Extractive Bilateralism: Health Aid Needs Urgent Attention and Action
This article was written by Kathya Acuña Luna, a student in Gavin Yamey’s Geneva-based summer course in global health policy. Kathya is a biomedical engineer with an additional MSc in AI, currently completing her second MSc in Global Health at the University of Geneva. Her main interests surround the development and application of technology for the improvement of healthcare access for the most vulnerable populations, addressing critical inequalities in health. A central pillar of the America First Global Health Strategy, released on September 18 2025, is bilateral agreements between the United States (US) and countries that receive US health aid. As of July 1 2026, 34 countries had signed such agreements, of which 25 are in Africa. Human Rights Watch has assessed seven of the bilateral agreements with African countries, specifically Ethiopia, Kenya, Mozambique, Nigeria, Rwanda, Liberia, and Uganda. The results of this analysis are deeply concerning—they show that the US government is making lifesaving health assistance conditional upon “surveillance…