On September 18, 2025, global health cooperation began to quietly reshape the relationship between the US and the African continent. Under what Washington calls the “America First” Global Health Strategy, the US is signing bilateral agreements across Africa that promise billions of dollars to support national health systems, fight disease and train health workers. While the initiative offers investment at a time of cuts in international funding, it also raises questions about how global health partnerships are evolving and what they mean for Africa’s future.
For decades, many African health programs relied heavily on international aid mechanisms based on multilateral initiatives. The approach promoted by Washington moves away from that model and promotes direct agreements between governments. Kenya, Uganda, Liberia, Nigeria, Mozambique and Ivory Coast have already signed.
These agreements involve a shift from shared public goods to interest-driven mechanisms. The main hidden objective of this strategy is to reposition geopolitical power to counter China’s influence in Africa by adopting a model that replicates Beijing’s Belt and Road Initiative. Questions also arise about the economic implications of the agreements. Reports indicate that they may be linked to broader commercial interests, such as access to critical minerals and other strategic resources. From an economic point of view, health aid is considered a key mechanism for ensuring influence in regions where US economic and security interests converge.
For defenders of this path, the strategy represents a step towards greater national ownership of health systems. By encouraging governments to increase their health spending, the agreements aim to reduce dependence on foreign aid in the long term and promote greater national responsibility. In theory, this would help African countries build more sustainable health systems capable of responding to future crises.
However, the initiative also generates debate among public health experts and civil society organizations. Critics worry that replacing long-standing multilateral programs with bilateral agreements could create uncertainty in countries that rely heavily on external financing. Others have expressed concerns about transparency, particularly regarding the sharing of health data and biological samples.
To manage these agreements, African states must develop long-term resilience that depends on domestic investment, responsible governance and strong public institutions. Therefore, this new stage invites a broader reflection. Is this the beginning of a phase in which African countries have more control over their health systems? Or is it a shift towards more transactional forms of international cooperation, in which aid and diplomacy are increasingly intertwined?
As these agreements begin to take shape on the continent, their impact will depend not only on the funds they mobilize, but also on how they reshape the balance between partnership, sovereignty and responsibility in Africa’s health future.
