By Dr. Matuikuani Dax
A new template for global health engagement is being rolled out across Africa under the banner of the America First Global Health Strategy.
The U.S is securing 5-year Memoranda of Understanding (MoU) that inextricably link health funding to mineral access.
At the heart of this shift is a statement by Caleb Orr, a U.S. Department of State official, who during a visit to Zambia declared that “economic cooperation supersedes and is a prerequisite for health funding.”
This rhetoric disrupts the traditional, solidarity-based aid model, upending it to hinge health funding directly on mineral access. This isn’t just aid with conditions; it’s a fusion of geopolitics, economics, and public health that may redefine global health architecture for the coming decade.
Namibia is not only one of Africa’s most politically stable and mineral-rich states, but is also on the brink of becoming a significant oil and gas supplier. Crucially, its mining and energy sector is a microcosm of global geopolitics, hosting diverse players from China, Iran, Canada, the EU, and Russia.
Instrumentalization of Health
The explicit linking of health support to mineral access signals a transactional model, one that aligns health aid with national security, industrial policy, and geopolitical competition. In this context, health is advertently reduced to a bargaining chip.
For Africa, the issue is not simply whether such agreements bring additional resources into underfunded health systems. The more pressing concern is the balance of power. How empowered are African governments to negotiate such arrangements on equal footing? And what institutional mandates govern who signs them?
Is this health diplomacy, economic diplomacy, or simply diplomacy in its most unvarnished form—where health outcomes become proxies for the quality of bilateral relations between a donor and a recipient state?
This question is particularly salient. Health governance falls within the remit of the Ministry of Health, while mineral agreements are negotiated through economic, trade, or mining portfolios. When these domains converge, who leads, who consents, and who is accountable?
The Kenyan Precedent
Kenya, the first signatory, now provides a model of pushback. Its High Court has frozen the implementation of the MoU following two separate legal challenges. Petitions raised two constitutional alarms: the risk to patient data privacy, and the executive bypassing Parliament in committing the country to a major international agreement. This legal roadblock is a landmark assertion of national sovereignty against a top-down, pre-packaged deal.
Namibia in the Crosshairs
While there is no confirmation that Namibia is in active talks, it is inevitable that the U.S. will come knocking. The question is: How empowered is Namibia to negotiate? The geopolitical upheavals of the past year have underscored that power lies in resource access. It was only a matter of time before this proxy war spilled into the health sector.
Unlike many nations, Namibia’s need for the financial support is not existential. Its mineral wealth can easily fund its own health sector several times over. This raises a radical, sovereign alternative: could this external pressure be the catalyst for Namibia to finally internalize its own power and rely on its own resources?
Imagine a future where Namibia uses progressive taxation, sovereign wealth funds, and value-addition policies to channel mineral and hydrocarbon revenues directly into strengthening its health system. It would mean building health sovereignty alongside economic sovereignty, freeing the nation from an aid trap that compromises long-term well-being for short-term aid.
Pathogen Sharing in a Time of Global Negotiation
A particularly troubling dimension is the inclusion of pathogen access and benefit-sharing (PABS) within these MOUs. While the Pandemic Treaty, in its article 12, is still under negotiation, the U.S., by pre-emptively locking African states into PABS agreements bilaterally, is effectively circumventing a multilateral process designed to ensure equity.
By locking itself into a 25-year bilateral PABS agreement with the U.S., Namibia could forfeit its right to the stronger, guaranteed benefits (e.g., tiered pricing, technology transfer, vaccine allocations) being negotiated in the Pandemic Treaty. It would be bound to a deal with a partner that has deliberately weakened the very global forum designed to protect their interests.
Does this signal a Faustian Bargain?For Namibia, the calculus is delicate. The need for robust health funding is acute, but at what cost? Signing such a deal could mean trading long-term sovereignty over natural resources for short-term health system support, while also committing to share biological data in a regulatory vacuum.
A Call for Transparency and Democratic Scrutiny
Author Emily Bass, posits that the day the Zambia-US health agreement was not signed as scheduled, marks the moment the curtain fully rose on the Trump Administration’s 21st century scramble for Africa.
Engagement with global partners need not cease, but it must be governed by new rules: full transparency, coordinated inter-ministerial review, and mandatory parliamentary oversight. Health financing agreements that hinge on economic concessions must be subjected to rigorous public interest scrutiny.
Kenya’s courts have pressed pause. Zambia saw its health funds held hostage. Namibia now has a choice: will it be a signatory to this coercive new model, or will it be a champion for an equitable one?
*Dr. Matuikuani Dax is a Global Health Specialist.
