Our health, our sovereignty – J.B. Allotey writes

What the President Said On Friday, 25 September 2026, President John Dramani Mahama was in New York for the United Nations General Assembly.

During a session at the Council on Foreign Relations, he was asked how Ghana is coping since the United States shut down USAID. His answer caught my attention, and I believe it should catch the attention of every Ghanaian.

He said that after USAID closed, the Americans came back with a new offer, a health compact meant to replace some of the money we had lost. The Ministry of Health studied it and prepared a Cabinet Information Paper. When it came to Cabinet, several things were flagged. The compact wanted Ghana to give the United States our pathogen profile, that is, the list of diseases we have in this country. It wanted our medical records. It wanted Ghana to put down a fixed amount of our own money as counterpart funding. And it said that medicines and medical products brought in under the programme would not be inspected by our Food and Drugs Authority.

Cabinet threw it out. The President said he had never seen Cabinet reject anything that fast, and he described the whole thing as humiliating. The Minister of Health was then directed to go and inform the US Ambassador that Ghana would not sign.

I want to be accurate about one thing. The rejection did not happen last week. Ghana walked away from the talks in April 2026, and Reuters and the Associated Press reported it at the time. What was new in New York was the President’s own account of what happened in Cabinet, and in particular the point about our FDA. So I went looking. What exactly was in this compact? Where did it come from? Who else was offered it, and who signed? This paper is what I found.

How We Got Here For more than twenty years, American money was one of the pillars holding up parts of our health system. It paid for malaria control, maternal and child health, nutrition, family planning, HIV testing and the medicines that keep people living with HIV alive. In 2024, the United States gave Ghana about US$219 million in assistance, and about US$96 million of that went to health.

Then came 2025. The new administration in Washington froze foreign aid, put programmes under review and closed down USAID altogether. At the World Health Assembly in Geneva in May this year, President Mahama said Ghana alone lost US$78 million when USAID programmes shut down. Some reports put the gap closer to US$156 million once related programmes are counted. Across Africa, outside money for health fell by almost 70 per cent between 2021 and 2025, according to the Accra Reset initiative.

Ghana did not just sit down and complain. In August 2025, Accra hosted the African Health Sovereignty Summit, which gave birth to the Accra Reset. At home, government removed the cap on the National Health Insurance Levy. Before that, any money collected above a set ceiling was taken away for other government spending. Removing the cap is what now pays for free primary health care and for the Ghana Medical Trust Fund, MahamaCares. That was our situation when the American offer arrived: a country trying hard to stand on its own feet.

From Aid to Deal On 18 September 2025, the US State Department published what it calls the America First Global Health Strategy. It says the aim is to protect Americans, strengthen American health security and help countries depend less on aid. Instead of sending money through NGOs as before, Washington now signs five-year agreements, called Memoranda of Understanding, directly with governments, covering the period 2026 to 2030.

The idea is simple. America puts in money that reduces every year. The country puts in its own money that increases every year, until it is carrying the programmes by itself. I have no problem with that principle. Every Ghanaian should want us to pay for our own health care. The problem is what else is written into these agreements, and the fact that almost nobody is allowed to read them.

Kenya signed first, on 4 December 2025, in Washington. As of 11 September 2026, the State Department says 35 countries have signed: 24 in Africa, six in Latin America and five in Asia. KFF, an independent American health policy research body, puts the total value at about US$24.1 billion over five years, with the countries themselves paying around 39 per cent. KFF also worked out that, for these same countries, American health money over five years is about US$7.5 billion less than before, a cut of roughly 34 per cent. The full list of the 35 countries, with the dates they signed, is in the appendix at the end of this paper.

What Is Inside the Compact Ghana’s own draft has never been made public. But every one of these agreements is built from one standard template written by the State Department. That template, and a guidance note that came with it, have been obtained and studied by the American group Public Citizen and by health researchers. When you put the template side by side with the agreements that have leaked and with what our own officials have said, you get a clear picture of what Ghana was being asked to sign. Five things stand out.

One: our money, with penalties attached

Every agreement states how much the country must put in each year, and it must be the country’s own money. Money from other donors does not count. If a country falls short, the template allows America to cut or stop its funding on its own. In the signed versions, the penalty ranges from a one-for-one cut to a two-for-one cut. That means that for every dollar a country fails to find, America takes away two. Uganda accepted two-for-one. Kenya, right next door, got one-for-one. This is the counterpart funding the President spoke about.

Two: our data, for 25 years Every country must also sign a separate data sharing agreement giving the American government access to its health information systems. The template sets this at 25 years, for money that lasts only five. Reports on the Kenyan deal say access could even continue for up to ten years after the agreement ends. Arnold Kavaarpuo, Executive Director of Ghana’s Data Protection Commission, was part of our negotiating team. He told the Associated Press that the Americans wanted not just our health data but also the metadata, dashboards, reporting tools, data models and data dictionaries. In other words, the whole design of how our health data is organised. He said up to ten American organisations could have used the data without first asking Ghana, and that there was a clause allowing individual people to be identified where it was “deemed necessary”. He compared it to handing the design of our national health data system over to a foreign body.

Three: our disease samples, within five days

Countries must also sign a specimen sharing agreement. According to copies seen by Health Policy Watch, a respected health news outlet in Geneva, this requires a country to send the United States physical samples and genetic data of any disease with epidemic potential within five days of detecting it. The template again said 25 years, which some countries later pushed down to between five and ten. This is the pathogen profile the President was talking about. And nowhere does the template promise that the country that gave the sample will get access to any vaccine, test or medicine made from it.

Four: our drug regulator, bypassed The template has two clauses on medicines. The first asks countries to accept approvals by the US Food and Drug Administration during outbreaks and emergencies, when speed matters. The second goes much further. It asks countries to change their own laws so that American approvals are accepted more widely, in normal times too. Public Citizen found that America has never before made acceptance of its own drug regulator a condition for health aid. It also works one way only, because America does not accept our approvals in return. The State Department’s own guidance note says this wider clause should be pushed on countries with large domestic markets or where there are other strategic reasons. To me, that is about opening markets for American drug companies. For Ghana, it would have meant products coming in under the programme without our FDA checking them, which is exactly what the President complained about.

Five: secrecy, and strings that have nothing to do with health

More than 30 of these agreements have been signed, yet the State Department will not publish them. Public Citizen has had to go to court under America’s Freedom of Information law to get them released. In some countries, the health deal has also been tied to things that have nothing to do with health. In Zambia, a leaked draft linked the health money to mining. Zambia’s Foreign Minister, Mulambo Haimbe, confirmed in May that Washington had made a critical minerals deal conditional on the health agreement, and Zambia insisted that the two must be judged separately. The outgoing American Ambassador in Lusaka denied that life-saving aid was being held back for minerals. In the Democratic Republic of the Congo and in Guinea, minerals agreements with America were signed shortly before the health agreements.

How Ghana Said No Talks between Accra and Washington started in November 2025. According to Reuters and the Associated Press, the deal was worth about US$300 million in total. Only about US$109 million of that would have come from America, spread over five years, and Ghana would have provided the rest. Reuters reported that Ghana’s exact obligations were never clearly spelt out.

Think about that. In 2024 alone, America gave Ghana about US$96 million for health. The new offer was about US$109 million for five whole years. In exchange, America wanted up to 25 years of access to our health data and disease samples, and a say over how our drug regulator works.

By the end of April 2026, Ghana had ended the talks. The State Department would only say that it does not discuss bilateral negotiations and that it is still looking for ways to strengthen the relationship. In New York, the President filled in the rest: the Ministry of Health review, the Cabinet paper, the flagged clauses, the quick rejection and the message sent to the Ambassador. He did not present it as a fight with America. He presented it as a matter of national dignity, and said Ghana would rather build up its own health financing and its own production capacity while still working with partners.

“I mean, who takes another country’s medical records?” President Mahama, as reported by Pulse Ghana

Africa Divided Ghana is not alone, and we were not the first. This compact has split Africa into three groups: those who signed, those who signed and ended up in court, and those who walked away.

Most signed. Twenty-four African countries have signed so far: Angola, Botswana, Burkina Faso, Burundi, Cameroon, Côte d’Ivoire, the Democratic Republic of the Congo, Eswatini, Ethiopia, Guinea, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mozambique, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, South Sudan, Tanzania and Uganda. Not all of them took the template as it was. Public Citizen compared the texts that have come out and found that several countries cut down the data and specimen periods. Lesotho removed the penalty for breaking the specimen agreement completely. Kenya, Mozambique and Ethiopia added words saying the FDA clause must follow their own laws. Nigeria’s agreement directs about 10 per cent of the money to faith-based providers and commits to buying 30 per cent of its supplies from Nigerian manufacturers. Liberia, on the other hand, must hire and pay 1,851 extra health workers and carry almost its entire bill for medicines and test kits by 2030.

Kenya shows what can happen after signing. Within a week, the Consumers Federation of Kenya and Senator Okiya Omtatah took the government to court. They argued that there had been no public participation and no parliamentary oversight, and that the deal broke Kenya’s data protection law. The High Court suspended the data sharing parts and later the whole agreement, and Washington paused full implementation. In May 2026, the Court of Appeal lifted the suspension for now, after the Attorney-General argued that only aggregate data, with no names attached, would be shared. The final ruling is due on 30 October 2026.

Then there are those who said no. In December 2025, President Emmerson Mnangagwa directed Zimbabwe’s officials to stop negotiating a US$367 million deal because it compromised national sovereignty. The government spokesman, Nick Mangwana, explained that Zimbabwe was being asked to share its biological resources and data for many years, with no guarantee of getting any vaccine or medicine that came out of it, and with no American data shared in return. The US Embassy has now confirmed that all American health funding to Zimbabwe ends this month. Zambia rejected its draft, reported to be worth between US$1 billion and US$2 billion, over data and the minerals link, and talks are stuck. Namibia, according to its local press, also refused over data and sample sharing, and America is now phasing out its HIV funding there. South Africa, a major recipient of American HIV money in the past, has not been given a deal at all because of wider political quarrels with Washington. And Ghana completes the list.

Table 1. African countries that have not signed

Sources: Reuters, Associated Press, Health Policy Watch, national press.

Why Our Data Matters Some people may think this is just a quarrel about paperwork. It is not. Today, health data and disease samples are raw materials, just like cocoa beans and gold. A genetic sample taken from a patient in Tamale can become the starting point for a test kit, a vaccine or a drug that is patented abroad and sold back to us at a price we cannot afford. Records of how our people respond to treatment are valuable to drug companies, to insurers and to researchers. Our national datasets and dashboards show exactly how our health system works. Nobody from outside should hold that without clear rules and clear consent.

We have seen this film before. During COVID-19, it was scientists in South Africa and Botswana who found the Omicron variant and told the world. What did Africa get for it? Travel bans, and a place at the back of the vaccine queue. That experience is why the world, through the World Health Organization, is negotiating a Pathogen Access and Benefit Sharing agreement. The principle is simple: if you share samples, you share in the benefits. Those talks were extended at the World Health Assembly in May 2026, mainly because richer countries do not want binding benefit-sharing contracts. America has left the WHO. Now it is collecting pathogen samples country by country, outside that global arrangement and without the same obligations. Zimbabwe made exactly this point when it walked away.

Dr Jean Kaseya, Director-General of the Africa Centres for Disease Control and Prevention, has said openly that there are huge concerns about data and pathogen sharing under these deals.

“We want to own our data in Africa.” Dr Jean Kaseya, Africa CDC

Then there is our FDA. The Food and Drugs Authority is what stands between Ghanaians and fake, substandard or unsuitable medicines. It is not perfect, but it is ours, and it answers to our laws. A clause that lets products in without FDA inspection does not just save time. It tells a Ghanaian mother receiving those medicines that her own government agreed not to check them. No amount of money should buy that.

The Other Side To be fair, I must also give the American side, and I must ask hard questions of our own side too.

Washington says that years of aid created dependence, that too much money was swallowed by middlemen, and that it is time for countries to own and pay for their own health systems. It says disease surveillance protects Africans as much as Americans, because an outbreak caught early in Accra is an outbreak stopped before it spreads anywhere else. It says accepting FDA approvals during emergencies is about getting vaccines and medicines to patients quickly, which many African countries already do informally. Kenya’s Attorney-General has told the courts that Kenya’s deal limits sharing to aggregate data. And Public Citizen’s own review shows that countries that negotiated hard got better terms. Looked at this way, the compact was a starting point for negotiation and not a take-it-or-leave-it offer.

Saying no also has a price, and it is not Cabinet ministers who pay it. In Zimbabwe, about 1.2 million people on HIV treatment supported by America now face a funding gap. Our exposure in Ghana is smaller, but it is real. The money under the compact was meant for malaria, HIV, tuberculosis and maternal health, and those needs did not disappear because we said no. If sovereignty is going to mean anything, government must show us where the replacement money is coming from, year by year and programme by programme.

Ghanaians also have every right to ask why we are hearing the details of this compact from a speech in New York and not from our own Parliament. The secrecy we criticise in Washington, we must not practise at home. Kenya ended up in court precisely because its citizens were not consulted. If our draft was as bad as the President says, and I have no reason to doubt him, the Ministry of Health should publish it together with the Cabinet Information Paper. Let citizens, Parliament, doctors, pharmacists and civil society see it for themselves, and let any future agreement be negotiated in the open.

What We Must Do Now Saying no was the easy part. The hard part is building a health system that never again has to choose between its dignity and its medicines. The President set the standard himself at the World Health Assembly. He said real health sovereignty means being able to pay for core health services predictably, to regulate quality, and to produce critical supplies locally. He also reminded the world that Africa carries a quarter of the world’s disease burden but makes less than one per cent of its vaccines.

“It is vulnerable. It is at best a ward of the international system.” President Mahama, 79th World Health Assembly

So what must we do? In my view, six things.

1. The National Health Insurance Levy must stay uncapped and ring-fenced, and its accounts must be published so that people can see the money reaching the clinics.
2. The FDA must be properly resourced so that it can work faster through trusted arrangements with other strong regulators and with the African Medicines Agency. Then nobody can ever use speed as an excuse to go around it.
3. We need clear rules on health and genetic data under our data protection law, covering where it is stored, who can access it and what benefits we get in return. The Data Protection Commission served this country well in these talks and should be strengthened.
4. Parliament should insist that any international agreement touching our health data, our biological samples or our regulators is laid before it for approval.
5. Local manufacturing of medicines, vaccines and test kits must move from speeches to factories.
6. Ghana should work through Africa CDC and the African Union for one common African position, so that no single African country has to negotiate alone with a superpower.

None of this is about hating America. Ghana and the United States share deep ties of family, history, education and trade, and we want that relationship to continue. What Ghana is saying is simple. Partnership must be between equals, and on terms we can read out to our own people without shame.

Not For Sale We have been here before as a continent. We saw it in the concessions of the colonial days and in the conditions that came with structural adjustment. This compact is the modern version, dressed up in words like ownership and sustainability. The money was small, the period was short, and the demands on our records, our samples, our treasury and our regulator were long and deep.

Ghana said no. Zimbabwe said no. Zambia said not on these terms. Kenya’s courts said not without the people’s consent. That is not ingratitude. It is a clear statement that the health of a people is not for sale, that our medical records are not a bargaining chip, and that the right to decide what goes into the bodies of Ghanaians belongs to Ghana alone. Our health is our sovereignty. We must never sell it, and we must never again leave it so poorly funded that anybody thinks we might.

Appendix: The 35 Countries That Have Signed

The table below lists every country the US State Department says has signed an America First health agreement as of 11 September 2026, in the order they signed. Most are five-year agreements running from 2026 to 2030. Where the State Department or the embassy announced an exact date, I have given it. Where the date was only reported by month, I have said so. All 35 are signed, but none is fully running yet; KFF reports that implementation is due to start later this year.

Sources: US Department of State and US embassy releases (December 2025 to September 2026); KFF tracker (15 September 2026); Public Citizen negotiation tracker; Health Policy Watch; Bloomberg. Dates given by month were not announced with an exact day.

Sources

1. MyJoyOnline and Adom Online, reports of President Mahama at the Council on Foreign Relations, New York, 25 September 2026.
2. Pulse Ghana, “Mahama explains why Ghana rejected US health deal”, 28 September 2026.
3. Associated Press, “Ghana becomes the latest African country to reject a US health deal, citing data sharing concerns”, 1 May 2026.
4. Reuters, via GhanaWeb, “Ghana rejects $109m US health aid deal over data privacy concerns”, 28 April 2026.
5. US Department of State, America First Global Health Strategy, 18 September 2025, and signing announcements, December 2025 to September 2026.
6. KFF, “America First MOU Bilateral Global Health Agreements” tracker, updated 15 September 2026.
7. Public Citizen, “Trump Administration Global Health Agreements: Negotiation Tracker”, June 2026, updated September 2026.
8. Health Policy Watch, reports of 12 December 2025, 19 January 2026, 27 February 2026 and 2 March 2026.
9. Capital FM Kenya and Daily Nation, reports on the Kenya Court of Appeal ruling, May 2026.
10. Reuters, via CNBC Africa and The EastAfrican, on Zambia and the minerals link, 4 May 2026.
11. Associated Press, on the end of US health funding to Zimbabwe, 25 September 2026.
12. President John Dramani Mahama, address to the 79th World Health Assembly, Geneva, May 2026.
13. Accra Reset, “A Sovereign Future For Health”, September 2026.
14. World Health Organization and Third World Network, on the Pathogen Access and Benefit Sharing negotiations, 2026.

Source: J. B. Allotey

— CitiNewsRoom