By Willem Kanyondi
The framing of a sudden American interest in African health data is worth questioning before it is accepted.
The United States has drawn on the continent’s health data for roughly two decades, largely through the President’s Emergency Plan for AIDS Relief (PEPFAR), which built one of the most detailed health reporting and monitoring systems of any foreign-assistance programme in history.
African governments shared HIV, tuberculosis, malaria and surveillance data with Washington with little resistance, and that data was routinely used for research.
What changed in 2025 is not that the interest appeared, but that it became explicit, contractual and conditional.
Access that once flowed quietly through donor programmes is now written into government-to-government agreements and tied directly to whether a country continues to receive support. That shift — from quiet byproduct to negotiated asset — is the real story.
What actually changed in 2025
The sequence began with disruption. An early-2025 foreign-aid freeze, the dissolution of USAID, and the transfer of global health programmes to the State Department cleared away the old delivery model.
On 18 September 2025, the State Department released the America First Global Health Strategy, which replaced the multilateral, donor-driven approach with bilateral, transactional
Memorandums of Understanding (MOUs) running from 2026 to 2030.
The logic of the new model is “country ownership”: the United States winds down its assistance while partner countries pledge to increase their own domestic health spending. But the MOUs carry a feature that has drawn the most scrutiny.
Each is reportedly bundled with a Specimen-Sharing Agreement requiring the signatory country to share physical pathogen specimens and genetic sequence data with the United States within five days of detection.
According to reporting on the MOU templates, that specimen-sharing obligation is envisaged to run for up to 25 years — long after the funding window of 2026–2030 has closed.
By early 2026, more than a dozen African countries had signed, and the number kept climbing; some reporting put the total African MOUs at around 26 by March 2026.
Notable holdouts included South Africa, Tanzania and the Democratic Republic of Congo — all high-disease-burden countries that had been significant PEPFAR recipients.
Crucially, this all unfolds against the backdrop of the U.S. withdrawal from the World Health Organization and its Pandemic Agreement process, including the Pathogen Access and Benefit Sharing (PABS) system.
Rather than share pathogen data through that multilateral channel, the United States is now building its own bilateral pipeline — one that risks undercutting the PABS negotiations entirely.
Why health data — and why African data specifically
There are two converging reasons, one commercial and one strategic.
The commercial driver is genetic. African populations carry the highest genetic diversity on earth, yet they remain the most underrepresented group in global genomic databases.
By one widely cited estimate, the share of African genomes in genomics studies was around 3 percent in 2016 and had actually fallen to roughly 1.1 percent by 2022 — and much of even that fraction is drawn from African-American rather than continental populations.
That gap is not academic. Most drugs are developed and dosed using data from people of European ancestry, and genetic variants more common in African populations can change how those drugs behave.
Standard doses of medicines such as the blood thinner warfarin or the HIV drug efavirenz can be ineffective or toxic for patients carrying particular variants.
For an industry moving toward AI- driven drug discovery and precision medicine, African genomic data is therefore one of the most valuable untapped datasets in the world — and the intellectual property that emerges from it (drug targets, proprietary algorithms, precision- medicine protocols) tends to belong to whoever trains their models on the data first.
The race is already concrete. A consortium led by Meharry Medical College, backed by roughly US$80 million from pharmaceutical companies including AstraZeneca and Roche, is working to build the world’s largest African-ancestry genomic database. The motivation, as one analysis put it, is not charity but a
market imperative.
The strategic driver is biosecurity. Pathogen and genomic surveillance data is not only a public-health resource; it feeds pandemic preparedness, biodefence and strategic planning.
With the United States now outside the WHO, bilateral pathogen-sharing agreements become its primary early-warning system for emerging infectious threats.
Washington’s own framing is consistent with this: the strategy emphasises protecting Americans from cross-border disease, detecting outbreaks within seven days, and delivering accountability to taxpayers — and it points to the 2025 Ebola outbreak in Uganda, detected within eight days using U.S.-supported laboratories and surveillance, as proof of concept.
The pushback: data as sovereignty
The terms have triggered a continental reaction.
In Kenya — whose roughly US$2.5 billion agreement (about US$1.7 billion from the United States) was the first and largest — the High Court issued an order in December 2025 suspending the data-transfer clauses pending a full hearing.
Petitioners argued both that the deal breached national data-protection and digital-rights law, and that it bypassed constitutional requirements for parliamentary approval.
In Nigeria, litigation has challenged provisions said to allow the transfer of medical records, blood samples, pathogen tests and genetic sequencing data to the United States.
The recurring objection is twofold: the agreements were largely negotiated without public consultation or parliamentary oversight, and they lack the protections that would make data-sharing equitable.
Critics note that the frameworks contain no explicit co-ownership of intellectual property derived from African biological material, no requirement that AI models trained on the data be deployed locally, and no guarantee of preferential pricing on any resulting medical products.
The historical memory is sharp here — when southern African scientists transparently shared the Omicron variant data in late 2021, the immediate reward was travel bans, while vaccine access lagged by more than a year.
The continental counter-move is institutional. Under the Africa CDC’s “Health Security and Sovereignty” agenda, the Africa Genome Archiving for Response and Insight (AGARI) platform was launched in November 2025 to anchor genomic data production, storage and governance within Africa rather than in fragmented national silos or foreign servers.
Alongside the push for a functioning PABS system, it represents an attempt to keep the value of the data — and the power to refuse extractive terms — on the continent.
Why this matters for African health systems
The deeper significance is a reclassification. Health data is being moved from a byproduct of clinical care into a strategic, tradeable asset — closer in character to a mineral resource than to a paperwork formality.
Once that reframing is accepted, the central question is no longer whether African systems should share data, but on what terms: who owns it, who profits from what is built on it, and whether any benefit returns to the patients and populations who generated it.
That places governance and data-asset management at the centre of health- system strategy. The institutions and countries that can value, secure, govern and negotiate over their own health data will capture a share of the benefit; those that cannot will continue to export the raw material and re-import the finished product at a premium.
It is the same dynamic that already leaves the continent manufacturing less than 3 percent of the vaccines it uses — only now playing out one layer up, in data rather than doses.
Seen this way, the American interest is neither sinister nor sudden. It is the rational behaviour of a buyer who has recognised the value of an asset before the seller has fully priced it. The open question is whether African health systems will treat their data with the same seriousness.
*Willem Kanyondi is a nurse practitioner turned clinical auditor and CIMA candidate, specialising in healthcare revenue integrity. He writes on the intersection of clinical operations, financial management and healthcare financing. He writes here in his personal capacity.
