Late in February, Zimbabwe pulled out of a proposed $367m United States health funding agreement after objecting to provisions requiring broad American access to sensitive health data.

The five-year programme was presented as support for HIV/AIDS, tuberculosis, malaria and epidemic preparedness efforts.

However, the terms demanded extensive sharing of national health intelligence, including epidemiological surveillance data and pathogen samples, while offering no binding guarantees that Zimbabwe would receive equitable access to medical technologies developed from them.

Harare called the proposal an “unequal exchange”, warning that Zimbabwe risked supplying the “raw materials for scientific discovery” while the resulting benefits could remain concentrated in the United States and global pharmaceutical firms. Critics increasingly describe this pattern as biomedical extractivism: a toxic combination of exploitative research practices and colonial thinking that reinforces Western dominance.

In Lusaka, officials and civil society organisations have raised concerns about a proposed United States-Zambia health partnership valued at more than $1bn over five years. The draft would require Zambia to contribute roughly $340m in domestic co-financing while granting the United States far-reaching access to national health data and pathogen-sharing arrangements.

One controversial provision would allow the agreement to be terminated if Zambia failed to conclude a separate bilateral compact with Washington over minerals such as copper and cobalt.

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Kenya provides a third warning sign.

Its High Court suspended a similar $2.5bn agreement last December after a legal challenge contending that it could expose sensitive health data without adequate safeguards under Kenya’s Data Protection Act.

Together, the disputes in Harare, Lusaka and Nairobi point to a broader pattern. They are unfolding against the backdrop of a rapidly expanding network of bilateral global health agreements Washington has been negotiating across Africa under its “America First Global Health Strategy”.

According to tracking by the Kaiser Family Foundation, a US-based independent health policy research organisation, the United States has signed more than 20 memoranda of understanding with African governments, with implementation timelines running from 2026 to 2030 and total commitments approaching $20bn.

A significant share of that funding is expected to come from African governments themselves, allowing Washington to market the model as partnership while deepening asymmetry, fiscal pressure and dependence. At least 17 African countries have already concluded similar agreements, many with fragile health budgets and little negotiating leverage.

These pacts finance programmes against HIV/AIDS, tuberculosis, Ebola and malaria while strengthening disease surveillance systems, laboratory capacity and outbreak preparedness.

Nonetheless, they shift bargaining power sharply towards Washington. In Nigeria, for instance, the funding is contingent on Abuja committing “to prioritise protecting Christian populations from violence”.

From Zimbabwe to Zambia and Nigeria, the central controversy lies in what the United States expects in return: health data and pathogen samples. In the era of biotechnology and pandemic preparedness, this information feeds the global bioeconomy, powering vaccine platforms, pharmaceutical patents and artificial intelligence-driven drug discovery. Biological data has become as strategically valuable as oil, minerals or rare earths.

African public health systems could become upstream suppliers of biological information, while the downstream benefits — intellectual property, pharmaceutical manufacturing and commercial profits — remain concentrated in wealthier countries.

Those anxieties resonate with a longer history in which medicine in Africa has been closely intertwined with imperial power, racial hierarchy and foreign domination for more than a century. During the colonial period, European administrations often deployed medical campaigns that combined disease control with surveillance and coercive governance over African populations.

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One of the most brutal colonial medical campaigns occurred during sleeping sickness control programmes in French Equatorial Africa between 1921 and 1956. At the time, colonial authorities assembled entire villages for compulsory medical inspections and treatment. In many cases, people were forcibly examined and injected with experimental drugs intended to combat the spread of disease. Some medications, including atoxyl, were later found to cause severe side effects such as blindness and, in some cases, death.

Scepticism is also shaped by modern medical ethics controversies involving Western pharmaceutical companies. In 1996, during a meningitis epidemic in Kano in northern Nigeria, Pfizer Inc tested an experimental antibiotic called Trovan on 100 children at a field hospital.

Nigerian investigators concluded that it had been conducted without proper regulatory approval and a government inquiry described it as an “illegal trial of an unregistered drug”. Pfizer faced lawsuits from the Nigerian government and affected families and agreed to a $75m settlement with Kano State in 2009 while continuing to deny wrongdoing.

Public health systems produce laboratory results, epidemiological records, genomic sequencing and biological samples gathered during outbreaks. The global biotechnology sector generates more than $1.5 trillion annually and is projected to reach $3.88 trillion by 2030, making genomic data and pathogen samples among the most valuable scientific resources of the 21st century.

For decades, scholars of global health ethics have argued that international medical research must avoid exploiting populations in low and middle-income countries. In a widely cited 2004 study, bioethicist Ezekiel Emanuel and colleagues argued that ethical research in developing countries requires collaborative partnerships with local researchers, policymakers and communities, as well as the fair distribution of benefits.

That principle is clearly absent from the structure of the American bilateral health arrangements, and the stakes are clearer in the post-COVID world. During the early stages of the pandemic, scientists and laboratories around the world depended on rapid sharing of viral samples and genomic data to track the spread of the virus and develop vaccines.

Yet, when vaccines became available, many African countries found themselves at the back of the queue while wealthier countries stockpiled supplies. The World Health Organization’s Pandemic Agreement, adopted in May 2025, seeks to address this imbalance through a proposed pathogen access and benefit-sharing system linking pathogen sharing to fairer access to resulting technologies.

Bilateral health agreements risk undermining those multilateral efforts. By negotiating directly with individual countries, powerful states such as the United States can secure privileged access to pathogen information without being bound by broader mechanisms designed to ensure equitable benefit-sharing.

Timely access to pathogen data remains essential to global health cooperation and pandemic preparedness. The controversy lies not in sharing itself, but in whether countries providing the data receive open and just access to the resulting vaccines, diagnostics and treatments.

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African countries therefore face a delicate balancing act: safeguarding life-saving health programmes while defending data sovereignty, legal oversight and reciprocal partnerships. The answer may lie in collective negotiation through institutions such as the African Union and its autonomous health agency, the Africa Centres for Disease Control and Prevention, rather than unequal and fragmented bilateral pacts.

Although formally voluntary, negotiations between a global superpower and financially constrained health systems rarely occur on equal footing. Washington, for example, has since moved to wind down its health funding in Zimbabwe following the collapse of the negotiations, underscoring the risk facing other African countries that refuse to bend to its will.

In the 19th century, colonisation advanced through divide-and-rule tactics as Western powers picked off African societies one by one. Only united action today can prevent powerful states from imposing new forms of imperial control through country-specific accords.

The United States is now pursuing biological data and pathogen intelligence through policies that risk reproducing the power imbalances of colonial extraction in new scientific form.

Our governments must therefore defend medical sovereignty with unity and resolve.

If Africa shares its data and samples, the United States must share its own on equal and transparent terms.

African bodies are not cheap, expendable commodities.

The views expressed in this article are the author’s own and do not necessarily reflect Al Jazeera’s editorial stance.