Rapid US health deals spark concerns over lack of public consultation

The United States is on a rapid-fire quest to sign dozens of new bilateral health agreements with countries in the coming weeks. In the past week, it’s inked deals with Kenya, Rwanda, Liberia, and Uganda. This is part of the new “America First” global health strategy that prioritizes direct agreements with governments as opposed to funneling money through nongovernmental organizations. It also aims to leverage faith-based organizations and the private sector. But concerns around this process are mounting. Forty-six civil society organizations published a letter to African government leaders on Wednesday expressing wide-ranging concerns around the deals in areas such as data sovereignty — and stating the terms are dictated by the U.S. and not by African interests. They wrote that the agreements have a “rushed timeline and extremely limited inclusion of civil society.” “Bilateral partnerships should be co-developed, mutually beneficial, aligned with national interests, and consistent with regional and international efforts to strengthen health systems and disease response,” the letter stated. The lack of public participation is particularly concerning for many because the agreements involve African countries putting forward their own taxpayer dollars for cofinancing. The Kenyan government, for example, is bolstering its agreement with the U.S. by adding $850 million from its own budget. Because the memorandums of understanding dedicate public resources, they should involve robust public participation, Aggrey Aluso, executive director of the Resilience Action Network Africa, told Devex. These agreements are helping define national health priorities that are going to receive investments for years to come — and those priorities should reflect the needs of the country, not the U.S., he said. In that vein, Kenyan Sen. Okoiti Omtatah is seeking a court order to suspend the agreement, saying it violated the country’s constitution when it was signed without public participation and parliamentary approval. “No consultations were held with health stakeholders, civil society, or affected members of the public prior to the signing,” he said. Many are also concerned that African nations are losing collective bargaining power by negotiating directly with the U.S. instead of as a continental bloc — and that this could leave some countries that have less geopolitical clout with less leverage at the negotiating table. “I call it a divide and conquer approach that the U.S. adopted,” Aluso said. “It's one of the biggest failings, and probably a strategy that was well calculated to isolate and conquer, so to speak, to get the maximum from countries that are vulnerable.” A key element of the “America First” global health strategy is to support countries with disease surveillance and early detection, but Aluso said these are cross-border issues and would benefit from a collaborative approach. He said he hopes that early signers of the agreement make their agreements public so that others can use them as a reference point to secure stronger agreements for themselves.