Why some African nations are turning down Trump aid money

A Kenyan court initially suspended the country's deal after legal challenges demanding protection of patient privacy.

Arnold Kavaarpuo, executive director of Ghana's Data Protection Commission, told the BBC the government in Accra had objected to the deal it was offered for similar reasons.

"We had concerns around the scope and breadth of data that was being required," he said.

"It was us generating data and passing it on to the US authorities, and there were no real reciprocal measures when it comes to the protection of Ghanaian data and Ghanaian sovereignty.

"And so from our perspective," he added, "once the data left the Ghanaian borders, we had no control over what becomes of it."

Zimbabwe also cited concerns about requests for medical data, presumably to be shared with US pharmaceutical companies, as the reason it rejected a deal.

There were no guarantees that drugs or vaccines developed from the pathogens would be available to its people, a government spokesman said, pointing out that the WHO already had a system for members to share data and benefit from any treatments in future pandemics.

African countries have previously passed on medical information through existing schemes including USAID and Pepfar, America's main programme to tackle HIV and Aids.

The US insists the sharing of data and specimens is key to continuing scientific development and mutual co-operation.

And a State Department spokesperson said the material requested was the same aggregated and de-identified data which has been used for years in the fight against infectious diseases.

What has changed is the context, says Nelson Aghogho Evaborhene, a PhD fellow in global health governance at Roskilde University in Denmark.

"It was an unequal relationship, but it was quite tolerable politically," he says, "because you could sell it to the domestic population as an altruistic need to improve health service.

"But now it has changed significantly, because it's more about very transactional leverage."

Many African nations have also drawn lessons from Covid, as the race to find a vaccine proved the value of pathogen data but left the continent struggling to get doses for its people.

"I think one of our biggest opportunities as Africa," says Aggrey Aluso, the executive director of Resilience Action Network Africa (Rana), "is the fact that we have important information that can help build the global health security ecosystem."

Rana joined more than 50 civil society groups in signing an open letter warning African leaders that US terms were not guided by African national or regional interests, a view shared by South Africa.

"Frankly speaking, no nation on Earth that respects itself should accede to [two requests]," South Africa's Health Minister Dr Aaron Motsoaledi told the BBC.

"That [the US] will get their pathogen if there's any pandemic or epidemic in their area.

"And they'll also provide them with a genome for life. But the US is going to give them money for five years."

The debate over health diplomacy has been thrown into sharper relief in recent weeks following the spread of a new outbreak of Ebola in the Democratic Republic of Congo.