The Nation Malawi (9 February 2026)
*By: Dr Atilla Kisla and Bradley Fortuin.
In the past 2 months, the U.S. has signed “health cooperation” Memoranda of Understanding (MOUs) with 15 African States. One of them is Malawi, which signed its MOU with the U.S. on 14 January 2026. The U.S. Embassy in Malawi reports that a five-year agreement has been signed, under which the U.S. will contribute $792M to Malawi’s health sector and Malawi will increase its annual spending to $143M, resulting in a pledge to finance 85% of the health cooperation budget.
While this might sound as good news at first, a broader picture reveals the signing of the MOUs as just one part of a wider strategy by the U.S. that ties in with the U.S. cutting aid for domestic health systems in Africa at the beginning of 2025, the release of the U.S. America First Global Health Strategy in September 2025, and the exit from the World Health Organization (WHO) from 22 January 2026. The question is, what is in it for the U.S.? In this case, it is health data, which can become a powerful tool for leveraging and influencing States in the 21st century and the age of AI.
The Malawi MOU: How did we get here?
A year ago, after the Trump administration cut U.S. foreign health assistance to countries like Malawi, it resulted in immediate damage to national programmes. What appeared to be crude populism has since revealed itself as a more calculated decision that led to a crisis, turning health aid into leverage.
On 14 January 2026, Malawi became the fifteenth African country to sign the America First Global Health Strategy agreement. While the U.S. contribution might appear generous, a closer look at such MOUs and others signed with the U.S. over the past weeks raises further questions. While the U.S. State Department states that the MOU with Malawi is “designed to leverage Malawi’s significant progress in addressing the HIV/AIDS epidemic, supporting the country’s commitment to maintaining its 95-95-95 goals for epidemic control through sustainable”, it also states that the “MOU marks a critical shift away from parallel NGO delivery systems”.
As most of the 15 MOUs that the U.S. has signed with African States have not yet been published, those that have, such as those for Kenya, Liberia, or Mozambique, provide insight into what the African countries are expected to provide. Under the guise of “health cooperation”, such agreements can include wide data-sharing agreements, relating to genomic sequencing or health surveillance systems. In a country like Malawi, where the health sector is under heavy strain, a country with high HIV prevalence rates, tuberculosis, persistent cholera outbreaks, and a maternal health crisis, the data generated can map vulnerabilities, reproductive health patterns, drug resistance, genomic diversity, or outbreak susceptibility across the entire population. While such data can be used to address health issues in the country, it can also be used to model epidemics, shape drug markets, influence which medicines are developed and how they are priced, anticipating demographic and biological trends, which can easily result in an asymmetry that can be used by the more powerful State to such an MOU as leverage.
This policy follows a strategy set out in the America First Global Health Strategy, where the U.S. considers the emerging population and markets in Africa as a counterweight to China’s influence on the continent. In that regard, it is unsurprising that some publicly available MOUs include provisions regarding preferences for American corporations, limitations on reproductive autonomy, or the U.S. terminating its funding if the country in question fails to provide the requested data. The asymmetry on which these MOUs are based can easily translate to political influence and power.
Maximum Influence with Zero Accountability
The real enabler of this power grab is medical, it is legal. It derives from the legal regime of the MOUs, which have been quietly signed between the U.S. and African governments. Washington is not building this parallel health-governance system through treaties that demand parliamentary approval, public debate, or legal scrutiny. It is doing so through MOUs, documents designed to avoid public attention and discourse.
MOUs such as the one for Liberia contain a provision clarifying the bindingness, rights, obligations with provisions stating that:
“This MOU is not an international agreement and does not give rise to legal rights and obligations under international or domestic law.”
However, despite the non-binding aspect of these MOUs, they have the power to reshape national health systems, embed surveillance technologies, facilitate large-scale data extraction, integrate U.S. ideology without ever facing any constitutional or judicial scrutiny that aims to safeguard fundamental rights. This is not a bug, it is a feature: maximising influence and the flow of data with very limited scrutiny and accountability. A further risk arises from subsequent agreements or contracts that follow the ideas and parameters set out in the MOU, which may become legally binding on State authorities.
The need for safeguards
While state officials might downplay the bindingness of the MOU, a review of available MOUs indicates an asymmetry in which data flows one way and influence and power flow the other. Any government decision that provides health data on such a scale must undergo strict constitutional and human rights scrutiny. Kicking the can down the road and procrastinating a proper public discourse is exactly what the architects of the MOUs intended.
It is not too late for Malawi. The same legal ambiguity that makes these MOUs so attractive to the White House also creates room for resistance. If they are truly “non-binding,” they can be paused, narrowed, renegotiated, or abandoned altogether. The minimum starting point is democratic scrutiny. These agreements must face parliamentary and judicial review before implementation. Data sharing, surveillance access, and platform integration cannot be smuggled into technical annexes. Kenya’s High Court order of 19 December 2025, blocking implementation of its MOU, can offer a blueprint for States like Malawi.
Health cooperation is not executive. It is constitutional. Malawi now faces a reckoning: an ambitious deal signed under pressure, a health system in crisis, and shrinking room to manoeuvre. The way out is not denial, but transparency, public discourse, binding data-protection rules, and renewed engagement with civil society.
*Dr Atilla Kisla – International Justice Cluster Lead at Southern Africa Litigation Centre
*Bradley Fortuin – Equality Rights Officer at Southern Africa Litigation Centre