Imagine a world where the world’s most powerful nation dangles essential health aid over countries like a carrot, but only if they surrender their most valuable biological treasures – that’s the shocking reality we’re facing today with the United States’ latest global health policy moves!
But here’s where it gets controversial… In a move that’s raising eyebrows and sparking heated debates, the US is pushing to require nations receiving its assistance for battling HIV, tuberculosis, and malaria to hand over every detail about ‘pathogens with epidemic potential’ as a condition of that help. This revelation comes from an internal US government document, the ‘PEPFAR Memorandum of Understanding (MOU) template,’ which Health Policy Watch has obtained. For those new to the terms, PEPFAR – short for the US President’s Emergency Plan for AIDS Relief – is a major initiative launched decades ago to combat AIDS globally, and it’s now evolving in ways that could reshape international relations.
Under these bilateral agreements, recipients aren’t just sharing data; they’re committing to a ‘specimen sharing agreement’ that obliges them to provide biological samples and genetic sequence information on these pathogens to the US within just five days of discovery. What’s more, this sharing commitment is designed to stretch for a full 25 years, far outlasting the aid period itself, which runs from 2026 to 2030. Intriguingly, the document notes that this specimen-sharing pact is still under development, but credible sources close to the matter confirm that the US is actively implementing these MOUs with several African nations.
And this is the part most people miss… These one-on-one deals with the US could completely derail the broader Pathogen Access and Benefit Sharing (PABS) framework that’s currently being hammered out by member countries of the World Health Organization (WHO). For context, the WHO is the United Nations agency dedicated to international public health, and it recently exited under the Trump administration in January. PABS represents the final piece of the WHO’s Pandemic Agreement, a landmark accord approved in May after years of intense negotiations. This system aims to ensure fair access to pathogen data while guaranteeing that sharing countries benefit from any resulting innovations, like vaccines or treatments. Developing nations, especially those in the Global South, have been adamant that they deserve a cut of the profits or benefits from research derived from their shared samples – think of it as a fair trade agreement for biological resources, much like how countries negotiate royalties for natural resources.
The Intergovernmental Working Group (IGWG), tasked with crafting a balanced PABS model, kicked off detailed text-based talks just this week, focusing on striking that delicate equilibrium between open access and equitable rewards. Yet, the US’s bilateral MOUs sidestep any mention of such benefits for the sharing countries, instead offering support to bolster their disease surveillance capabilities and lab infrastructure. To illustrate, the US pledges to fund an evaluation of each country’s outbreak detection systems, covering everything from safe procedures for collecting, transporting, storing, testing, and disposing of pathogen samples.
Additionally, there’s commitment to pay salaries for field epidemiologists – those frontline experts tracking diseases – but only through 2026. After that, countries must gradually take over an increasing share of these costs until the grant ends in 2030. Similarly, funding for certain lab technicians and all necessary supplies for pathogen identification starts at 100% in 2026, contingent on available funds, but it’s slated to taper off in subsequent years. Even the logistics of shipping specimens to labs will shift to the recipient countries post-2026. This approach might sound pragmatic for building sustainability, but it leaves some wondering if it truly empowers local systems or just shifts burdens.
The goals here are tightly defined, as outlined in a companion technical guide, emphasizing collaboration between the US Department of State and partner nations to promote American interests, preserve lives, and foster robust health systems. The PEPFAR template hones in on nine specific targets: boosting HIV testing and antiretroviral therapy, cutting tuberculosis fatalities, reducing malaria deaths in kids under five, improving maternal and under-five mortality rates, and ramping up polio and measles vaccinations. It’s heavily oriented toward outbreak response, demanding that recipient countries detect potential epidemics or pandemics within seven days of emergence and alert the US within 24 hours.
Once these MOUs are inked, funding could flow starting in April 2026, a timely relief for African nations hit hard by disruptions. Recall that in January, the US imposed a three-month freeze on foreign aid, abruptly halting or interrupting HIV treatment programs in many places. Despite reassurances that life-sustaining efforts continue, full resumption has been patchy, leaving communities in limbo.
This all ties into the US State Department’s September unveiling of the America First Global Health Strategy, which promises to restart funding for HIV, tuberculosis, malaria, and polio medications, along with salaries for health workers delivering these services – at least for the 2026 fiscal year. These funds will flow through direct deals with governments and faith-based groups. The strategy’s three core pillars? Keeping America secure, robust, and affluent. It also outlines how the Trump administration plans to overhaul PEPFAR and take over roles previously handled by the now-disbanded US Agency for International Development (USAID), which was a key player in global aid.
US Secretary of State Marco Rubio hailed the plan as ‘a positive vision for a future where we stop outbreaks before they reach our shores, forge bilateral agreements that advance our national priorities while rescuing millions of lives, and champion American health innovations worldwide.’ It’s a vision that prioritizes US security and prosperity, but does it come at the expense of global solidarity?
Here’s the controversy that could divide opinions… Critics argue this ‘America First’ approach might undermine collective efforts like the WHO’s PABS, favoring unilateral US dominance over multilateral cooperation. Is this a smart way to protect American interests, or does it risk alienating allies and hindering global responses to future pandemics? For instance, if countries feel exploited by one-sided deals, they might hesitate to share data openly, potentially slowing down breakthroughs. On the flip side, proponents might see it as a pragmatic enforcement of transparency that saves lives by enabling rapid US-led interventions. What do you think – does this strategy foster true global health partnership, or is it just a veiled grab for power? Could there be a win-win compromise that balances national interests with international equity? We’d love to hear your takes in the comments – do you agree with this ‘America First’ pivot, or do you see it as a step backward for worldwide collaboration?
Image Credits: UNAIDS.
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