After dismantling USAID in January 2025, the Trump administration has been negotiating bilateral health agreements with over 30 countries, predominantly in Africa, under its “America First Global Health Strategy.” The deals tie what was previously humanitarian assistance to a bundle of strategic demands:

1. Personal health and genomic data

Ghana walked away from a $109 million deal after Washington demanded access to personal health data (Ärzteblatt, April 2026). In Zambia, the US demanded 10 years of access to national health and genomic data in exchange for only 5 years of funding, with no guarantee that Zambia would benefit from any vaccines or drugs developed from that data (IBTimes UK).

2. Mining concessions for US companies

A leaked State Department memo proposed explicitly using HIV aid for Zambia’s 1.3 million PEPFAR-dependent patients as leverage to extract access to copper, cobalt, lithium, and rare earth minerals (FPRI, March 2026). In the DRC, after demanding 20-year corporate tax exemptions, windfall tax waivers, and duty-free treatment for US imports, Washington secured a deal giving US firms right-of-first-offer on certain mining sites (Capital & Main, April 2026).

3. Recipient country co-financing

Zambia’s proposed deal required the country itself to contribute roughly $340 million in domestic health spending alongside the US offer of $1 billion over five years, sharply reducing the net benefit (Observer Research Foundation, March 2026).

4. Regulatory reforms favoring US investment

Several agreements include clauses requiring recipient governments to create favorable regulatory environments for US direct investment in mining and pharmaceuticals (Al Jazeera, April 2026).

So the strategic goal is to redirect African critical minerals — cobalt, copper, lithium, rare earths — into US supply chains and counter China’s dominance in African mining.

PEPFAR, long regarded as one of America’s most successful humanitarian programs (credited with saving over 26 million lives globally), is now being openly wielded as a negotiating tool. Zimbabwe, Zambia, and Ghana have rejected or walked out of talks; Kenya, Nigeria, Ethiopia, and over a dozen others have signed agreements. Malawi’s Kayelekera uranium mine  restarted and now shipping to the US.

Critics, including former USAID officials, have called the approach “coercion dressed in the language of strategy.”