Human Rights Watch: U.S. Tied Health Aid to Sweeping Data, Specimen and Inspection Conditions in African Deals

Human Rights Watch said Monday that the United States tied critical health aid to sweeping data-sharing, inspection and pathogen-sample provisions in bilateral agreements with several African countries after the 2025 pullback of U.S. Agency for International Development operations.

In an assessment published June 8, titled “Human Rights Assessment of the 2025-2026 US Bilateral Health Agreements,” and a related release headlined “US: Global Health Aid Tied to Harmful Conditions,” the rights group said the terms raise serious privacy, equity and transparency concerns. Human Rights Watch said it assessed seven U.S. health agreements signed in late 2025 with Ethiopia, Kenya, Mozambique, Nigeria, Rwanda, Liberia and Uganda.

The allegations matter because the agreements, according to Human Rights Watch, came as Washington shifted from the old USAID-led aid model to State Department-led bilateral deals after USAID operations were shut down or sharply curtailed in early 2025. Human Rights Watch said the cuts disrupted health supply chains and programs and included more than $800 million in health aid to the seven countries it examined.

“The agreements show the US intends to condition vital health assistance for millions of people on acquiescence to troubling conditions,” Julia Bleckner, a senior health researcher at Human Rights Watch, said in the group’s release.

Many of the specifics, however, remain based on documents Human Rights Watch said it reviewed, leaked texts and records that were only briefly posted online. The full set of signed agreements has not been publicly disclosed, according to the group, which said 31 agreements were reportedly signed with other governments.

Human Rights Watch said agreements with Ethiopia, Kenya, Mozambique, Nigeria and Uganda were briefly posted to the State Department’s FOIA/Case-Zablocki library on March 13, then removed days later. It said the Rwanda and Liberia agreements became public only through leaks. That means key details in the assessment rely on records Human Rights Watch says it obtained or reviewed rather than a complete public archive of the deals.

According to Human Rights Watch, the agreements condition continued U.S. funding on broad access to health-system surveillance data. The group said some of the deals also require pathogen or specimen sharing. It specifically identified agreements with Rwanda, Ethiopia, Uganda, Nigeria and Mozambique as referencing specimen-sharing arrangements that would give the U.S. access to biological samples and data from detected pathogens with epidemic potential.

Human Rights Watch said the agreements provide broad data access without clear limits, uniform safeguards or meaningful protections for patient confidentiality, including in countries with weak or no domestic data-protection laws. It also said the agreements contain no prohibition on sharing that data with U.S. pharmaceutical companies without patient consent.

The group said some agreements also permit unannounced inspections of health facilities to monitor compliance with the Helms Amendment, the longstanding U.S. restriction on foreign-aid funding for abortion services. And it said failure to provide required data could trigger the loss of all funding, in some cases with as little as 180 days’ notice.

On pathogen sharing, Human Rights Watch pointed to a draft template of the terms published by journalist and activist Emily Bass. According to the group, that draft shows no guaranteed equitable access for participating countries to diagnostics, vaccines or treatments developed from the samples or data they provide.

That concern, Human Rights Watch said, extends beyond the bilateral deals themselves. The group argued that the provisions risk undercutting ongoing World Health Organization negotiations over a Pathogen Access and Benefit-Sharing annex to the Pandemic Agreement, a multilateral effort to set rules for sharing pathogens and ensuring fair access to benefits such as vaccines, tests and treatments. WHO member states were still negotiating that annex between March and May 2026, Human Rights Watch said.

Opposition to the agreements has also come from African civil society, according to the group. It said more than 60 organizations wrote to African heads of state in December 2025 warning about draft terms.

Human Rights Watch also cited country-level resistance. It said Ghana withdrew from negotiations in April, citing concerns about broad data-access demands, and that Zimbabwe withdrew from negotiations entirely. The group cited Nick Mangwana, Zimbabwe’s secretary for information, publicity and broadcasting services, as saying that “development aid should empower nations, not create dependencies or serve as a vehicle for strategic extraction.”

In Zambia, Human Rights Watch pointed to reporting by The New York Times on a leaked State Department memo tied to a proposed $1 billion health package and access to minerals. The Times reported that the memo said, “We will only secure our priorities by demonstrating willingness to publicly take support away from Zambia on a massive scale.” That language has not been officially confirmed in the materials described by Human Rights Watch.

The central fact of this story is both the seriousness of the allegations and the limits on independent verification. Human Rights Watch says the U.S. attached broad surveillance, specimen-sharing and inspection conditions to health aid agreements with multiple African governments. But because most of the agreements have not been fully and publicly released, many specifics remain based on texts Human Rights Watch says it reviewed, leaked documents and records that briefly appeared online before being removed.