At the Council on Foreign Relations in September on the sidelines of UNGA 2026, President Mahama explained why his Cabinet rejected a proposed US health compact worth about $109 million over five years. It would, he said, have required Ghana to hand over its pathogen profile and medical records, and would have barred our Food and Drugs Authority from inspecting imported medical products. He called the terms "humiliating" and said Cabinet threw the compact out in record time.
Ghanaian radio and social media
have been thrilled. Here, many said, was an African leader prepared to face the
West without ambiguity. The US Embassy in Accra soon replied that it had sought
only aggregate data without personal identifiers, as under PEPFAR, and that
America had invested $2.2 billion in Ghana's health sector since 2012. The
door, it said, remains open.
Having spent time in both civil
society and state security assessing questions of intelligence and national
security, I read this exchange with both admiration and caution. Cabinet drew
the right line. But a refusal, however eloquent, is not yet a policy. Sovereignty
is not proven by what a government declares rather by what it can sustain,
verify and apply consistently.
What was on the table
The negotiating text has not been
published, so honest analysis must separate three kinds of claim.
Confirmed by the President: the
pathogen profile, medical records, counterpart funding and an exemption from
FDA inspection.
Reported by sources: a 25-year data term on a
five-year programme; a US pledge subject to congressional approval against a binding
Ghanaian commitment of about $70 million; broad US discretion over the data,
including use by American pharmaceutical firms; and a first draft presented in
November 2025 with a one-week deadline.
Contested: whether "medical
records" meant patient files or aggregate indicators. That is now the
central factual dispute.
Reading the Embassy's answer
The Embassy's reply was diplomatic
in tone and pointed in substance. It ignored the word "humiliating",
letting the President's language look like the escalation. It framed the US
phase-out as being "in alignment with" Ghana's push for health
sovereignty, a polite way of saying Ghana is sovereign and should now fund it.
Its $2.2 billion figure quietly answered the President's description of $109
million as a pittance. And by responding publicly at all, it signalled that its
real audience was the Ghanaian public, not the government.
Its strongest point is precedent:
aggregate reporting under PEPFAR has run for years, and accountability to
Congress is a legitimate need. But an Intelligence Analyst reads a denial for
what it leaves out. The statement was silent on the 25-year term, commercial
use of the data, the FDA exemption and the asymmetry of obligations. A narrow
denial that skips the specific charges tells you where Washington feels
exposed.
Each side's case is weaker than it
sounds. The Embassy compared specimen sharing to cooperation against Ebola, but
that analogy cuts both ways. The Ebola response left West African governments
complaining about samples taken abroad and not returned. In 2007, Indonesia
refused to share H5N1 flu samples over a similar imbalance, and that refusal
produced WHO's influenza benefit-sharing framework. The Ebola precedent is an
argument for guaranteed benefit-sharing, which is precisely what is in dispute.
"No personal
identifiers" is also narrower than it sounds. Long-term access to health
information systems can allow re-identification without names, and an assurance
about the content of data says nothing about access to systems or its duration.
Yet the asymmetric funding language is probably standard US drafting, because
the executive cannot bind future congressional appropriations. The asymmetry is
real for Ghana; the motive may be mundane.
An important gap worth noting. The
first draft reportedly came with a one-week deadline; the Embassy speaks of
months of good-faith negotiation. Both can be true. We do not know whether
Cabinet rejected the original draft or a softer negotiated text. The two sides
may be describing different documents.
The real bargain
Many Ghanaians suspect a hidden
agenda or conspiracy. There is likely none, only a transactional bargain in
which health data and biological material are among the things being bought. It
has three layers. The declared layer is outbreak detection and accountability
to Congress, both legitimate. The structural layer is aid as leverage, as when
health funding was reportedly linked to critical minerals in Zambia. The
strategic layer is access without obligation: bilateral terms secure pathogen
samples outside the WHO system that guarantees supplying countries fair access
to the resulting vaccines. The United States has left the WHO and will not join
that system.
Population-scale health data can
reveal disease burden, resistance patterns and genetic characteristics. There
is no evidence any partner has misused such data, and we should say so without
ambiguity. The decisive issue is irreversibility. Troops can be withdrawn and
agreements terminated; on the contrary, data and specimens cannot be recalled.
Access also accumulates. Ghana granted operational access through joint
military medical exercises and territorial access through the 2018 Defence
Cooperation Agreement, and neither has been reversed. The compact would have
added informational, biological and regulatory access, each less visible and
harder to undo.
Dignity and its price
A clear “NO” has value. It sets a
floor for other African states, strengthens Ghana's hand and builds domestic
support for a harder line on data and regulation. But words like
"humiliating" and "pittance", spoken to an American
audience, make quiet renegotiation harder and invite Washington to show what
its absence costs. The phase-out has already begun.
Rhetoric does not buy
antiretrovirals. The shortfall already touches HIV testing, antiretroviral
supply and laboratories. If clinics face inventory depletion next year, critics
will say principle was paid for with patients' health. The durable model is
firm in substance and measured in tone: refuse specific terms, publish the
reasons, fund the alternative and keep a counter-offer on the table. That shows
the West something more persuasive than defiance: that Ghana can manage without
the money.
The idea of leaders who face the
West also carries moral force only if it applies to every partner. Bluntness
toward Washington with silence toward Beijing, Brussels or private technology
vendors is practicing geopolitical positioning, not principle.
Publish the text
Only the published text can settle
the dispute. Some reasons for secrecy are legitimate: negotiating drafts and
Cabinet papers are confidential by convention, and publishing the other party's
draft unilaterally could damage Ghana's standing as a negotiating partner.
Others are convenient. Publication would show whether the final text matched
the President's description, and would expose the terms the Embassy avoided.
Ambiguity serves both sides, which is exactly why the public should insist on
disclosure.
There is a middle path. The
government could release the contested clauses, brief Parliament's Health and
Foreign Affairs committees in closed session, or propose a joint release of the
final draft to test the Embassy's confidence in its own account. Any of these
would move the debate from competing narratives to evidence.
From refusal to doctrine
African responses have varied.
Botswana signed a narrow HIV-focused deal while funding most of it. Zimbabwe
refused and is losing US funding. Zambia reportedly won removal of the
contentious terms. Kenya signed, but a court suspended implementation. Terms,
leverage and fiscal room drove each outcome, not courage or its absence.
Ghana should turn one decision
into standing policy:
- Define in law what Ghana will share: aggregate indicators freely,
de-identified data under strict agreements, identifiable records never.
- Table a counter-offer: audit access through Ghanaian-hosted
dashboards with independent verification. The Embassy says it wants only
aggregate data; this takes it at its word.
- Keep the FDA sovereign and require binding benefit-sharing for
any pathogen shared, with no term longer than the funding.
- Require parliamentary approval. The 2018 defence agreement went to Parliament; a health
data agreement of greater long-term consequence should too, with every
annex published.
- Ring-fence domestic financing for HIV, TB and malaria commodities,
with public reporting on inventory levels. This is the centrepiece, not an afterthought.
- Apply the same rules to every partner and every digital-health vendor.
- Build a regional floor through ECOWAS and Africa CDC, or neighbours' deals will expose the sub-region's data
anyway.
The work of sovereignty
We should be realistic. Ghana's
leverage is modest, dozens of countries have already signed, and Washington may
ignore a counter-offer. Domestic financing and regional coordination are
therefore the real safeguards. Our answer need not be anti-American. It can be
selective sovereignty: generous on surveillance, training and aggregate data;
firm on identifiable records, uncompensated specimens and control of our own
regulator.
The President voiced a real
grievance, and the Embassy gave a careful reply. Neither settles the matter.
The text, the law and the budget line will. Dignity declared at a podium must
be defended in the pharmacy, the laboratory and the negotiating room. That is
the work of sovereignty, and it has only begun.
The author, Nana Attobrah Quaicoe
is an Intelligence and National Security Analyst, a former Director General of
the Bureau of National Intelligence (2022-2025) and writes on national security
and intelligence reforms, risk, integrity assessment and institutional
governance in the Ghanaian context.
