No prime-time address. No presidential speech. No spectacular interviews. On Friday, 22 January 2026, the US quietly completed its withdrawal from the World Health Organization (WHO).
While most people might shrug at such news in an age of permanent outrage, there is more to the US departure from the WHO. This was not just an impulsive retreat from global health. It was a calculated move, part of a far more ambitious power play set out in the US America First Global Health Strategy from September 2025.
A deeper look into the US decision reveals a geopolitical pivot in plain sight. In just six weeks, the US concluded bilateral health cooperation memoranda of understanding (MOUs) with 15 African countries, under which the US will provide funding to their health systems, ranging from $106-million to $2.1-billion. What is in it for the US? Not oil, not cobalt or lithium. The MOUs in question secure health data, which results in power in the 21st century and a troubling picture for the future of the African countries in question.
Bilateral agreements with benefits
While the conventional narrative may categorise the latest move by the US as an abandonment of multilateralism, that is only half true and dangerously misleading.
One of the goals of the America First Global Health Strategy is to “create a conducive environment for American businesses to deploy their innovative health products and services globally” and to advance “commercial diplomacy”. While the cutting of aid to healthcare systems in Africa, including Pepfar funding, appeared as impulsive decisions to please the Maga base at the time, the latest moves reveal a crucial repositioning of the US in this context.
Africa, with its growing population and expanding health market, is regarded as an opportunity to create a counterweight to China’s power on the continent. Bilateralism is not a retreat in this context. It is an upgrade that comes with multiple advantages.
Bilateral agreements allow Washington to exercise its power fully and set the rules without international standards, control data flows, bypass multilateral scrutiny and attach ideological conditions to funding. It follows the goal of maximising unilateral influence, disguised as technical cooperation to the health sector in Africa, while reshaping global health in the US image: transactional and ideological.
Africa’s health data: extraction 2.0
Most of the MOUs in question have not been publicly disclosed, which, by itself, constitutes a red flag. However, publicly available MOUs such as those concluded with Kenya, Liberia or Mozambique reveal a system of “cooperation” with provisions on data sharing, access to national disease surveillance systems, access to genomic sequencing and integration of US health-security platforms.
This extraction of data, unlike natural resources, does not run out — it compounds. It can feed AI systems, pharmaceutical pipelines, predictive analytics and national security models. Population data can reveal disease susceptibility, genomic diversity, reproductive health patterns, and outbreak vulnerability across entire societies. Welcome to extraction 2.0! On top of that, MOUs like the one for Kenya clearly favour US companies when stating that:
“The Participants intend to work together to support American companies seeking to establish operations in Kenya in accordance with the laws and regulations of the Republic of Kenya.”
With such data, states with the necessary resources could model epidemics, shape pharmaceutical markets and anticipate demographic and biological trends across states. A leverage that can easily be translated into direct power over another state.
Benefit of a broken system
Between 4 December 2025 and 14 January 2026, 15 African countries signed these MOUs: Botswana, Cameroon, Ivory Coast, Eswatini, Ethiopia, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mozambique, Nigeria, Rwanda, Sierra Leone and Uganda.
African governments are not passive actors in this story. They know the value of their data. They know the risks of dependency. They know the history of extraction. But they also see the reality of an underfunded WHO and stagnant global health financing, which affects national health systems and creates a massive challenge for governments.
In a broken system, the African states in question operate in an environment that produces dangerous dependencies. The US has a history of using global health funding to export its domestic culture wars. The “global gag rule” toggled on and off depending on who sits in the Oval Office, has repeatedly forced African governments to choose between US funding and women’s reproductive autonomy. The MOUs are designed to set up a system in which data flow one way and ideology flows the other. Supercharging such dynamics with health data can create a system in which partnership can quickly become subordination under the guise of saving lives.
The fiction of non-binding MOUs
The legal architecture that makes all of this possible and serves as a disguise for this power grab is the MOUs signed by the US and African states. The US is not building this parallel health governance system through treaties or formal agreements that require parliamentary approval, public debate, or international scrutiny.
MOUs sound harmless. Technical. Bureaucratic. Under international law, their ambiguity is precisely the point. Unlike treaties, MOUs are typically classified as “non-binding”. No enforceable obligations. No ratification. No transparency. No accountability. This is not a bug. It is a feature. The MOU for Liberia, for instance, has a specific clause in this regard:
“This MOU is not an international agreement and does not give rise to legal rights and obligations under international or domestic law.”
A similar clause exists in other MOUs with Kenya, Mozambique and Uganda. In practice, MOUs create a form of shadow governance commitments that shape national health systems without ever being subject to constitutional or human rights scrutiny.
They allow the US to extract data, embed surveillance tools and influence policy while maintaining plausible deniability. If implemented, however, the effects of these MOUs are indistinguishable from binding obligations and rights. A quiet and genius strategy: maximum influence, minimum accountability.
Data as a weapon? It is not too late
The elephant in the room is what happens if all the data handed over are abused and not only used to support healthcare in African states, but also used as another tool of an impulsive and authoritarian system. Health and genomic data are uniquely intimate and can reveal vulnerabilities or population-level traits, and they can be used for discrimination, surveillance, or coercion.
In fact, a US counterintelligence fact sheet from 2021 lists some of these risks arising from large-scale genomic dataset collection as a national security concern. With AI, the risks multiply and without appropriate safeguards, today’s health cooperation becomes tomorrow's biosecurity vulnerability.
However, it is not too late yet. The 15 African states in question are not yet locked into this trajectory. The very legal ambiguity that makes the MOUs so attractive to the White House also creates space for resistance. If these agreements are truly “non-binding”, they can be paused, narrowed, renegotiated, or terminated. The sovereignty of the states in question has not yet been formally signed away.
A first step is that these agreements must undergo a rigorous judicial and parliamentary review before signing or implementation. Data-sharing arrangements, surveillance access, or platform integrations must be debated publicly, not buried in technical annexes.
The conservatory order by the high court in Kenya, issued on 19 December 2025, to restrain state officials from implementing, operationalising and executing the MOU is a crucial first step that must be replicated in other States.
Health cooperation is not merely administrative; it is constitutional and affects everyone. History shows that when data, infrastructure, or natural resources are handed over without debate, they shape societies long after the politicians who signed them are gone. DM
Dr Atilla Kisla is the international justice cluster lead at the Southern Africa Litigation Centre.