{"text":[[{"start":7.35,"text":"In the wake of gutting USAID, Donald Trump’s administration is rolling out a new “America First” global health strategy that it sees as the future of foreign assistance: granting money in return for data."}],[{"start":19.45,"text":"In memorandums of understanding (MOUs) signed with more than 30 nations since December, worth $20.6bn, governments have accepted five years of funding — often much reduced from previous levels — in return for a pledge to provide up to 25 years of patient data and, in some cases, pathogenic specimens, along with a commitment to co-invest."}],[{"start":43.599999999999994,"text":"Recipient countries have promised to stump up $7.8bn, about a third of the total, and the US can withdraw funding if it determines nations are not meeting their co-investment pledges."}],[{"start":55.14999999999999,"text":"Critics have likened these transactional agreements to a form of digital and genomic colonialism, warning that data could be made available to unnamed private US corporations, including pharmaceutical companies and big data analytics groups."}],[{"start":69.94999999999999,"text":"Some African officials have also accused the US of predicating aid money on other demands, including preferential access to critical minerals, though Washington has categorically denied this."}],[{"start":81.29999999999998,"text":"“It’s a recolonisation of our health system,” said Ayoade Alakija, a Nigerian ministerial health envoy and co-chair of the African Vaccine Delivery Alliance, of the $5bn MOU Nigeria signed with Washington in December. “They can create vaccines and diagnostic tools with our data and we get scraps off the table.”"}],[{"start":null,"text":"

"}],[{"start":102.79999999999998,"text":"The US, which quit the World Health Organization in January, says it needs data and specimens it no longer receives through the multilateral system to protect itself against future pandemics."}],[{"start":114.09999999999998,"text":"Washington has said it cannot grant benefits that come from any data — such as access to medicines developed from pathogen samples — to origin countries because that would contravene companies’ intellectual property rights, a position it says is shared with other OECD nations."}],[{"start":129.95,"text":"“In a suspected outbreak, one of the first phone calls most countries make is to the US CDC [Centers for Disease Control and Prevention],” a senior state department official said. “We want to continue to be partners of choice. We’re saying to countries that if you find you have a pathogen on your hands and you’re not sure what it is, send it to us and we’ll help you figure out what it is.”"}],[{"start":150.79999999999998,"text":"Several African countries, including Ghana, Zambia and Zimbabwe, have publicly rejected the deals, however, saying they violate patient privacy and national sovereignty. "}],[{"start":160.99999999999997,"text":"One senior Nigerian health official, speaking on condition of anonymity, said: “My first thought is we are not going to give the US 25 years of data in return for five years of money, that’s not going to happen.” Washington says, in many cases, countries have successfully negotiated down the 25-year period. "}],[{"start":null,"text":""}],[{"start":181.94999999999996,"text":"Muhammad Ali Pate, Nigeria’s health minister, said his country’s deal with Washington, which requires Nigeria to contribute $3bn of the $5bn over five years, was a nonbinding MOU."}],[{"start":195.34999999999997,"text":"“Any data sharing will have to conform with Nigerian laws and policies [and] either party can withdraw,” Pate told the FT. The agreement marked what he called a “definitive end to US aid dependency by 2030”."}],[{"start":207.84999999999997,"text":"But health experts warned that Washington was pushing for implementation too quickly to deal with such complex issues. “America is giving countries very little time,” said Serah Makka, executive director for Africa at the One Campaign, which advocates for an end to extreme poverty and preventable diseases. “Even the American government doesn’t work that fast.”"}],[{"start":229.59999999999997,"text":"The new-style MOUs signed with governments in Africa, Latin America and Asia are focused on HIV, tuberculosis, malaria and maternal health. They are designed to replace roughly $44bn of funding from USAID, which was abolished by the so-called Department of Government Efficiency (Doge) last year."}],[{"start":null,"text":""}],[{"start":250.19999999999996,"text":"The process is being driven by Brad Smith, a former Doge official who is now a global health adviser to the US state department. Cuts to US funding over the next five years range from 12 per cent in the case of Ethiopia to 71 per cent for Rwanda, according to KFF, a non-profit specialising in health policy research."}],[{"start":270.4,"text":"Mulambo Haimbe, Zambia’s foreign minister, took to Facebook last month to describe Washington’s attitude towards aid as “patronising”."}],[{"start":280.29999999999995,"text":"“Key among the reasons for Zambia’s reluctance to accept the terms of the proposed agreement is the insistence on preferential treatment of US companies over Zambia’s critical minerals,” he said."}],[{"start":292.99999999999994,"text":"The senior state department official said: “There is no linkage in the discussions with Zambia between critical minerals and health. They are not linked.”"}],[{"start":301.94999999999993,"text":"Haimbe also said that US demands for access to Zambians’ patient data were “unconscionable from the perspective of the people of Zambia”. They were “in violation of our citizens’ right to privacy”, he added."}],[{"start":null,"text":""}],[{"start":313.99999999999994,"text":"US officials remained optimistic that a deal with both Zambia and Ghana could be struck. "}],[{"start":320.69999999999993,"text":"“President Trump’s administration is advancing a historic, mutually beneficial approach to global health through the America First Global Health Strategy,” said Anna Kelly, the White House deputy press secretary. “The United States remains the most generous country in the world because President Trump has a humanitarian heart.”"}],[{"start":338.8499999999999,"text":"Some African health officials cautiously welcomed the transactional nature of agreements as more transparent. “Aid has always been conditional,” said Makka of the One Campaign. “What we are seeing is the overt nature of it, and, quite frankly, overt is better than covert.” "}],[{"start":355.5499999999999,"text":"Githinji Gitahi, chief executive of Amref Health Africa, said: “We always knew aid was not charity, so we have no problem with an America First policy.” The problem, he said, was the power imbalance. Recipient countries were desperate for money to keep HIV and other programmes going and were signing agreements in a rush, he said."}],[{"start":376.4499999999999,"text":"Kenya’s high court suspended implementation of a $2.5bn MOU with the US after a consumer lobby group brought a case. “Let us first determine the issues being raised by civil society around data sovereignty [so] the public can feel safe that their data is being protected,” said Gitahi."}],[{"start":null,"text":""}],[{"start":394.0499999999999,"text":"The US government says it requires data to monitor the efficacy of programmes and recipient governments’ fealty to co-investment commitments."}],[{"start":403.5999999999999,"text":"Gitahi said it was right that African governments contributed. “Demanding that countries put skin in the game: it is a good thing,” he said. But the US should not be able to determine spending priorities, he added, for example, by diverting money from family planning, which US packages specifically preclude."}],[{"start":421.6499999999999,"text":"One American health expert said the MOUs came “in the aftermath of the destructive, chaotic and strategic elimination of USAID and vast swaths of the Pepfar [President’s Emergency Plan for Aids Relief] programme”, which was introduced by George W Bush."}],[{"start":436.94999999999993,"text":"To offer reduced funding now, the person said, was like “torching your car” and then offering to help pay for a new one."}],[{"start":444.44999999999993,"text":"Cartography by May Bancoyo"}],[{"start":453.99999999999994,"text":""}]],"url":"https://audio.ftcn.net.cn/album/a_1779432873_4093.mp3"}