Kenyan health workers wait to receive a COVID-19 vaccine supplied by Gavi, the Vaccine Alliance. Credit: Simon Maina/AFP via Getty
The United States is rolling out bilateral health agreements across Africa under its America First Global Health Strategy. Its announcement on 4 December of a US$1.6-billion health agreement with Kenya was the first, and signals a shift in how the United States intends to engage with African health systems. Rather than strengthening relevant continental bodies such as the World Health Organization (WHO), the African Union and the Africa Centres for Disease Control and Prevention (CDC), the strategy leans towards one-to-one agreements between governments.
The timing could not be more delicate. It follows the United States’ withdrawal of funding from Gavi, the Vaccine Alliance, and the WHO, two international health institutions that African governments rely on for vaccines, coordination and technical support, and the importance of which in the region has grown since the COVID-19 pandemic.
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During the pandemic, countries across Africa faced devastating delays in accessing vaccines, medical supplies and diagnostic tools. Front-line responders and laboratories struggled. Surveillance systems had uneven coverage. Outbreak information moved too slowly. Countries negotiated alone for tools they needed but could not secure.
In 2022, led by the Africa CDC, African leaders endorsed a New Public Health Order to build continent-wide systems to protect everyone, not just the states with the most leverage. One example is the Continental Cholera Emergency Preparedness and Response Plan for Africa. Developed by the Africa CDC and the WHO, and endorsed by heads of state in August, it outlines how countries should respond to cholera as a single coordinated unit.
The plan establishes one team, one plan, one budget and one monitoring framework. It describes how responders can deploy from one country to another rapidly; how national laboratories with sequencing capacity can support testing for neighbours with fewer resources; and how information should flow seamlessly across borders so that no outbreak is hidden by a lack of capacity.
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Another example is Africa’s Health Security and Sovereignty Agenda, which was outlined by the Africa CDC in November. It includes stronger mandates for the CDC, harmonized regulatory pathways, expansion of regional manufacturing and cross-border surveillance systems built on shared data.
By contrast, the America First Global Health Strategy prioritizes bilateral health agreements with individual governments, with limited reference to the role of continental bodies. It creates space for parallel systems that might not connect to Africa’s surveillance networks or regulatory structures. This shift raises three concerns.