The America First Global Health Strategy and the Dilemma of Pan-Africanism

Nelson Aghogho Evaborhene explores the credibility of Pan-Africanism as a governing principle in an era of geopolitical fragmentation.

In his 1966 speech at the inauguration of the University of Zambia, Julius Kambarage Nyerere, then President of Tanzania and a key architect of Pan-African thought, reflected on what he called the dilemma of the Pan-Africanist: the tension between pursuing national priorities and advancing continental unity. At the time, the continent had recently emerged from colonial rule, and newly independent states faced the urgent task of building functional governments, economies, and institutions while also pursuing the broader vision of African solidarity. Nyerere warned that each state, accountable primarily to its own citizens, would inevitably confront conflicts between short-term domestic imperatives and the long-term goal of continental unity. 

Six decades later, this dilemma persists in global health. African leaders have articulated renewed commitments to self-reliance, domestic resource mobilization, and continental coordination. Yet the United States’ America First Global Health Strategy, along with a growing number of bilateral health and pathogen-sharing agreements, has exposed the inherent tension between national pragmatism and collective continental ambition.

The challenge therefore is not engagement with external partners, but the absence of continental rules over how such engagement occurs. While the African Union has developed frameworks such as the Malabo Convention on Cyber Security and Personal Data Protection, which establishes principles for cross-border data exchange, privacy, and national control of sensitive information, implementation remains uneven across member states. 

In practice, many bilateral health agreements proceed without reference to such continental standards, leaving gaps that weaken collective negotiating positions. What is defended domestically as pragmatic bilateralism is, in aggregate, eroding the credibility of Africa’s health sovereignty agenda. The America First Global Health Strategy did not create this dilemma. It exposed it.

From Aid Retrenchment to Continental Resolve

The retrenchment of traditional development assistance has defined the post-pandemic period. Cuts to global health financing and the reorientation of donor priorities toward domestic resilience and national security have undermined predictable funding for core health programmes, exposing the fragility of aid-dependent models.

In response, African leaders have articulated an unusually assertive agenda for rebalancing the global health system toward African leadership, sustainability, and self‑reliance. A landmark expression of this shift was the Africa Health Sovereignty Summit, convened by His Excellency John Dramani Mahama, President of Ghana, in August 2025. Heads of state, continental policymakers, and key global health stakeholders endorsed a declaration calling for a reconfigured global health order that embeds equity, national ownership, and sustainable financing at its core. Among other outcomes, summit participants formally endorsed the Accra Initiative. 

This momentum continued with the launch of the Accra Reset at the 80th session of the UN General Assembly in September 2025. Framed as Reimagining Global Governance for Health and Development, the Accra Reset proposes a new architecture of cooperation anchored in sovereignty, workability, and shared value creation, with health as a central entry point. It seeks to move beyond aid toward innovative financing, strategic investment coalitions, and political leadership across Africa, Asia, and Latin America.

These initiatives were widely welcomed across African political and institutional circles as a substantive effort to reposition health governance on terms that reflect African priorities. They have drawn support from multilateral and private sector figures alike: former UK Prime Minister Gordon Brown described the Accra Reset as “a plan for the future,” while WHO Director‑General Dr Tedros Adhanom Ghebreyesus and WTO Director‑General Ngozi Okonjo‑Iweala signalled institutional interest in re‑engineering global norms to enable greater African agency.

The renewed emphasis on domestic responsibility resonates with longstanding Pan‑African aspirations to reduce external vulnerability, assert sovereign agency, and negotiate with global partners from a position of strength. It reflects a strategic reassessment of Africa’s role in shaping its own health destiny.

Bilateralism and the Return of the Dilemma

Despite efforts to strengthen continental health governance, several African states have pursued bilateral agreements with the United States under the America First Global Health Strategy. Kenya became the first to sign the framework in December 2025, securing approximately US$1.6 billion over five years in exchange for increased domestic health spending and workforce commitments. Rwanda followed with a US$228 million agreement, while Uganda concluded a roughly US$2.3 billion pact pairing U.S. funding with national co-investment obligations to scale up domestic health financing and co‑investment in priority disease programmes.

These agreements were concluded while negotiations on the global Pathogen Access and Benefit Sharing system under the Pandemic Agreement remain incomplete, raising questions about the timing and strategic implications of bilateral deals finalized before multilateral frameworks are operationalized. At the same time, the shift toward country-to-country arrangements is occurring in a highly constrained institutional environment. 

U.S. legislative proposals explicitly prohibit global health compacts with the African Union and its affiliated entities, including the Africa Centres for Disease Control and Prevention. In response, Africa CDC has undertaken targeted engagement with U.S. policymakers to safeguard continental coordination.  Yet African countries are still expected to shoulder greater responsibility and financial obligations, even as the platforms designed to coordinate that responsibility remain marginalized.

The AU has formally called on the United States to remove Africa CDC from the list of prohibited entities and to promote collaboration through regional and continental platforms. The AU has argued that such engagement would not undermine bilateral cooperation but instead strengthen it by providing a coherent framework through which bilateral initiatives can align with continental priorities.

These dynamics illuistrate a familiar paradox of Pan-Africanism: collective vulnerability coexisting with individual incentives to defect. The outcome, as Nyerere noted, is “not only in worse terms for each country in relation to aid or trade, but also in a climate of mutual suspicion, where neighboring states may seek to exploit any perceived weakness for their own advantage.”  Today, short-term domestic pressures are again generating asymmetry and mistrust, even as all countries profess a shared interest in health sovereignty.

Divergent African Responses to Bilateral Health Agreements

Responses across countries illustrate the tension. In Kenya, the framework sparked parliamentary debate, civil society mobilisation, and legal action, including a High Court Conservatory order temporarily suspending implementation of provisions related to data transfer and health information sharing pending further review. 

Similar dynamics are now visible in West Africa. In Liberia, a proposed US$176 million bilateral health cooperation memorandum with the United States has triggered parliamentary demands for full disclosure and public debate. Legislators have raised concerns over data sovereignty, digital surveillance, and long-term financial obligations, particularly in the absence of a national data protection framework. 

By contrast, in Rwanda, the agreement proceeded with limited public contestation, reflecting the country’s more centralized policymaking environment. Uganda framed its partnership as a co-investment model aimed at strengthening national health systems and enhancing self-reliance; high-profile litigation or suspension actions have not yet emerged, though civil society discourse on sovereignty and data governance continues.

These divergent pathways underscore that continental unity is most fragile precisely where national political institutions and economic conditions differ most sharply.

Reimagining Pan-Africanism in Global Health

The current moment demands a more pragmatic interpretation of Pan-African health governance. As Nyerere warned, “To talk of unity as though it would be a panacea of all ills is to walk naked into a den of hungry lions,” highlighting the risks of assuming African solidarity without mechanisms to enforce it—a lesson that resonates today in global health governance. The Africa CDC and, more recently, the African Medicines Agency have been at the forefront of the continental health project. 

In response to donor retrenchment, Africa CDC first launched the Africa Health Financing in a New Era framework, signaling a shift toward domestic resource mobilization and sustainable financing. Later, it articulated the “Africa’s Health Security and Sovereignty Agenda”.  To translate this agenda into practice, the African Union has requested Africa CDC to host the Africa Health Sovereignty Initiative, led by H.E. John Dramani Mahama, and to report regularly to the AU Assembly on progress made. Yet, unity cannot rest solely on declarations or shared history; it must be operationalized through institutions, incentives, and accountability mechanisms that make cooperation politically viable.

This operationalization is especially crucial following the adoption of the Pandemic Agreement and South Africa’s 2025 G20 commitments, both of which underscore the importance of strengthening national, regional, and global capacities for pandemic preparedness and building resilient, equitable health systems.

Pragmatism requires that African countries retain flexibility to pursue bilateral agreements when immediate domestic needs demand it, while ensuring alignment with AU-endorsed frameworks. In this context, mechanisms to monitor compliance, reconcile national and continental priorities, and provide a coherent interface for external partners are critical. Without this, the promise of “health sovereignty” will collapse under the weight of its contradictions.

To fully realize African health sovereignty, external partners—including the United States—must engage constructively with continental institutions. Bilateral agreements, while addressing immediate domestic needs, cannot substitute for the coordinating role of Africa CDC and other AU bodies. By channeling funding, technical assistance, and policy engagement through these platforms, external partners can support harmonized health strategies, pooled procurement, cross-border surveillance, and crisis response mechanisms. Such engagement would not limit national flexibility but would provide a structured interface to align bilateral initiatives with continental priorities, reduce duplication, enhance accountability, and strengthen Africa’s collective negotiating position in global health diplomacy.

Conclusion

The America First Global Health Strategy did not invent the dilemma of Pan-Africanism. It stripped away the illusion that it had been resolved. As external partners increasingly prioritize national interest and bilateral control, the burden of sustaining collective action falls more heavily on African institutions themselves.

The question is whether sovereign states can act together when the incentives to act alone are strongest. In global health, the answer will shape not only Africa’s negotiating position but also the credibility of Pan-Africanism as a governing principle in an era of geopolitical fragmentation.

Nelson Aghogho Evaborhene is a PhD Fellow in Global Health Governance at the Centre for Interdisciplinary Study of Pandemic Signatures, Roskilde University.

Photo by Odonti Photography