Oladimeji Solomon Yemi (Lead writer)
For decades, global health governance was shaped by aid flows, multilateral institutions, and shared norms of solidarity. Countries received funding, technical assistance, and essential commodities through systems anchored in organisations such as the World Health Organization (WHO), the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), UK Foreign, Commonwealth and Development Office (FCDO), the United Nations, United States Agency for International Development (USAID), and other multilateral mechanisms. This model rested on collective risk management and the belief that global health security was a shared responsibility.
That model is now being quietly, but decisively reconfigured. The restructuring of USAID, reductions in Official Development Assistance (ODA), the United States’ withdrawal from the WHO, and the rise of the “America First” global health agenda have signalled a shift away from multilateralism toward a more transactional, bilateral, and security-oriented approach; one in which health data, surveillance, and digital infrastructure are emerging as strategic assets.
From pooled aid to bilateral compacts
In September 2025, the United States of America formally articulated this reorientation with the launch of the America First Global Health Strategy. The strategy positions the United States’ health assistance not as aid, but as a tactical instrument to stop outbreaks at their source, advance their interests through tightly negotiated bilateral agreements, and promote American health innovation. The strategy reaffirms the life-saving legacy of programmes such as the United States President’s Emergency Plan for AIDS Relief (PEPFAR) but argues that decades of global health financing have produced inefficiencies, parallel systems, and dependency, calling for a pivot toward government-to-government agreements, mandatory co-investment, performance-based funding, and deep integration of surveillance, data systems, and supply chains. In doing so, it crystallises a broader shift in global health governance from shared stewardship to conditional partnership.
This reorientation meets with another ambition gaining pace across the African continent. African governments are no longer content to remain constant importers of medicines, vaccines, and diagnostics, a realisation that is a fall-out from the COVID-19 pandemic. As a result, they are increasingly treating health as an industrial policy question. Yet the new American policy raises an awkward question. Whether bilateral health agreements that deepen data access and surveillance integration will reinforce Africa’s push for domestic manufacturing and regulatory convergence, including through the Africa Medicines Agency (AMA), or quietly limit it by favouring foreign suppliers.
This shift is already visible in the Kenya–U.S. Cooperation Framework, where health financing is linked to interoperable surveillance systems, real-time epidemiological reporting, and sustained United States access to national health data platforms, positioning data infrastructure not as a by-product of cooperation but as a core deliverable.
In practice, these arrangements embed asymmetry. While African states commit to granting long-term access to surveillance systems, laboratory networks, and digital health platforms; reciprocal guarantees, such as assured access to vaccines, therapeutics, diagnostics, or technology transfer derived from shared data are largely absent from the agreements’ core clauses. In Kenya’s case, negotiations have reportedly included requests for direct health system access and credentials to national health information platforms, raising concerns about sovereignty, cybersecurity, and compliance with domestic data protection laws, even as official narratives frame the engagements as strategic partnerships.
For African governments, this moment is profoundly consequential. It unfolds alongside Africa’s collective push for a multilateral Pathogen Access and Benefit-Sharing (PABS) system under the WHO Pandemic Agreement, an effort to ensure that data sharing is matched by equitable access to countermeasures and technology. Yet the proliferation of one-to-one bilateral agreements risks fragmenting that solidarity, locking countries into data obligations that outlast funding cycles and weaken collective bargaining power. Global health governance, in other words, is not merely shifting; it is being re-engineered through contracts, credentials, and code. What was once mediated through pooled aid is now negotiated through access rights, interoperability standards, and surveillance architectures.
The geopolitics of health data: Power beyond aid
What is unfolding under the “America First” Global Health Strategy is a shift towards bilateral agreements that exchange short-term to medium-term funding for long-term integration into national health information systems, laboratories, and surveillance architectures. Health data, once treated as a technical output of public health programmes, is now the primary asset being negotiated.
This logic is visible across recent United States bilateral health agreements in Africa. Funding commitments are typically time-bound, lasting two to five years, with clear expectations that recipient governments progressively assume financial responsibility. Liberia’s Memorandum of Understanding with the United States illustrates this clearly. While U.S. financing is expected to decline gradually across surveillance, laboratory systems, and frontline health support over five years, Liberia commits to building interoperable electronic medical records, disease surveillance platforms, and a centralised national health data warehouse.
Kenya became the first country where the political and legal tensions embedded in this approach surfaced publicly. Civil society organisations and lawmakers challenged the agreement, arguing that its data and specimen sharing provisions conflicted with Kenya’s Data Protection Act, Digital Health Act, and constitutional requirements for public participation and parliamentary oversight. Kenya’s High Court suspended implementation of the agreement, not as a rejection of cooperation, but as a response to how data governance had been negotiated. The case exposed a critical fault line where health partnerships framed as technical and benign can quietly reallocate control over national data infrastructure without adequate transparency, legal alignment, or public consent.
In Zambia, some reports suggest health cooperation became entangled with parallel negotiations in the mining sector. This showed that health cooperation is no longer insulated by humanitarian exceptionalism. Instead, it is increasingly embedded within broader geopolitical and commercial bargaining. Uganda’s large-scale bilateral health framework similarly prioritises surveillance, outbreak preparedness, and system interoperability, yet offers limited public visibility into long-term data governance arrangements.
What emerges is a new geography of power in global health. In earlier eras, influence was exercised primarily through aid volumes, commodity pipelines, and technical assistance. Today, influence flows through information: who collects health data, who sets interoperability standards, who has visibility into disease surveillance systems, and who retains access long after funding cycles end. Once integrated into global surveillance architectures, health data acquires value far beyond national health planning. It feeds early warning systems, informs global risk models, and shapes preparedness decisions in distant capitals. This is the geopolitical dimension of health data: information generated in one context produces security and strategic dividends in another.
Africa sits at the centre of this transformation. As countries invest in digital health systems, national data warehouses, genomic surveillance, and interoperability frameworks, they become indispensable nodes in the global outbreak early-warning system. At the same time, fiscal pressure, shrinking multilateral aid, and uncertainty in global financing push governments toward bilateral arrangements that promise predictability. This convergence creates opportunity, but also vulnerability. When negotiating power is asymmetric, data sovereignty can be quietly exchanged for short-term financial stability.
Civil society organisations across Africa have raised alarms about the opacity of many of these agreements. Key annexes governing data and specimen sharing are often negotiated behind closed doors, with limited parliamentary scrutiny and weak guarantees around domestic legal alignment, secondary use restrictions, or benefit-sharing. Notably absent from many agreements are binding commitments on reciprocal access to vaccines, diagnostics, therapeutics, or technology transfer derived from shared data. Data flows outward; benefits do not necessarily flow back.
For African governments, the defining question is no longer only how to replace declining aid, but how to negotiate health data governance arrangements that protect sovereignty, public trust, and long-term autonomy. Because in a world where funding ends but data flows endure, the real costs of these partnerships are paid long after the grants expire. As aid recedes and data rises, power follows the pathways of information. And unless governance frameworks evolve to match this reality, health data risks becoming the quiet conduit through which global power is consolidated. This consolidation can occur beyond aid, and beyond consent.
What governments must now insist on
If health data is becoming a strategic asset in global health cooperation, then governments, particularly in Africa, must engage with this new order deliberately, not defensively. The task is not to reject bilateral health partnerships, but to define non-negotiable governance conditions under which they operate.
At a minimum, future health cooperation frameworks should insist on the following.
Clear and enforceable limits on data access and use — Agreements must specify precisely what data is shared, for what purpose, for how long, and with whom. Vague clauses that allow open-ended access, undefined secondary use, or broad references to “future public health needs” effectively convert temporary cooperation into permanent asymmetry.
- Data sovereignty and domestic legal supremacy — No health agreement should supersede national data protection laws, digital health statutes, or constitutional privacy protections. Domestic courts and regulators, not external partners, must retain final authority over how citizens’ health data is governed, audited, challenged, and remedied.
- Alignment with regional and multilateral norms — Bilateral agreements should reinforce, not undermine African and global governance frameworks, including AU data policy instruments, Africa CDC surveillance standards, and WHO-led multilateral processes such as the Pathogen Access and Benefit-Sharing system. Governments should resist arrangements that fragment collective bargaining power or weaken shared rules.
The real test
The question facing governments is no longer whether global health engagement will continue; it will. The question is whether health data will replace aid as the primary currency of influence, and whether countries will manage that transition with clarity or under constraint. In this new era, the strongest health systems will not be those that collect the most data, but those that govern it best.