Nigeria-US health deal under scrutiny

By Afeez Hanafi, Dalhatu Liman & Seun Adeuyi

A health agreement worth $5bn between Nigeria and the United States has raised dust after Ghanaian President, John Dramani Mahama, revealed that his country rejected a similar deal over data infringement concerns.  

Findings by Daily Trust show that the Memorandum of Understanding (MoU) requires Nigeria to share data on health outcomes and specimens on novel and emerging infectious diseases with the US government.

This is just as medical experts fault a section of the specimen sharing agreement which requires the US to retain the use of the already shared data even if Nigeria terminates the agreement.

The US had signed a five-year MoU with Nigeria on December 19, 2025 “to advance the America First Global Health Strategy,” a framework that deploys global health diplomacy and foreign assistance to make America safer, stronger and more prosperous through bilateral agreements.

The deal involves about $2.1bn health aid by the US and counter-funding of about $3bn by the Nigerian Government to expand access to affordable, preventive and curative services for HIV/AIDS, tuberculosis (TB), malaria, polio and maternal and child health.

The federal government had said that under the MoU, both countries would work together to strengthen disease surveillance and outbreak response; improve laboratory systems and biosafety procedures for pathogen sample collection, transport, testing, storage, and disposal; support frontline healthcare workers; strengthen data systems; ensure access to essential health commodities; and provide strategic investment and technical assistance across the health sector.

At the time of signing, the government did not provide further details on the agreement, which has sparked conversation following President Mahama’s comment.

Speaking on the sidelines of the 81st United Nations General Assembly (UNGA) at the Council on Foreign Relations in New York on September 25, Mahama revealed that his government turned down the proposed agreement worth over $100 million after the country’s health ministry reviewed it and raised red flags.

He said the proposed health compact, which was intended to replace some health funding previously provided through the United States Agency for International Development (USAID), raised several concerns.

He said, “We received the health compact from the US to replace USAID funding, and Ghana is a sovereign nation and we have our processes as a democratic country. When the compact was received, the health ministry started examining it and did what we call Cabinet Information Paper. The compact was brought to cabinet, and we flagged several things in the compact.”

“One, it says that we shall give the United States our pathogen profile. It means, what are diseases that are endemic in Ghana? What are the pathogen profile of our country, whether it captures American standard?

“It also says we should give our medical records. I mean, who takes another country’s medical records? That was strange. And then, it says we will have to put a certain amount of money into healthcare as part of the programme. It also says that any medications or any medical products that shall be brought into our country, our Food and Drugs Administration has absolutely no right to inspect.”

Mahama said the “humiliating” compact was thrown out in record time by the cabinet and the health minister was directed to inform the US ambassador that Ghana did not need it.

What US, Nigeria say about MoU

A statement by the US Embassy and Consulate in Nigeria said the MoU aims to “advance the America First Global Health Strategy, supporting resilient, self-reliant, and durable health systems while promoting accountability and shared responsibility.”

The US will support surveillance and outbreak response, laboratory systems, health commodities; frontline healthcare workers and data systems.

“Under the five-year MOU, the United States intends to commit nearly $2.1 billion in health assistance, with nearly $3.0 billion in new domestic health expenditures by the Government of Nigeria over the same five-year period,” it said.

According to the statement, the MoU places a strong emphasis on Christian faith-based healthcare providers, recognising their indispensable role in delivering care to communities in need.

It stated that Nigeria has more than 900 faith-based clinics and hospitals that serve more than 30 per cent of the country’s 230 million people, especially in areas where healthcare facilities are limited or absent, adding that the agreement provides approximately $200 million in dedicated support to strengthen and support the Christian facilities, enhance workforce capacity and expand access to integrated HIV, TB, malaria and maternal child health services.

“Investments in Christian faith-based health institutions are uniquely positioned to complement public-sector facilities and reinforce Nigeria’s overall health infrastructure. The MoU was negotiated in connection with reforms undertaken by the Government of Nigeria to prioritize the protection of Christian populations from extremist violence,” it said.

The statement further stated that the President and Secretary of State have the right to pause or terminate programmes that do not align with the US national interests, noting that “the United States expects Nigeria to continue making measurable progress in combating religiously motivated violence against Christian communities.”

The claim that Christians are being targeted in Nigeria has been debunked with data even showing that terrorists have killed more Muslims than Christians.

The federal government described the deal as a landmark MoU to deepen bilateral health cooperation, strengthen health security, and build a more resilient and self-reliant health system for Nigerians.

It said the agreement would enhance collaboration on the early detection, prevention, and control of emerging, re-emerging, and existing infectious diseases, including HIV/AIDS and Tuberculosis, while expanding access to quality primary healthcare services nationwide.

The Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, said the MoU signals a major step toward safeguarding the health of Nigerians while strengthening national resilience.

“The MoU builds on Nigeria’s ongoing health sector reforms, including the Nigeria Health Sector Renewal Investment Initiative (NHSRII), launched in 2023 to improve healthcare accessibility, affordability, quality, accountability, and efficiency. The reforms are implemented through a Sector-Wide Approach (SWAp) that aligns Federal, State, and Local Governments, development partners, civil society, and the private sector under a unified national plan, budget, and reporting framework,” the minister said.

The health agreement

Under the agreement co-signed by the U.S Ambassador to Nigeria, Richard M. Mills Jr. and Prof Pate, a copy of which Daily Trust sighted, Nigerian Government, among others, agreed to use digital medical record solutions, including existing Electronic Health Records (EHRs) or equivalent Optical Character Recognition technologies, as its EHRs and roll them out in 20% facilities by 2026, 40% facilities by 2027, 60% facilities by 2028, 80% facilities by 2029, and 100% facilities by 2030.

The government also “plans to implement financial penalties or rewards or other non-financial incentives for healthcare providers to ensure greater than 50% of encounters are loaded in the EHR within 1 year of rollout in a facility and 90% of encounters are loaded in the EHR within two years of rollout in a facility.”

By 2030, it is expected that there will be 15-20% reduction in maternal mortality in targeted LGAs, that 95% of people living with HIV know their status, that 95% are on treatment and 95% of those on treatment achieve viral suppression.

The MoU also projects 95% reduction in tuberculosis deaths, remarkable reduction in malaria prevalence and deaths, zero Polio cases by 2030 and increase in Nigerians covered by health insurance.

For surveillance and outbreak response funding, the US will provide $20,855,000, while Nigeria provides $238,050,759 and for lab commodities, the US will supply $214,468,458 as against Nigeria’s $184,180,620.

The US will provide support for commodities to the tune of $442,142,452 while Nigeria provides $511,809,132; the US will provide $196m to fund data systems, while Nigeria provides counter-funding of $119,025,379 and for strategic investment and technical assistance funding, the US will provide $1,023,176,417 while Nigeria will provide $1,600,891,351.

The US will fund a total of 4,843 frontline lab workers between 2026 and 2029 while Nigeria funds the same number between 2027 and 2030. While the US will fund 64,240 frontline healthcare workers between 2026 and 2029, Nigeria will fund 57,816 between 2028 and 2030.

Concerns over specimen sharing agreement

A critical part of the MoU is specimen sharing pact signed by the two countries on behalf of their representatives: Mills and Prof Pate.

Article 1 of the specimen sharing agreement states that “The purpose of this Agreement is to promote global health security through the facilitation of the rapid sharing of specimens, samples, sequencing data, and any other associated data related to novel and emerging infectious diseases with epidemic or pandemic potential (“specimen and related data”) between the U.S. Government and the Federal Republic of Nigeria for legitimate public health purposes, including responding to outbreaks and the development of diagnostics and medical countermeasures.”

Article 2 (a) states that upon a request by the U.S. Government, Nigeria will “initiate sharing specimen(s) and related data with the U.S. Government within five days of Nigeria receiving such a request from the U.S. Government or on an alternative timeline as mutually agreed to between the U.S. Government and The Federal Republic of Nigeria, on a case-by-case basis. If requested by the U.S. Government, The Federal Republic of Nigeria may provide sequencing data via sharing on a public database instead of or in addition to directly sharing specimens and related data with the U.S. Government.”

Article 2 (b) states that “Nigeria consents to the U.S. Government sharing the specimen and related data for the purpose of developing diagnostics and medical countermeasures with non-U.S. Government U.S. entities (“U.S. Recipients”), each of whom must have the capability to assist in developing diagnostics and/or medical countermeasures. The U.S. Government will provide the Federal Government of Nigeria written notice when a specimen is shared with a U.S. entity.”

Article 3 notes that if a medical countermeasure is developed primarily from specimen, subject to the availability of funds and applicable law, the US shall prioritise Nigeria in ensuring access to such medical solutions.

The U.S. Government also pledges to explicitly acknowledge contribution of Nigeria and its relevant institutions in publications, presentations, and reports arising from the use of the specimen and related data.

The agreement states that analyses, discoveries, innovations, or other outputs resulting from the use of specimens or related data provided by Nigeria may generate significant public health value and the U.S. intends to share relevant associated findings that may support public health objectives and capabilities with  Nigeria.

Article 4 (b) emsphasises that so long as the U.S. Government provides any funding under the MOU, it has “a significant and material interest in ensuring that the Federal Government of Nigeria fulfills the commitments for specimen and related data sharing set out in this Agreement and that failure by either party to fulfill these commitments could result in changes in U.S . Government planned assistance contemplated under the MOU the discontinuation of the MOU, or the termination of this Agreement by the U.S. Government. The U.S. Government shall enter into good faith consultations with the Federal Government of Nigeria before taking any action under this subparagraph.”

Article 5 specifies that the specimen sharing agreement shall be effective 30 days after signature by both parties and shall remain in force for five years, renewable for another 5 years by mutual agreement.

It further states that “In the event the Federal Republic of Nigeria terminates this agreement, termination shall NOT affect the use by the U.S. Government of any specimens and related data previously shared under this Agreement.”

The document notes that the transfer, use, management and control of specimens and related data shared under the agreement “will be carried out consistently with the relevant applicable domestic laws, including protection of human subjects, relevant biosafety/biosecurity laws and regulations, and internationally recognized standards of specimen handling.”

It concludes that the deal neither “precludes new agreements nor negates or replaces existing agreements for sharing specimen and related data between the U.S. Government and the Federal Republic of Nigeria.’’

Former Vice-President and the African Democratic Congress (ADC) presidential candidate, Atiku Abubakar, called on the federal government to immediately publish the full text of the health agreement.

Atiku, in a statement by the Director of Strategic Communication of his campaign council, Phrank Shaibu, insisted that Nigerians have a fundamental right to know whether the exact provisions that alarmed Ghana are embedded in the agreement signed by President Bola Ahmed Tinubu’s administration.

Atiku also cast doubt on the federal government’s ability to honour its multi-billion-dollar domestic funding commitments under the agreement, pointing to recent revelations by Prof Pate, who informed lawmakers that only a meager N36 million had been released from the N218 billion appropriated for capital projects at the ministry’s headquarters in 2025.

“A government that cannot release funds for approved health projects must explain how it intends to honour a multibillion-dollar commitment,” Atiku said.

Attempts to get the reaction of the Federal Ministry of Health and Social Welfare were unsuccessful as calls to its Assistant Director, Information and Public Relations, Ado Bako, went unanswered.

A WhatsApp message sent to him seeking clarification was also not answered as of the time of filing this report.

In an interview with Daily Trust, a former President of the Nigerian Medical Association (NMA), Professor Innocent Ujah, maintained that it is normal for the US to request data from Nigeria on health outcomes under the MoU.

“Health outcome is the eventual outcome of the treatment and the follow-up including the laboratory findings, clinical findings and the rest. Data sharing is a research focus. I’m not privy to the MoU they signed, so it will be difficult for me to make a conclusion, but sharing data is no problem at all. At the moment, we are sharing data with Havard and other universities,” he said.

But Prof Ujah, who was Director of the Nigerian Institute of Medical Research, questioned the specimen sharing agreement.

“If the agreement is terminated, every other thing regarding that process should stop and no further action. Whatever is done with the data after the termination can be injurious to the country,” he added.

Dr Rotimi Adesanya, Director, Medical Services Federal College of Education (Technical), Akoka, Lagos, corroborated Prof Ujah, saying, “They say there is no free meal in Freetown. So even if they want to use the data for anything, they are backed by the fact that they are sponsoring the programme. When they give a fund like that to support health programmes, normally they need figures.”

“They need figures to corroborate what they are doing to be sure that what they are doing is right. There is no donor agency that will give you funds without asking for the reports.

“So the data they are asking for is like the reports of how the money was spent, the number of people that have a particular ailment such as HIV, the number of people that are taking drugs, the number of people that don’t have access to drugs etc. So there is nothing unethical about it. They need to get the health outcomes,” he added.

However, Adesanya, a fellow of Academy of Public Health, faulted the clause that allows the US to continue using “specimens and related data,” even after termination of agreement.

“The truth is that it is one-sided. The benefit is supposed to be mutual. That is why countries should be careful before they sign any agreement. Countries should not rush to sign any agreement. They should ensure that every expert involved is carried along at every stage,” he added.

Nigerians’ health data at risk – Expert

Dr Olumide Babalola, privacy and data protection expert and founder of the Data Privacy Lawyers Association of Nigeria (DPLAN), said the proposed data integration would mean that large volumes of sensitive health information could be continuously collected, linked, stored and shared beyond periods of public-health emergencies.

He said though such systems could strengthen the detection, surveillance and management of public-health threats, he warned that their permanent nature raised significant data protection concerns.

“From a privacy perspective, while the integration can potentially improve the early detection, surveillance and management of public-health threats, it also means that large volumes of health data may be collected, linked, retained and shared on a continuing basis, rather than only during emergency periods.

“From a data protection standpoint, it must first be noted that health data are categorised as sensitive personal data, which requires heightened protection obligations,” Babalola said.

He said the proposed systems would raise questions under the Nigeria Data Protection Act 2023, particularly over the lawfulness and purpose of processing, data minimisation, retention periods, transparency and the secondary use and sharing of health information.

“The creation of interconnected databases also increases the possibility of profiling, unauthorised access, re-identification and function creep, where information initially collected for outbreak response is subsequently used for unrelated purposes,” he said.

Babalola called for secure and interoperable infrastructure, clear data standards, strong identity and access controls, encryption, audit trails, regular vulnerability assessments and tested incident-response and disaster-recovery mechanisms.

He said Nigeria would also require a strong governance framework defining who could collect, access, share and retain health information and for what purposes.

He added that citizens should be adequately informed about how their health data was being used, while mechanisms should be established to handle complaints and respond promptly to data breaches.

“These safeguards should operate within the framework of the Nigeria Data Protection Act 2023, so that the public-health value of integrated surveillance is pursued alongside confidentiality, security, accountability and respect for individuals’ data-protection rights,” Babalola said.