U.S. Africa health data agreements negotiated by the Trump administration are tying medical aid to access to national health systems, according to a ProPublica review, prompting warnings from African digital rights advocates and global health experts about privacy, consent and sovereignty.
Uganda accepted one such agreement on Dec. 10, after weighing access to U.S. funding for HIV, malaria, tuberculosis and other health programs against demands for data access. Frank Ssekamwa, a Ugandan attorney and digital rights expert, told ProPublica the choice amounted to exploitation either way, calling it “digital colonialism.”
ProPublica reported that Zambia, Zimbabwe and Ghana rejected initial versions of similar deals. The negotiations follow the dismantling of the U.S. Agency for International Development and form part of Secretary of State Marco Rubio’s America First Global Health Strategy, which says aid should directly advance U.S. interests.
What are the U.S. Africa health data deals?
The agreements are country-by-country arrangements that exchange U.S. global health funding for commitments from recipient governments, including greater domestic health spending and data sharing. ProPublica said it reviewed nine agreements or related documents, including Uganda’s data-sharing deal, Kenya’s data agreement, pathogen-sharing agreements and templates analyzed by Public Citizen.
The State Department told ProPublica it needs the data to improve health outcomes abroad and protect Americans from infectious disease threats. A department spokesperson said the deals involve aggregated, de-identified information of the kind already used in programs fighting HIV/AIDS, malaria, tuberculosis and other diseases, and said no personally identifiable information is being shared with or received by the U.S. government.
What data would the U.S. get from Uganda?
Under Uganda’s agreement, ProPublica reported, the U.S. gets direct, real-time access for seven years to nine national health data systems. Those include Uganda’s central health information repository, laboratory data, information collected by community health workers and the system used to manage electronic medical records.
The agreement says the shared information should be aggregated and stripped of personally identifiable details, and used for delivering and auditing health services. Uganda is set to receive up to $1.7 billion over five years for global health security and treatment or prevention of diseases including malaria, tuberculosis, HIV and polio.
Privacy specialists consulted by ProPublica said the terms are too vague and omit limits commonly found in data-sharing agreements, including tighter controls on what can be collected and how it can be used. They warned that anonymized health records can sometimes be reidentified, especially when large datasets are combined with other information or processed with AI tools.
Stephanie Psaki, who coordinated global health security under President Joe Biden, described the administration’s demand as asking for a login to another country’s data systems. She told ProPublica the U.S. would not accept the same arrangement if another government asked for American records.
Ssekamwa said Ugandans have not received clear answers about whether U.S. protections are adequate, whether local systems can reliably provide anonymized data and whether health records could later affect decisions such as visa eligibility. Uganda’s health ministry, foreign ministry, data protection office and Washington embassy did not respond to ProPublica’s questions.
Kenya’s deal is already in court
Kenya signed its agreement first, with $1.6 billion in aid tied to access to seven years of health records, according to ProPublica. Activist Nelson Amenya posted concerns on X that the deal could expose records involving HIV tests, tuberculosis diagnoses, malaria cases and children’s health data.
Kenyan Sen. Okiya Omtatah sued government officials, arguing the agreement threatens constitutional privacy rights by allowing broad foreign access to sensitive data. A Kenyan nonprofit also sued. Kenya’s government argued in court that it must pursue the highest attainable standard of health and cannot do so without support. In May, a Kenyan court temporarily allowed the agreement to proceed while it considers the case.
Several reviewed agreements also cover pathogen samples. Some require countries to begin sharing specimens and related data within five days of a U.S. request, ProPublica reported. Five of six specimen-sharing agreements reviewed say the U.S. would prioritize its own needs before a partner country’s request if a medical product is developed mainly from that country’s sample. The State Department said each agreement contains benefit-sharing provisions.
This story draws on original reporting from Techdirt.
