A raft of new bilateral health deals between the US and 14 African countries illustrates how Washington is following through on putting America First at the expense of global health and helping poor countries to reduce their disease burden.
Furthermore, the African countries with which the US has failed so far to make any health deals reveal how it is making aid assistance contingent on favourable trade and political terms.
A deal with Zambia is delayed, reportedly until Washington meets its goals in the local mining sector. Any accord with the DRC also appears to hinge on access to its mineral resources, while political tensions mean Washington has yet to make any deals with South Africa and Tanzania.
Last month, the US signed memoranda of understanding with 14 countries amounting to around $16 billion in assistance and about 50% less than 2024 levels. The countries are: Kenya, Rwanda, Liberia, Uganda, Lesotho, Eswatini, Mozambique, Cameroon, Nigeria, Madagascar, Sierra Leone, Botswana, Ethiopia and Cote d’Ivoire.
The MOUs for five-year agreements starting on 1 April lay out the framework for US aid in return for prioritising patient and infectious disease surveillance data.
The details have yet to emerge, and the deals still need to be translated into concrete contracts, but they do offer opportunities for US companies to provide logistics, data and supply-chain support, said the Health Policy Watch news site.
One of the criticisms made by Republican critics of USAID was that it spent too much money on staff and office overheads, but there is so far little to indicate in the new deals on how private-sector entities would do any better to cut waste and inefficiencies.
Rising mortality rates follow USAID cuts
The impact of scrapping USAID and steep funding cuts last year was rapidly shown in rising mortality rates in many countries, particularly affecting maternal and child care, nutrition and anti-HIV/AIDS programmes.
Thousands of health workers also lost their jobs, many of them in highly-indebted African countries.
There is already pushback to the new aid deals. A Kenyan court suspended implementation of the new agreement after challenges were filed over concerns about patient privacy in the pathogen-sharing clause.
The government said it would challenge the court ruling, and further hearings are expected in early next month.
Marco Rubio, US secretary of state, had hailed the Kenya deal signed on 4 December, saying it “aims to strengthen US leadership and excellence in global health while eliminating dependency, ideology, inefficiency, and waste from our foreign assistance architecture.”
Agreements amount to a 49% cut on average in annual US financial support compared with historic funding levels
Under the deal, the US contributes $1.7 billion and the Kenyan government $850m before gradually taking on more responsibility. The accord focuses on preventing and treating diseases such as HIV/AIDS, malaria and tuberculosis with an emphasis on faith-based medical providers.
Family planning programmes that comply with US restrictions on the provision of abortion services will also be eligible.
Funding for maternal and child health has been almost eliminated, according to analysis of eight of the MOUs by the Center for Global Development (CGD).
It said the agreements amount to a 49% cut on average in annual US financial support compared with historic funding levels. Liberia faces a cut of 63%, while Kenya, a relatively wealthier country, faces only a 28% cut.
Countries have to bear a bigger share of health financing under the deals, which do not yet define domestic spending but do specify that funds from other donors would not count as co-investments.
“Operationalising a reconfigured approach to US global health assistance—particularly direct government assistance—at this scale and speed is unprecedented, and each potential point of failure risks lives,” said the CGD.
US retreat from multilateralism
The US retreat from multilateralism was driven home by Trump’s announcement last week that he plans to withdraw from 66 UN and international organisations, including the Intergovernmental Panel on Climate Change, which brings together the world’s top scientists.
The US withdrawal from the World Health Organization is due to come into effect on 22 January
Trump has already quit the Paris Climate Agreement and the UN Human Rights Council. The US withdrawal from the World Health Organization is due to come into effect on 22 January.
However, the US did say in late December it would give $2 billion to fund humanitarian aid co-ordinated by the UN, which welcomed the move as it seeks to raise $23 billion for emergency relief this year.
Africa continues to suffer US neglect, particularly if Trump follows through with the abrupt recall of nearly 30 US ambassadors by the middle of this month.
About a dozen were told to leave their posts in sub-Saharan Africa, where Trump has also not chosen nominees for a number of vacant ambassadorships.
China has now surpassed the US in the number of diplomatic missions around the world. Jeanne Shaheen, the top Democrat on the US Senate Committee on Foreign Relations, said on X that Trump was “giving away US leadership to China and Russia” and that the mass recall “makes America less safe, less strong and less prosperous.”
