When “America First” Risks Putting Nigerians Last - Health Aid or Power Play?

Make It Make Sense: Why This Health Deal Needs Public Scrutiny—Now

Let me begin by saying this plainly: the Nigerian government has taken commendable steps to place health back on the national agenda. The Renewed Hope Agenda, through the National Health Sector Renewal Compact, has elevated health as a development priority. The release of funds to primary health care facilities through the Basic Health Care Provision Fund has strengthened frontline service delivery. The “Red Letter” campaign launched by the Federal Ministry of Health and Social Welfare in October 2025 was particularly bold, calling on Nigerians to take ownership of health funds and demand transparency and accountability at the community level.

We have also seen a steady increase in health budget allocations between 2022 and 2025. While Nigeria is still far below the 15 percent target set by the Abuja Declaration, this gradual upward trend is welcome and signals political intent. These actions matter. They build trust. And that is exactly why the recently signed U.S.–Nigeria Memorandum of Understanding (MoU) under the America First Global Health Strategy deserves serious public scrutiny.

COVID-19 taught the world a lesson written in loss and suffering: weak health systems anywhere are a risk everywhere. Viruses do not respect borders. Investments in health are not acts of charity; they are acts of collective security. When health systems fail in one country, the consequences ripple across regions and the globe. This is why multilateralism matters and why bilateral cooperation must be rooted in shared responsibility rather than geopolitical advantage.

Only last year, many African countries experienced the shock of the dismantling of USAID, a move that created major disruptions in health systems across the Global South. Clinics closed, programs stalled, and health workers were left uncertain. This moment triggered an overdue reckoning. African leaders openly acknowledged the dangers of aid dependency and renewed calls for domestic financing, regional manufacturing, and health sovereignty.

These conversations led to major political commitments, including the Lusaka Agenda and the Accra Reset. The Lusaka Agenda emphasized strengthening primary health care, fostering domestic financing, promoting equity, aligning partners to national plans and budgets, coordinating research and manufacturing, and reinforcing country leadership. The Accra Reset went further, calling for a fundamental shift from aid dependency to health sovereignty, from donor-driven models to co-creation, and from fragmented aid to people-centered, resilient systems. Nigeria was present at these meetings and endorsed these principles. That context makes the America First MoU deeply troubling.

The agreement has been presented as a landmark achievement. According to reporting by the U.S. Embassy in Nigeria and an opinion piece by the Special Assistant to the Coordinating Minister of Health and Social Welfare, the MoU is valued at $5.1 billion over five years, with approximately $2.1 billion from the United States and $3 billion from Nigeria (U.S. Embassy Nigeria, 2025). Areas of cooperation include disease surveillance, laboratory systems, outbreak response, health commodities, and expanded prevention and treatment services.

The figures are significant. But Nigerians must ask: at what cost?

First, the manner in which the agreement was signed raises serious concerns. The MoU was concluded quietly, just days before the Christmas holidays. The document itself has not been made publicly available. This secrecy directly contradicts the spirit of the Red Letter campaign, which calls on citizens to hold government accountable for health resources. If Nigeria is contributing the larger share, $3 billion over five years, why is the public not allowed to see the terms? Will resources under this MoU be subject to the Health Sector-Wide Approach (SWAp) Joint Annual Reviews, or do they sit outside national accountability frameworks? Transparency cannot be selective. The Federal Ministry of Health and Social Welfare should publish the full MoU and submit it to legislative and public scrutiny to build public confidence and trust.. Beyond process, the substance of the agreement raises deeper concerns about alignment with national priorities. The name America First Global Health Strategy is not symbolic; it is policy. The strategy explicitly states that U.S. health assistance must advance U.S. economic and national security interests. Africa is described as strategically important because of its deposits of critical minerals and rare earth elements used in military and commercial technologies. Nigerians must ask: what did Nigeria give in return for $2.1 billion? Access to which resources? Expanded corporate privileges? Security or Military arrangements? These questions may be uncomfortable, but they are necessary.

The risks of Nigeria aligning its health agenda too closely with the current U.S. policy environment become even clearer when we examine what those policies actually are and what they signal about the use of aid as a tool of influence rather than genuine global health solidarity. In January 2026, the U.S. Department of Health and Human Services, acting on a presidential memorandum, revised the childhood immunization schedule to recommend fewer vaccines for all children, shifting some vaccines into a “shared clinical decision-making” category rather than maintaining universal recommendations, a move that has alarmed public health experts, who warn it could weaken protections against preventable diseases. This matters deeply for Nigeria because immunization remains one of the most cost-effective tools for preventing childhood death, and one that the Nigerian government has repeatedly worked to expand. Yet coverage remains far from optimal: only 39% of the children aged 12-23 months received all the recommended vaccines, leaving millions vulnerable to preventable illnesses that contribute significantly to under-five mortality. Allowing external policy signals that downgrade the importance of broad immunization coverage to influence Nigeria’s priorities would be dangerous.

On sexual and reproductive health, the trend is equally troubling. Under the current U.S. administration, international family planning and reproductive health programs have faced massive funding cuts, including the elimination of hundreds of millions of dollars in foreign assistance for these services. Experts estimate that these reductions could result in millions of unintended pregnancies and tens of thousands of preventable maternal deaths globally each year. Nigeria, according to the UN’s 2023 Trends in Maternal Mortality report, accounts for nearly 28.5 percent of global maternal deaths—figures that make investment in sexual and reproductive health not optional, but essential. These concerns are further sharpened by examining Nigeria’s own budgetary signals. The 2025 health budget shows a significant reduction in allocations for family planning compared to 2024 (Development Research and Projects Centre, 2025). While it would be inaccurate to draw a direct causal link between this reduction and U.S. government influence or the newly signed MoU, the timing and direction of the cut send a worrying signal that cannot be ignored.

This pattern reveals something critical: when foreign aid is tied to shifting domestic political winds in donor countries, it risks becoming a vehicle for exporting ideology rather than supporting sustainable health outcomes. Overreliance on such aid can allow external political agendas, reflected in donor-country decisions about which services are prioritized or deprioritized, to shape how Nigeria defines its own health priorities. This concern becomes even more pressing in the context of the new MoU, under which the U.S. Government is expected to cover 100 percent of the cost of commodities procurement in 2026. What does this mean for contraceptive supplies or other essential commodities that the current U.S. administration may politically oppose or deprioritize? Nigeria cannot allow itself, intentionally or inadvertently, to be nudged into adopting policy approaches that run counter to its national health commitments, including the National Health Sector Renewal Compact commitments on maternal and child health and the regional and global obligations it has undertaken. These are not abstract development targets; they represent real lives. The only responsible path forward is clear: Nigeria must explicitly ringfence sexual and reproductive health, childhood immunization, and maternal health funding, independent of U.S. health policy positions.

The U.S. full financing of Nigeria’s health commodities in 2026 also raises a more profound concern about whose products will be procured and on what terms. Under the America First Global Health Strategy, U.S. aid explicitly aims to expand markets for American technologies, ensuring U.S. products become “a cornerstone of health systems around the world,” shifting global health from a rights-based approach to a commercial one. A clear example is Lenacapavir, a long-acting HIV prevention drug developed by U.S. company Gilead, whose rollout has been framed as a “market-shaping investment” to secure early global dominance. Its inclusion in bilateral agreements with countries like Mozambique and Eswatini risks locking public health cooperation into strategies that prioritize U.S. corporate market capture over national choice, affordability, and local manufacturing. This trajectory directly contradicts Nigeria’s Presidential Vaccine Advisory Committee (PVAC), established under the Renewed Hope Agenda to build health commodity manufacturing capacity, because PVAC represents Nigeria’s hard-learned lessons from COVID-19. Health security is industrial security, and any bilateral agreement that weakens Nigeria’s ability to produce its own essential commodities is not just a policy mismatch but a strategic setback.

Another deeply concerning element of the MoU relates to data sharing, both pathogen sequence data and broader health information, and how that data may be used long after the five-year financial commitment ends. Under similar agreements tied to the America First Global Health Strategy, partner countries are being asked to share detailed pathogen sequence data with U.S. government entities and affiliated recipients capable of developing diagnostics and medical countermeasures. Critics have warned that such proposals require countries to share biological specimens and genetic sequences of “pathogens with epidemic potential” within days of detection, without guarantees that contributing countries will receive equitable access to the vaccines, diagnostics, or treatments developed from this data, raising serious concerns about reinforcing the vaccine and treatment inequities witnessed during COVID-19. This issue directly intersects with ongoing global negotiations on the WHO Pandemic Agreement, which seeks to establish a Pathogen Access and Benefit-Sharing (PABS) System to ensure that pathogen materials and sequence information are shared rapidly and fairly, with benefits returned on an equitable, needs-based basis. When bilateral arrangements diverge from these principles, data sharing risks becoming extractive rather than mutually supportive of pharmaceutical product development, while offering little assurance of fair access for the populations whose data enabled those innovations. The intentional undermining of the WHO and negotiated multilateral agreements comes as no surprise, as this U.S. administration has formally withdrawn from the WHO and is actively weakening its influence through bilateral deals that sidestep multilateral norms.

The concern deepens further when we consider that access to Nigerian health data would not end with the MoU’s financial timeline. The MoU template shows that data-sharing requirements could extend for up to 25 years, and once data is transferred, it can be stored, analyzed, and reused indefinitely—potentially by private companies and research institutions long after the agreement expires. In effect, Nigerian health data could be leveraged to support foreign product development, market strategies, and commercial advantage without commensurate benefit to Nigerians themselves. If the U.S.–Nigeria health MoU is structured without robust consent, cross-border safeguards, NDPC oversight, transparency, and enforceable benefit-sharing that honors Nigerian citizens’ privacy and control rights, the agreement could be in violation of the Nigeria Data Protection Act 2023 and GAID 2025, thereby undermining Nigeria’s legal protections over health data and digital sovereignty. This fear of unchecked data access has already become a legal battleground elsewhere: in Kenya, a High Court temporarily suspended a $1.6 billion U.S.–Kenya health agreement after civil society groups argued that its data-sharing provisions violated national data protection laws, halting health data transfers until the case is heard.

Sharing health data as part of genuine cooperation is not inherently problematic if it is grounded in mutual benefit, transparency, and equitable access—ensuring that the people whose data is shared also benefit from the resulting research, vaccines, diagnostics, and treatments. But that assurance remains ambiguous under the current America First bilateral frameworks. Nigeria cannot afford to have its health data mined for private profit or geopolitical leverage. The Nigerian National Assembly must exercise its oversight authority to ensure that this and future agreements include strict safeguards guaranteeing equitable access to resulting products, local manufacturing partnerships, shared intellectual property, robust data privacy protections, and sovereign ownership of data generated from Nigerian patients and health systems. Anything less is not partnership; it is extraction.

Finally, the MoU’s explicit emphasis on Christian faith-based health facilities is deeply concerning. According to the U.S. Embassy, approximately $200 million is earmarked to support Christian faith-based clinics and hospitals, which reportedly serve over 30 percent of Nigeria’s population. While faith-based providers have long played an important role in service delivery, singling out one religious group in a deeply plural country risks inflaming existing tensions and politicizing health. It also overlooks the substantial contributions of Muslim faith-based health facilities such as the women-led FOMWAN Hospital in Kaduna, which, like their Christian counterparts, deliver care to Nigerians regardless of faith or background. At the same time, while we recognize the contributions of faith-based entities in expanding access to health services, often in hard-to-reach and underserved communities, we must be honest about the limitations that can arise when service delivery is shaped by religious doctrine rather than public health need. Evidence shows that many faith-based facilities are less likely to provide family planning services, STI prevention, and some vaccinations, due to ideological beliefs. Acknowledging these limitations is not an attempt to delegitimize their work, but a practical reality. If any category of provider, for whatever reason (religious, technical, financial, or geographic), cannot deliver certain essential services, that creates a coverage gap, and the Federal Ministry of Health and Social Welfare must plan accordingly and responsibly. The Ministry must ensure that all players in the health system provide the approved package of essential services, or, at a minimum, have robust referral systems in place, so that no person is left without access to care. Health access cannot depend on faith, ideology, or donor preference; it must respond to the needs of the people.

Nigeria’s responsibility to deliver equitable health services, therefore, requires a diverse, inclusive, and people-centered health ecosystem that brings together public facilities, Christian and Muslim faith-based clinics, NGO-managed services, and other private health providers. While the U.S. administration may choose to allocate portions of its contribution to specific types of faith-based institutions, the Nigerian government must assert its sovereignty over its own financing to ensure that other providers are adequately resourced and fully integrated into national service delivery. This includes explicitly rejecting religion-based conditions in health financing and ensuring that all providers adhere to national service standards or operate within robust referral networks, so that access to care is determined by need, not faith, ideology, or the preferences of external partners.

This is why Nigerians must look beyond the headline figures and ask the harder question: Is this health aid or a power play? When a deal is branded America First, we should believe it. The strategy is explicit that U.S. health assistance is designed to advance American economic, political, and security interests. No government exists to put another country’s interests ahead of its own people, so Nigeria must be vigilant! Nigeria does not need to reject cooperation to protect its sovereignty, but it must reject secrecy, misalignment, and silence. Publishing the MoU is the bare minimum. Aligning it with national health priorities is non-negotiable. Ring-fencing health priorities such as sexual and reproductive health, maternal health, and child health must be treated as a red line, not a bargaining chip. Data sharing must be renegotiated to uphold the Nigerian data protection law and guarantee equitable access, local manufacturing, and fair pricing, not corporate monopolies. And any attempt to import religion-based conditions into health financing must be firmly refused, in the interest of national unity and human rights. This is the moment for Nigeria to prove that “Renewed Hope” is not just a slogan, but a governing principle. Nigeria must demonstrate that in global health, where people’s lives are the currency, the country will not agree to deals that would mean “Nigeria go carry last”!