Under the "America First" Global Health Strategy, the US has negotiated opaque agreements with several countries to restore funding previously slashed by the shuttering of USAID. These deals, which follow a massive withdrawal of support in 2025, force nations like Ethiopia, Kenya, Mozambique, Nigeria, and Uganda to adopt measures that threaten reproductive rights and medical privacy. In one instance, a draft memorandum with Zambia explicitly linked $1 billion in disease prevention aid to a separate treaty granting US companies access to local mineral resources.
Internal documents, including a State Department memo prepared for Secretary Marco Rubio, frame these tactics as a deliberate strategy to secure US priorities through the threat of withholding aid. Beyond resource extraction, the agreements mandate that recipient nations share biological specimens and provide Washington with unrestricted access to patient data and health facility audits. These requirements are ostensibly designed to monitor compliance with the Helms Amendment, but critics warn the lack of safeguards leaves private health information vulnerable to exploitation by US pharmaceutical firms without patient consent.

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