Article by Sharifah Sekalala, Shajoe J. Lake, Allan Maleche, and Timothy Wafula: “On 4 December 2025, Kenya became the first country to sign a five-year bilateral global health agreement (BGHA) called a Health Cooperation Framework with the US, worth about US$1.6–2.5 billion and presented as a bold move to strengthen HIV, TB, malaria, and pandemic preparedness, including surveillance and workforce reforms. Soon after, Rwanda and Uganda signed similar BGHAs worth US$228 million and US$2.3 billion, respetcively. These agreements are explicitly branded as part of an “America First” global health strategy, under which dozens of similar bilateral deals are expected across Africa.
The official explanation is that the US needs near real-time access to Kenyan health data, including outbreak surveillance, to protect global health security and guide its investments. The BGHAs give US agencies access to digital health systems and outbreak databases, and authority to audit a sample of facilities, in exchange for large-scale funding that is framed as helping these countries achieve “health sovereignty”. A separate US template for BGHAs, reported in November, asked partner countries to share biological specimens and genetic sequences of pathogens with epidemic potential within days of detection, with specimen-sharing commitments lasting up to 25 years but without guaranteed reciprocal access to any vaccines or treatments later developed. Here, health data and pathogen access are the price of re-entering US funding circuits after earlier aid cuts.
Kenyan officials claim that only aggregated data will be shared and that Kenyan law, including the Data Protection Act and Digital Health Act, formally prevails over the agreement. However, in practice, when core systems, hosting, and analytics are controlled through foreign-designed architectures and contracts, local regulators face a steep uphill battle to supervise what happens once health data migrates…(More)”.
