any AI models developed on African data through the America First agreements will primarily benefit entities outside of the continent. “Countries such as Keyna, Rwanda, and Uganda are asked to trade health data and pathogens for funding under the language of “partnership,” while the principal gains from expanded surveillance capacities, patent portfolios, and AI tools continue to accrue to the US and its allied markets,” Sharifa Sekalala, a professor in the United Kingdom, and her colleagues wrote in the journal Plos Global Public Health in February.
A challenge to unity. Trump’s new health aid strategy and its emphasis on bilateral deals stands in contrast to efforts meant to improve health coordination across African countries as well as broader global efforts to improve pandemic response.
African countries have been working to develop viable pharmaceutical and vaccine industries—for example through the African Medicines Agency, which will work to harmonize regulations. The African Union has set a goal of producing 60 percent of the vaccines the continent uses locally by 2040, meaning that Africa won’t be last in line for therapies and vaccines the next time there’s a pandemic crisis. Outside the continent, WHO member countries are negotiating an agreement to share pathogen samples and more equitably distribute products developed from those samples.
The America First model has undermined this continental cohesion, Evaborhene says, “because while African countries are trying to consolidate through the Africa CDC and the African Medicines Agency, they are obligated right now to choose between continental unity or access to funding from the US.”
Leverage. The organizers behind the creation of the UN in 1945 quickly understood there needed to be international cooperation to control the spread of diseases and developed the World Health Organization to fulfill that aim. The WHO, reliant on dues and donations, would marshal the international community to confront disease challenges from smallpox, to polio, to HIV, and more. Since the start of the second half of the 20th century, this multilateral approach to global health prevailed, with the United States as its largest benefactor. Between 2012 and 2024, the United States sent hundreds of millions of dollars a year on average to the WHO. No more. The America First Global Health Strategy “is about US interests, American prosperity, access to American products, supply chains, and American security,” Evaborhene says. “This has a lot of implication for global health, which is a field defined by equity and solidarity.”
Though the Trump administration’s global health policies have been controversial, Evaborhene doesn’t expect the America First ethos to completely disappear from US policy, even if a future presidential administration returns to emphasizing greater international cooperation. We’re in an era of fierce geo-political jockeying, he says, with large powers like the United States, China, and Russia seeking advantage. “The era of deals that are struck for just altruistic purposes, for moral purposes, I think that era is gone,” he says.
Countries need to adapt, Evaborhene and Munga say, and play a more transactional game themselves. For Evaborhene, African countries should diversify their partnerships. They should negotiate to strengthen the deals, for example, so that the Trump administration couldn’t simply terminate aid at will. Munga says countries should get something for providing data for products and artificial intelligence. “They’re sitting on something that is of value” that may help grow their economies, she argues.
“I think it’s an imperative for countries to start looking at this differently and find the silver lining. They need to find the silver lining.”
For some countries, their resources and their importance in various geopolitical machinations give them currency—leverage in dealings with the United States or other countries. The reward may be a healthier population with more access to medicine. But, Evaborhene says, for countries without leverage, it’s a different story: “You know, what are they going to get? But that is the era that we are in right now, and it’s very sad.”
