US Accused of Exploitation in Bilateral Health Aid Deals with Developing Countries
TL/DR –
In 2025, the United States suspended its global health aid, leading to predictions of 700,000 additional deaths per year. Following this, the U.S. began proposing bilateral health agreements to developing countries, often involving health aid in return for sensitive health data or access to national minerals. These proposals have been controversial, with criticisms of exploitation, and two countries in dire need of health aid have rejected them.
US Bilateral Health Agreements Spark Controversy Amid Aid Suspension
Following the surprising suspension of global health aid by the US in late 2025, Washington has proposed unusual bilateral health agreements primarily with African nations, causing outrage amongst officials and health activists. Critics argue these deals hint at “exploitation”. Zimbabwe and Zambia, two countries in desperate need of health aid, have rejected these agreements.
US Requests in Exchange for Aid
In November, the US offered Zimbabwe over $300m in funding in return for sensitive health data, a proposal Zimbabwe rejected. Similarly, Zambia declined a $1bn US funding offer which required access to the country’s minerals. Despite these reactions, countries like Nigeria and Kenya have accepted the health pacts. The content of these agreements remains undisclosed.
Impact of Terms on African Nations and US
Policy experts warn that tying crucial funding to sensitive national assets could have negative repercussions for both African nations and the US. Sarang Shidore, Africa director at the Quincy Institute for Responsible Statecraft, emphasizes that linking aid to extraction of critical minerals is exploitative and calls for reform in foreign aid sector.
Zambia’s Resistance to Minerals-for-Aid Pact
Africa relies significantly on US funding for health and humanitarian needs, receiving $5.4bn in US assistance in 2024. However, the abrupt cut in funding in January 2025 by the Trump administration had a devastating impact. The aid cuts, part of the America First agenda, led to over 780,000 deaths from manageable diseases like HIV and tuberculosis, and around 10 million new cases of malaria.
Contrarily, Washington is concentrating on government-to-government deals. However, the secretive nature of these negotiations has caused concern, as health NGOs and civil society groups in Africa claim it leaves them out of crucial discussions. The terms of these deals have also sparked outrage due to demands for access to data and resources.
Zambia and US Negotiations
In Zambia’s case, the US requested access to its critical minerals for $1bn over five years, on condition that Zambia contribute $340m in new health funding. Failure to secure this deal by Wednesday would result in discontinuation of US aid funding to Zambia, leading to potential losses from the PEPFAR programme, which provides free HIV treatment for 1.3 million people.
A Possible Middle Ground?
Zimbabwe is the only country known to have rejected negotiations after the US demanded access to epidemiological data and biological samples for research. Meanwhile, Kenya faced a lawsuit after signing an aid agreement with the Trump administration due to concerns over violation of data privacy.
Since late 2025, over a dozen African countries have signed memorandums of understanding with Washington. However, the specific terms and benefits of these deals for the US remain largely unclear. While some countries have seen reduced aid, experts argue that significant foreign aid in global public health remains crucial.
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