The Trump administration is pushing foreign governments — including countries with high HIV rates — to sign new agreements or lose access to life-saving aid. Global health organizations warn the approach could put millions of lives at risk.
“America First Global Health Strategy is unabashedly transactional,” Emily Bass, an expert consultant with Physicians for Human Rights, told Scripps News.
Nearly half of all African nations have signed these bilateral global health deals or Memoranda of Understanding (MOUs). While the deals largely focus on health funding, one proposal involving Zambia is drawing significant concern.
“Where Zambia's really, really different is that in the draft of the MOU that’s been circulating for a couple of months now, the U.S. basically says the quiet part out loud,” Bass said. “In other agreements, there’s definitely an understanding that there are things not on paper in this health-related MOU that are definitely in play.”
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According to The New York Times, the draft agreement outlines that the U.S. would provide Zambia with $1 billion in health funding over five years if the country commits $345 million of its own health funding. Additionally, Zambia would grant American businesses more access to its mining industry.
While a draft obtained by Scripps News does not explicitly mention mining rights, a previous plan between Zambia and the U.S. included a commitment to “a plan that aims to unlock a substantial grant package of U.S. support in exchange for collaboration in the mining sector.”
The Times reported that Zambia faced an April deadline to sign the MOU. A State Department spokesperson told Scripps News on Tuesday that discussions over the agreement continue and that the U.S. has not cut health funding for Zambia.
In its “America First Global Health Strategy,” the U.S. stated that the aim of these deals is to reduce American investment and push nations to increase their own health spending. However, experts warn that tying non-health demands to health aid risks destabilizing treatment systems built over decades.
“When we look at South Africa, we can see what happens when a government is doing its level best to respond with resources to address an epidemic — and then the U.S. pulls out,” Thomas McHale, public health director of Physicians for Human Rights, told Scripps News.
South Africa, which has the largest HIV population in the world and was the top international recipient of National Institutes of Health research funds, has seen a disruption to critical community-based systems. McHale said these systems expanded access to health programs for the most marginalized and deeply impacted groups during the HIV/AIDS epidemic.
“Those systems in the communities for people to access care and treatment have evaporated. Those were uniquely funded by the U.S.,” McHale said. “And now international donors and those programs aren’t there. People told us about no longer seeing the vans that would come to their community with testing supplies and linkages to services.”
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McHale added that the new infrastructure envisioned under America’s global health strategy — which abandons these systems — makes it harder to understand the scale of the epidemic after funding cuts.
“We’re seeing a decrease in people accessing prevention services, and we’re seeing a decrease in those accessing the community-based programs that were really critical because those programs have been taken offline,” Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition, told Scripps News.
“What we’re seeing is a step backward in terms of the types of transparency that we’ve expected and had under the current programming,” Brian Honermann, deputy director of amfAR’s Policy Office, told Scripps News.
Honermann said the metrics and targets being set for MOUs don’t provide a real basis for transparency or oversight.
“When we take our foot off the gas in terms of continuing to put all our effort and focus into getting people diagnosed, identifying where disease is being spread in very small geographic areas, and investing our resources in those responses, we create the space where diseases can resurge,” Honermann said.
“And we go back to a situation where we’re going to need major investments just to get people back to where we are now,” he added.
