Like a moth to the flame

Co-authored with Sarah Bermeo, Associate Professor in the Sanford School of Public Policy at Duke University.

The abrupt shuttering of USAID and canceling of foreign assistance left many partners, abroad and at home, anxiously awaiting news from the State Department on what’s next. We recently received a glimpse, and it is not pretty. Although shrouded in the rhetoric of “America First”, it is only America First if one has the foresight of a moth flying into a flame.

The State Department has made provision of medication and HIV assistance to African countries conditional on the countries’ granting of access to confidential patient data, with limited or no promise of sharing resulting medical advancements. In some cases, it is also conditional on granting the U.S. market access and/or partnerships with U.S. firms (see “America First” Global Health MOU template obtained by Public Citizen). A draft memo, reported by Stephanie Nolen in the New York Times in March, previewed this approach in Zambia. Similar approaches have since been used in MOUs with the governments of Ghana, Kenya, Liberia, Nigeria, Uganda, Zimbabwe, among others. Negotiations have stalled as countries pushed back on the deals, with some, like Zambia, walking away. This could negatively impact U.S. long-term strategic interests.

To the average person this “aid for minerals and health data” may seem like a small negotiating strategy change, but it represents a major and short-sighted foreign policy shift. There has consistently been broad bipartisan support for the idea that providing international aid for health purposes serves U.S. interests. Former Senate majority leaders Bill Frist (R) and Tom Daschle (D) long championed “strategic health diplomacy.” They argued that fighting diseases such as HIV/AIDS and malaria serves U.S. self-interest via soft power: countries receiving higher amounts of U.S. health funding have a more favorable view of the U.S. than those receiving less, which enhances standing in the world, improves international cooperation, and decreases the likelihood of malicious acts against the U.S. by individuals or rogue groups. High prevalence of HIV/AIDS and other potentially dangerous diseases also breeds instability and conflict within affected societies, which can become a security and border problem for the U.S.

This short-term view of what it means to be “America First” will have long-term negative consequences for American self-interest: as Secretary of Defense Robert Gates once noted, “development is a lot cheaper than sending soldiers.” And it may not even achieve the stated aim of securing mineral rights, which could be deemed illegally secured under a logic similar to doctrines on odious debt. Agreements made at gunpoint are not typically enforceable – except with another gun.

China has dominated the critical minerals sector in African countries through at least partially extractive and anti-competitive trade policies. Countering such efforts could benefit the U.S., Zambia, and the broader global economy (as long as our oligopolists do not abuse their market power as much as Chinese oligopolists would). But holding Zambia and other countries hostage by threatening to cancel life-saving aid pursues a lazy short-sighted transactional strategy in lieu of working toward a much harder – but likely more durable and beneficial – diplomatic solution.

Popular support for China in Zambia has fallen: In 2014, 72 percent of those surveyed by Afrobarometer believed that Chinese economic and political influence was positive; this fell to 51 percent ten years later. The U.S. could work with allies to seize this opening and develop durable win-win solutions with African countries that promote U.S. economic and strategic interests, position the U.S. as a leader in diplomatic efforts regarding critical minerals, and foster long-term goodwill and cooperation with African nations by offering more equitable partnerships than China offers.

Instead of working toward long-term solutions on access to critical minerals, the State Department is looking for a quick “win” achieved by withholding life-saving medical assistance to a country that has the sixth highest poverty rate in the world, with 64 percent of its population living on less than $2.15 per day. Reputational damage to the U.S. from reports of this possible policy shift has already extended well beyond Zambia and the African continent. There is little upside to this bullying and transactional approach, but there is still time for a course correction, and still an opportunity to reshape aid policy to genuinely serve long-term U.S. strategic interests.

Life-saving food and medicine have historically been emblazoned with the motto “From the American People.” A more accurate motto now might be, “Bought under Duress from the American People.” We are acting as a Bad Samaritan, telling the victim that we will only help them if they sell us their future.

Co-authored with Sarah Bermeo, Associate Professor in the Sanford School of Public Policy at Duke University.