(Washington, DC) \u2013 The\u00a0United States government is conditioning lifesaving health assistance on broad access to surveillance data and extractive rights to pathogen samples and data for pharmaceutical development, Human Rights Watch said today. Human Rights Watch issued an assessment of seven bilateral health agreements signed in late 2025 with Ethiopia, Kenya, Mozambique, Nigeria, Rwanda, Liberia, and Uganda.
\u201cThe agreements show the US intends to condition vital health assistance for millions of people on acquiescence to troubling conditions,\u201d said\u00a0Julia Bleckner, senior health researcher\u00a0at Human Rights Watch. \u201cAfter the sudden and devastating pullback from US assistance in 2025, governments are now being pressured to accept agreements with contingencies that jeopardize human rights.\u201d
The agreements raise serious concerns about access to people\u2019s private health care data and about exclusive agreements that would prohibit a more equitable distribution of health care goods, Human Rights Watch said.
\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n \n \n June 8, 2026\n \n \n Human Rights Assessment of the 2025-2026 US Bilateral Health Agreements\n\n \n \n \n \n\n \nThe US government\u00a0has not publicly disclosed details of\u00a0the 31 agreements reportedly signed with other governments. The agreements with Ethiopia, Kenya, Mozambique, Nigeria, and Uganda were briefly posted to the US State Department\u2019s Freedom of Information Act Library on March 13, 2026, under the Case-Zablocki Act, which requires timely public disclosure of international agreements.
They were removed days later, after the New York Times\u00a0reported that the US had\u00a0linked a US$1 billion health package to access to Zambia\u2019s minerals, with a\u00a0leaked State Department memo stating that the US would \u201conly secure our priorities by demonstrating willingness to publicly take support away from Zambia on a massive scale.\u201d
Rwanda and\u00a0Liberia\u2019s agreements were never officially released and became publicly available only through leaks. The US should immediately publish all of these agreements, Human Rights Watch said. It should also disclose information on any ongoing negotiations for access to natural resources in countries that have signed these agreements, in light of the Zambia revelations.
The agreements were negotiated after the US government shut down the US Agency for International Development (USAID) in early 2025, which abruptly cut\u00a0health care supply chains and shuttered health programs around the world. These cuts included\u00a0over $800 million in health aid to Ethiopia, Kenya, Mozambique, Nigeria, Rwanda, Liberia, and Uganda, creating a public\u00a0health crisis and\u00a0threatening to undo decades of progress on HIV, Human Rights Watch said.
Civil society organizations across Africa have opposed these new agreements. In December, more than 60 organizations wrote to African heads of state raising concerns about what they saw as \u201cdangerous\u201d terms of the draft agreements.\u00a0LGBT rights organizations in Kenya and Uganda said the agreements fail to adequately address the needs of marginalized groups who cannot safely access public health services due to criminalization and discrimination.
In Zambia, two human rights organizations\u00a0filed an appeal with the national human rights commission for its failure to disclose the Zambia-US agreement and, on March 30, a coalition of civil society organizations\u00a0urged the Zambian government not to sign the deal. Zimbabwe withdrew from negotiations entirely, with Nick Mangwana, Zimbabwe\u2019s Information, Publicity and Broadcasting Services Secretary\u00a0stating that \u201cdevelopment aid should empower nations, not create dependencies or serve as a vehicle for strategic extraction.\u201d
The agreements require recipient countries to allow the US broad surveillance over their health systems and, in some cases, unannounced inspections of health facilities to ensure compliance with the Helms Amendment, a US law banning foreign assistance for abortion services.
While US foreign aid agreements have historically required compliance with US law, including\u00a0the Helms Amendment, the terms in the current agreements enforce compliance through extensive surveillance without proper privacy safeguards and state that failure to provide this data could result in the withdrawal of all funding. This could create conditions that cut off their access to lifesaving medications with as little as 180 days\u2019 notice.
The agreements with Rwanda, Ethiopia, Uganda, Nigeria, and Mozambique reference specimen sharing arrangements to provide the US with biological samples and data of detected pathogens with epidemic potential as a condition of continued health funding. The terms of these arrangements have not been made publicly available.\u00a0A draft template of the terms published by Emily Bass, a journalist and HIV/AIDS expert and activist, indicates that there is no guarantee that countries will receive equitable access to diagnostics, vaccines, or treatments developed from their own biological resources.
The terms of the pathogen access and benefit sharing portion of the agreements threaten to undermine ongoing negotiations at the WHO to create a pathogen access and benefit sharing system that commits to more equitable distribution of healthcare goods derived from shared pathogens and data, Human Rights Watch said.
The agreements raise serious concerns about use of people\u2019s private health data, without clear limits, uniform safeguards, or meaningful protections for patient confidentiality, including in several countries with weak or absent domestic data protection laws. The agreements contain no prohibition on this data being shared with US pharmaceutical companies without patient consent. In April, Ghana\u00a0withdrew from negotiations citing concerns over the broad demands for data access.
\u201cGovernments negotiating health assistance agreements with the United States face difficult choices,\u201d Bleckner said. \u201cThey should be wary of terms asking them to sign away their populations\u2019 rights and push for the inclusion of civil society representative and multilateral global health organizations like the Global Fund in deliberations.\u201d
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