America First, Africa Last? How Health Diplomacy Became a Tool of Extraction

By Dishant Shah

Under the America First Global Health Strategy, launched in September 2025, the United States began offering African nations a straightforward proposition: five years of limited health assistance in exchange for 25 years of access to data on pathogens with epidemic potential. In several cases, the terms went considerably further.

Health memoranda of understanding with the Democratic Republic of Congo and Guinea were made conditional on signing separate agreements granting the United States access to critical minerals. In Zambia’s case, the State Department reportedly threatened to withhold HIV funding as a negotiating lever to compel the government to open its copper and cobalt reserves.

It is the most explicit instance yet of a health agreement being deployed as an instrument of economic statecraft.

The ask, stripped of its diplomatic language, is stark. African nations are being invited to share biological resources and epidemiological data over an extended period, with no corresponding guarantee of access to the medical innovations, vaccines, diagnostics, or treatments that might result from that shared data.

The raw materials of scientific discovery, in other words, handed over with no assurance that the finished products would ever return to the people who provided them.
This is not a new story dressed in new clothes. It is the oldest story on the continent – wearing a stethoscope.

The Architecture of Asymmetry

Health data is not a byproduct of disease surveillance. It is a strategic asset, shaped by the bodies, genetics, disease patterns, and lived conditions of entire populations across generations.

Pathogens do not belong to whoever sequences them first. They belong, in any meaningful ethical sense, to the communities that carry the accumulated history of surviving them.

The current framework asks African governments to accept a familiar asymmetry: contribute to the global knowledge commons, absorb the costs of data collection and community trust, and then purchase back – at market rates – whatever innovations that contribution eventually enables.

That arrangement has a name. Scholars of development economics have been arguing about it for decades. It is not partnership.

What makes the current episode distinctive is the brazenness of the conditionalities. Linking health memoranda to mineral access agreements is not subtle. It forecloses the diplomatic pretense that these are purely public-health instruments.

The minerals and the microbes are on the same negotiating table. The connection is written into the terms.

A Continent That Reads the Fine Print

The response has been something the architects of this strategy may not have adequately anticipated: pushback, conducted through courts, legislatures, and public health budgets.

A group of Congolese lawyers filed a legal challenge to the minerals deal, arguing it violates national sovereignty over natural resources. Kenya’s High Court suspended elements of its own bilateral agreement over constitutional concerns about patient data transfers across borders. Zambia stalled negotiations entirely and demanded revisions.

Africa CDC Director-General Jean Kaseya declined an observer role in the bilateral talks and was unambiguous in his reasoning. “We want to own our data in Africa,” he told journalists. “We want to own our future.”

Quietly, and without waiting for external permission, African governments also began filling the financial gaps themselves.

Nigeria increased its domestic health allocation by US$200 million within a month of the USAID cuts. Ghana redirected the full proceeds of its National Health Insurance Levy to the health sector. Ethiopia nearly doubled its health budget in 2025.

These are not symbolic gestures. They are the arithmetic of a continent recalculating its dependencies.

The Vocabulary Changes. The Logic Does Not.

The scramble for Africa has always found new vocabularies. Development. Structural adjustment. Capacity building. Global health security.

Each era generates a fresh lexicon that softens the underlying transaction. What remains remarkably consistent is the direction of the extraction – and what remains equally consistent, though it receives far less analytical attention, is that Africa pushes back.

It does so quietly, legally, at considerable cost, and with a patience that should not be mistaken for acceptance. The legal challenges in Kinshasa and Nairobi, the budget redirections in Abuja and Accra, the public refusal by a continental health institution to participate in a process it regards as structurally compromised – these are not isolated acts of defiance. They are a coherent, if distributed, argument.

The argument is this: the continent is being asked to choose between its people’s health today and its sovereignty tomorrow. Several governments are refusing to accept that as the only available choice.

They are right to refuse it. And the international community, if it retains any genuine commitment to equitable global health architecture, should be paying close attention to the terms being set – not merely the ones being resisted.

Dishant Shah is a partner at Legion Exim, a company specializing in facilitating the export of high-quality engineering products directly sourced from manufacturers in India to Africa. His areas of expertise include new business development and business management.