The United States is pursuing multiyear bilateral health agreements that link funding to data-sharing arrangements and greater domestic health spending, while China is expanding its medical diplomacy through hospital-ship missions, free treatment and broader healthcare cooperation.
Under the America First Global Health Strategy, Washington has pursued five-year bilateral agreements intended to support programmes addressing HIV, tuberculosis and malaria. However, concerns over access to sensitive medical records, epidemiological information, biological samples and pathogen data have prompted debate about who ultimately controls Africa’s health resources.
There are questions about the extent to which African countries can secure US health funding without compromising control over their health data, biological resources, critical minerals and rare earth deposits. Proposals under the America First Global Health Strategy risk undermining public trust if African countries cannot guarantee that their citizens’ information and biological materials will be protected and used in the public interest.
While disease surveillance and the exchange of scientific information are essential to responding to infectious diseases, such arrangements must be equitable, transparent and reciprocal. African governments should not have to choose between financing essential health services and safeguarding their citizens’ privacy, research resources and national interests.
Agreements must provide clear protections for data, meaningful African oversight and tangible benefits for the populations whose information and biological materials contribute to medical research.
Under the “America First” Global Health Strategy, the US government has shifted from traditional non-governmental organisation (NGO) assistance to transactional, five-year bilateral Memoranda of Understanding (MOUs) spanning 2026–2030.
The “America First” Global Health Strategy promises to provide bilateral health deals totalling over $26.7 billion across partner countries, replacing legacy USAID/PEPFAR models with co-financed state agreements.
The recipient countries are required to co-finance roughly 36% to 78% (averaging around 40%) of their national health spending, while overall US global health allocations face cuts. Bilateral agreements require partner countries to hand over near real-time epidemiological data, medical records, blood/tissue samples, and pathogen specimens, potentially stretching up to 25 years.
Targeted African countries have raised concerns about the use of such data to power US artificial intelligence (AI) training and pharmaceutical research. They also argue that such bilateral contracts frequently lack guarantees of affordable local access, tech transfer, or reciprocal vaccine and drug distribution for African populations, usurp their (data) sovereignty, and do not guarantee the privacy of their citizens.
Around 21 African nations signed initial or revised bilateral MOUs — including Nigeria ($2.1B), Kenya ($1.6B–$2.5B), Uganda ($2.3B), Rwanda ($228M), plus Cameroon, Côte d’Ivoire, DRC, Botswana, Burkina Faso, Burundi, Eswatini, Ethiopia, Lesotho, Liberia, Madagascar, Malawi, Mozambique, and Sierra Leone.
Zambia initially pushed back and declined a $1 billion deal over demands linking health financing to critical mineral access (copper, cobalt, lithium) and data but later signed a revised five-year health financing arrangement after public disputes.
Zimbabwe walked away completely from a $367 million US health offer, citing uncompensated exploitation of raw biological data and a lack of local medical return. Zimbabwe’s refusal prompted Washington to terminate health assistance in September, raising concerns about the future of programmes supporting people living with HIV and other infectious diseases.
Ghana and Namibia rebuffed the US health agreement terms over data sovereignty concerns. In Kenya, civil society groups and citizens challenged the agreement in court, leading the Kenyan High Court to temporarily suspend parts of the data-transfer provisions due to data privacy and sovereignty violations. South Africa was largely frozen out or alienated from US health funding over geopolitical stances and policy disagreements.
China, by contrast, has demonstrated a more immediately visible form of health diplomacy through its hospital ships and medical outreach missions. These initiatives offer tangible benefits, particularly where healthcare services and specialist resources are limited. Treating patients, training medical personnel, and supporting local healthcare capacity can help address urgent needs while strengthening bilateral relationships.
Its naval medical deployments provide consultations, surgical procedures, medicines and professional exchanges in African countries. The Auspicious Ark’s October 2026 visit to Côte d’Ivoire and other African countries forms part of a wider initiative intended to strengthen China-Africa health cooperation, which covers hospital construction, medical training, disease control and support for pharmaceutical production.
China’s People’s Liberation Army Navy (PLAN) hospital ships — such as the Peace Ark and the Auspicious Ark — send floating medical teams to African countries to provide free healthcare services. Doctors treat thousands of local patients aboard the vessels, which are equipped with sophisticated operating theatres to handle major surgeries, caesarean sections, and specialised treatments. The ships also provide free medication supplies and prescriptions with pharmaceutical products directly distributed to patients.
Onboard medical staff conduct consultations and academic exchanges regarding traditional Chinese medicine (TCM), while outreach teams including doctors and nurses travel to local military hospitals, regional medical centres, and universities to conduct joint treatments and training.
The ships are fully equipped with hundreds of general hospital beds and dedicated intensive care unit (ICU) beds, operating theatre equipment, including multiple sterile surgical rooms capable of performing dozens of major operations daily, diagnostic equipment such as X-rays, ultrasound, laboratory testing facilities, and gynaecological examination rooms, and air ambulances such as ship-borne rescue helicopters for emergency medical transport
The Chinese initiative, Mission Harmony-2026, has offered thousands of medical consultations and surgeries in countries like Côte d’Ivoire, Mauritania, Senegal, and Guinea to extend humanitarian diplomacy and strengthen relations and cooperation with African nations.
In Djibouti, the vessel received supplies and provided medical support to Chinese personnel stationed at Beijing’s military base, before leaving for Mauritania, where medical teams conducted more than 7 500 consultations and over 30 surgical operations.
In Senegal, doctors carried out 6 060 consultations and 29 operations, before proceeding to Guinea, where they treated more than 4 000 patients. In Côte d’Ivoire, Chinese doctors will treat patients aboard the vessel and conduct medical outreach at Abidjan Military Hospital and the local university.
These visits form part of Beijing’s efforts to strengthen healthcare cooperation and build closer relationships with African governments. According to the spokesperson of China’s Ministry of Defence, Jiang Bin, China remains committed to fostering health cooperation with partner countries. Jiang Bin said that the “Chinese military will continue to provide effective and efficient medical services to the people of Africa, deepen traditional friendship and practical cooperation between China and Africa, and contribute to the building of a community with a shared future for humanity”.
The scope of China-Africa health cooperation spans medical infrastructure, human resource training, disease control, pharmaceutical manufacturing, and traditional medicine, evolving from bilateral aid to a comprehensive framework guided by the Forum on China-Africa Cooperation (FOCAC).
China has helped construct and equip more than 130 hospitals, clinics, and specialized centers (such as ophthalmic and diagnostic centers) across over 50 African countries. Since sending its first medical team to Algeria in 1963, China has dispatched over 22 000 medical personnel to African nations, providing hundreds of millions of patient consultations and treatments.
Recent FOCAC commitments pledge thousands of additional medical and public health experts, capacity building and training of more African health workers, implementers, and policymakers through dozens of specialized clinical and technical training courses, and cooperation in public health emergency and disease control.
The new commitments target major infectious diseases such as malaria, Ebola, HIV/AIDS, tuberculosis, and COVID-19 through vaccine donations, joint production partnerships, mobile clinics, and support for the Africa Centers for Disease Control and Prevention (Africa CDC).
There is no doubt that Africa needs international partnerships to support its healthcare; however, such cooperation must prioritise shared human welfare over geopolitical interests.
Gideon H Chitanga, PhD. is a Political and International Relations Analyst.