What's happened
Human Rights Watch says US health aid deals with several African states condition aid on data access and pathogen sharing. Leaked documents show agreements in seven countries, amid broader US aid cuts that have disrupted health programs and may threaten outbreak response.
What's behind the headline?
Analysis
- The documents show a pattern: health aid tied to conditions that extend U.S. oversight over health data and facilities. This raises questions about data privacy, sovereignty and equitable access to medicines and diagnostics.
- The leverage comes from the post-2025 funding pullback. With USAID dissolved, recipient governments face a constrained negotiating environment, making them more vulnerable to terms that may undermine public health rights.
- The practical impact could be slower outbreak responses, weaker patient confidentiality protections, and greater dependence on external donors, especially in fragile health systems.
- For readers, the key question is how transparent negotiations remain and whether civil society and multilateral bodies gain a seat at the table to balance accountability with health needs.
- Looking ahead, publishing all agreements and ensuring independent verification will determine whether these frameworks improve or erode health outcomes in the coming years.
How we got here
The U.S. dismantling of USAID in 2025 and subsequent aid cuts have disrupted health programs and supply chains globally. Recent leaks reveal bilateral health agreements with Ethiopia, Kenya, Mozambique, Nigeria, Rwanda, Liberia and Uganda that would grant the U.S. surveillance access to health data and, in some cases, unannounced inspections. Support from donor nations remains a critical factor as health systems in many African countries struggle with high maternal and child mortality and recurring outbreaks.
Our analysis
The Independent (Liz Cookman) and All Africa aggregations cite HRW’s assessments of seven bilateral health agreements signed in late 2025 across Ethiopia, Kenya, Mozambique, Nigeria, Rwanda, Liberia and Uganda. The reporting notes the post-USAID funding environment and leaks of MOUs and drafts. The coverage is complemented by regional context on Liberia’s health system and broader donor dependence.
Go deeper
- What do the leaked documents reveal about data sharing and privacy safeguards?
- How might donor dependence affect Ebola or other outbreak responses in the region?
- What steps can civil society take to push for transparency and accountability?
More on these topics
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Human Rights Watch - Non-governmental organization
Human Rights Watch is an international non-governmental organization, headquartered in New York City, that conducts research and advocacy on human rights.
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United States - Country in North America
The United States of America, commonly known as the United States or America, is a country mostly located in central North America, between Canada and Mexico.
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Liberia - Country in West Africa
Liberia, officially the Republic of Liberia, is a country on the West African coast. It is bordered by Sierra Leone to its northwest, Guinea to its north, Côte d’Ivoire to its east, and the Atlantic Ocean to its south-southwest.
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Zambia - Country in East Africa
Zambia, officially the Republic of Zambia, is a landlocked country in Southern-Central Africa. Its neighbours are the Democratic Republic of the Congo to the north, Tanzania to the north-east, Malawi to the east, Mozambique to the southeast, Zimbabwe and
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United States Agency for International Development - Agency
The United States Agency for International Development is an independent agency of the United States federal government that is primarily responsible for administering civilian foreign aid and development assistance.
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Ebola hemorrhagic fever - Human disease
Ebola, also known as Ebola virus disease (EVD) and Ebola hemorrhagic fever (EHF), is a zoonotic viral hemorrhagic fever in humans and other primates, caused by four of the six known ebolaviruses. Symptoms typically start anywhere between two days and three weeks after infection. The first symptoms are usually fever, sore throat, muscle pain, and headaches. These are usually followed by vomiting, diarrhoea, rash, hepatic and renal dysfunction, at which point some people begin to bleed both internally and externally. Outbreaks of the disease have had a mortality rate of between 25 and 90%, averaging out at approximately 50%. The viral species involved and timing of treatment play a critical role in its prognosis. Death is often due to shock from fluid loss, and typically occurs between 6 and 16 days after the first symptoms appear. The viruses have caused intermittent outbreaks in sub-Saharan Africa since 1976 when the disease was first reported, with the largest one being the 2013–16 Western African epidemic. They spread through direct contact with body fluids, such as blood from infected humans or other animals, or from contact with items that have recently been contaminated with infected...