In Africa, about twenty countries have signed a bilateral aid agreement with the United States as part of the 'Global Health Strategy - America First' launched by the Trump administration. This program aims to protect U.S. territory by preventing infectious disease outbreaks from reaching American shores while simultaneously promising to save millions of lives and reduce the countries' dependence on foreign aid. However, some countries, including Zambia and Zimbabwe, have chosen not to comply with the American conditions for these agreements.

The refusal from countries like Zambia and Zimbabwe seems to stem from a desire to maintain sovereignty over their health policies and continue to rely on diverse sources of funding. These nations may perceive the conditions attached to U.S. aid as restrictive or counterproductive to their national interests. Furthermore, the aftermath of the restructuring and significant reductions of various American health programs has also impacted the perception of such agreements, leading to skepticism about their real benefits amid the uncertainties of American policy.

As the global health landscape evolves, these refusals highlight the complexities of international aid and the balancing act that countries must perform between accepting foreign assistance and preserving their autonomy. It raises questions about the future of health collaborations and dependencies in Africa, particularly as nations weigh the impact of external influence versus their ability to chart their own health strategies and policies.