tags: trump, africa, health, data

America's New Colony: Health Data

The United States is trading lifesaving medicine for access to the private medical records of millions of Africans, and the countries have no real choice but to say yes.

"If you take the deal, you're going to be exploited. If you don't take it, you're going to die. It's the essence of digital colonialism."

— Frank Ssekamwa, digital rights attorney, Uganda

After the Trump administration dismantled USAID last year, terminating thousands of humanitarian programs and firing nearly its entire workforce, the countries that depended on American aid faced an existential crisis. Clinics lost their medicine. Health workers lost their salaries. In places where malaria, tuberculosis, and HIV run rampant, the lifelines were cut.

Congress eventually forced the administration's hand, appropriating billions in foreign aid and directing the State Department to keep global health programs running. But the aid that followed came with a new condition that had never been attached before: give the United States direct access to your citizens' health data, or lose the funding entirely.

More than 30 countries have signed agreements under the Trump administration's "America First Global Health Strategy." ProPublica's review of nine of those deals reveals a pattern of aggressive data extraction from nations too desperate to refuse. The United States is gaining real-time access to national health databases, electronic medical records, lab data, and community health worker records. In exchange, it is offering less funding than before, decreasing over the life of each agreement.

Translation: this is not aid. This is a toll.

In Uganda, the deal was straightforward. The U.S. would provide up to $1.7 billion over five years for HIV, malaria, tuberculosis, and polio programs. In return, Uganda would grant the U.S. government direct access to nine of the country's health data systems, including its central health information repository and its electronic medical records system. The agreement lasts seven years.

Frank Ssekamwa, who runs the African Centre for Digital Justice, said the Ugandan government understood the terms but had no leverage. "We are happy to benefit from technological advancement and the fruits of big data," he said. "Instead, the U.S. has left so many gaps within the agreement, which can be exploited in their favor."

The agreement says personally identifiable information will be removed. But data privacy experts point out that anonymized health data can be reverse-engineered, particularly with AI tools. People living with HIV, tuberculosis, or mental health conditions could be re-identified. In parts of Africa, that disclosure can lead to discrimination, job loss, and violence.

Kenya faced the same dilemma and made the same choice under pressure. A deal worth $1.6 billion came with seven years' worth of health records access. The U.S. support only runs for five. Two Kenyan lawsuits have challenged the agreement as unconstitutional, arguing it violates citizens' right to privacy. A court temporarily allowed it to proceed while it considers the case.

Zambia, Zimbabwe, and Ghana were outraged enough to reject initial deals. The result: aid dried up. PBS reported on Ghana's struggle to fight disease and poverty without vital U.S. assistance. Doctors Without Borders documented how HIV funding cuts are undermining years of progress in Zimbabwe.

The United States made its position clear: sign the deal, or watch your clinics close.

The push for data access was driven by Brad Smith, a former DOGE advisor brought on to restructure the State Department's global health apparatus after USAID was destroyed. Smith had founded healthcare data companies before joining the administration, including CareBridge, which sold for $2.7 billion in 2024. He worked around the clock, calling State Department staff at all hours, pushing spreadsheets through budget review.

The resulting agreements lack standard safeguards found in most data-sharing contracts. They do not require the U.S. to limit data collection to the minimum necessary. They leave open questions about who ultimately has access to the data and how it can be used beyond the stated purpose of auditing and disease prevention.

In the era of artificial intelligence, large health datasets are worth billions. They are used to train diagnostic models, develop drugs, and drive pharmaceutical innovation. The agreements provide no guarantee that the populations whose data is extracted will benefit from products developed from it.

Five of six specimen-sharing agreements reviewed by ProPublica state that if a medical product is developed from a country's biological samples, the U.S. government will "prioritize" that country's request for access behind the needs of American citizens. Only Nigeria's agreement includes a commitment to donate products developed from its specimens.

Stephanie Psaki, the former U.S. coordinator for global health security under Biden, called the approach a "blunt instrument of 'just give me the login to your data systems.'" She added that the U.S. "would never agree to that" if the deal were reversed.

She is right. Ask the United States to hand over direct access to its national health records to any foreign government, and the idea collapses under its own absurdity. The fact that it is being imposed on nations that cannot afford to say no is the whole point.

The State Department declined to release its agreements with partner nations, telling ProPublica the documents would not be available until September 2027. Public Citizen recently filed suit to force disclosure. The agency described its refusal as "protecting sensitive negotiations, not secrecy."

Meanwhile, the Trump administration's withdrawal from the World Health Organization and its refusal to participate in pandemic preparedness negotiations have created gaps in global disease surveillance. The patchwork of bilateral deals cannot replace the multilateral systems the U.S. abandoned. During the current Ebola outbreak in the Democratic Republic of Congo, five of the nine neighboring countries have not signed agreements with the U.S. Psaki noted that the U.S. needs data and samples from all nine to respond effectively. "We don't have that."

The administration's own numbers illustrate the scale of the retreat. By the end of March 2026, the State Department had obligated just $190 million in global health spending, roughly 5% of the average pace in the five years before Trump returned to office. Typical administrations obligate about half of their annual budget by that point.

The OMB, led by Russell Vought, has labeled over $500 million in global health money as "unallocated," meaning the State Department cannot spend it without White House approval. The implication, according to career officials, is that the administration plans not to spend it at all.

The America First Global Health Strategy openly states its purpose: make the country "more prosperous" and "promote American health innovations." A State Department spokesperson said both sides are "putting skin in the game to ensure lasting impact."

But the countries signing these agreements are not negotiating partners. They are nations facing preventable epidemics with dwindling resources. When a government holds the keys to malaria medication and tells a country to hand over its health database in exchange, that is not a negotiation. That is extortion with a press release.

The U.S. once provided aid to save an estimated 170,000 Ugandan lives per year, with no strings attached beyond basic accountability. Now the same aid comes with demands that would be unthinkable in any bilateral relationship between equals. The aid is less than before, decreasing annually, and the country must surrender its data sovereignty for the privilege of receiving it.

The question is not whether these deals are colonial. The question is why anyone pretended they were not.