U.S. Bilateral Health Agreements: Texts and Related Information
Following the dismantling of USAID and large-scale disruption to U.S. foreign assistance programs, the Trump administration is restructuring health aid according to its “America First Global Health Strategy.” Under the strategy, the Department of State is negotiating multi-year bilateral health funding agreements with dozens of countries. The administration is negotiating these agreements on tight timelines, with limited transparency and minimal civil society engagement, despite their significant impact on how health systems and funding operate for years to come.
The State Department posted the main texts of several signed agreements (but not the related agreements that cover data and specimen sharing) to its website along with additional information reported to Congress regarding the specimen sharing agreements. It subsequently removed these documents.
PDFs of the health agreements published by the Department of State are available in the table below. Only five signed agreements have been published by the U.S. government. Twenty-seven agreements have been signed to date. The table below additionally includes agreements not published by the U.S. but posted by other sources.
| Country | Agreement Date | Main text published by State Department* | Other information disclosed by State Department** | Texts posted by other sources | |
|---|---|---|---|---|---|
| Kenya | Dec. 4, 2025 | Yes (PDF) | Data Sharing Agreement (Health Policy Watch) | ||
| Rwanda | Dec. 5, 2025 | Main text (Emily Bass, Substack) | |||
| Liberia | Dec. 9, 2025 | Main text (Health Policy Watch) | |||
| Lesotho | Dec. 10, 2025 | Specimen Sharing Agreement reported to Congress (text not disclosed) | |||
| Uganda | Dec. 10, 2025 | Yes (PDF) | Specimen Sharing Agreement reported to Congress (text not disclosed) | ||
| Eswatini | Dec. 12, 2025 | Specimen Sharing Agreement reported to Congress (text not disclosed) | |||
| Mozambique | Dec. 15, 2025 | Yes (PDF) | Specimen Sharing Agreement reported to Congress (text not disclosed) | ||
| Cameroon | Dec. 16, 2025 | Main text (Think Global Health) | |||
| Nigeria | Dec. 20, 2025 | Yes (PDF) | Specimen Sharing Agreement reported to Congress (text not disclosed) | ||
| Sierra Leone | Dec. 22, 2025 | ||||
| Botswana | Dec. 23, 2025 | ||||
| Ethiopia | Dec. 23, 2025 | Yes (PDF) | |||
| Madagascar | Dec. 22, 2025 or Dec. 23, 2025 | ||||
| Côte d'Ivoire | Dec. 30, 2025 | Specimen Sharing Agreement reported to Congress (text not disclosed) | |||
| Malawi | Jan. 14, 2026 | ||||
| Burundi | Feb. 6, 2026 | ||||
| Burkina Faso | Feb. 25, 2026 | ||||
| Panama | Feb. 25, 2026 | ||||
| Democratic Republic of the Congo | Feb. 26, 2026 | ||||
| Dominican Republic | Feb. 26, 2026 | ||||
| Niger | Feb. 26, 2026 | ||||
| El Salvador | Feb. 27, 2026 | ||||
| Guatemala | Feb. 27, 2026 | ||||
| Guinea | Feb. 27, 2026 | ||||
| Honduras | Mar. 13, 2026 | ||||
| Senegal | Mar. 13, 2026 | ||||
| Angola | Mar. 19, 2026 | ||||
| Cambodia | April 2, 2026 | ||||
| Tajikistan | April 6, 2026 |
* Main agreement texts were originally published by the State Department here. Additional details regarding information reported to Congress were originally published here (original publication is viewable here).
** Information regarding specimen sharing agreements was originally published by the State Department here (original publication is viewable here).
Source of country agreement dates: KFF or State Department press releases.
Public Citizen filed a lawsuit against the U.S. State Department for failing to produce records responsive to Freedom of Information Act requests for the health agreements and related information. Read the press release related to the suit here. The Washington Post covered the suit in its reporting on the Trump Administration’s secretive approach to global health assistance.