“Malawi has signed away its bargaining power at the very moment the region is pushing back,” says Alex Kaomba, a community health rights advocate and member of the Civil Society Advocacy Forum (CISAF).
“The question is not whether we need support. The question is whether this agreement protects Malawi’s long-term interests.”
Kaomba spoke alongside Dingaan Mithi, a CISAF member and Programme Manager for Journaids. The two are calling for full public disclosure of the five-year Memorandum of Understanding signed between the Government of Malawi and the United States Government, reportedly valued at 792 million dollars.
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“As it stands, the MoU is not clear in terms of equity and sustainability,” Kaomba said. “There are no firm guarantees that support will continue in a way that benefits both parties. There is no clear sustainability roadmap.”
The reported 792 million dollars averages roughly 158 million dollars per year. By comparison, previous multilateral arrangements such as PEPFAR and the The Global Fund to Fight AIDS, Tuberculosis and Malaria delivered higher annual inflows embedded in pooled financing systems rather than concentrated in a bilateral package. PEPFAR averaged 150–181 million dollars annually through 2024, funding roughly 36.7 percent of the HIV response via COP plans. The Global Fund contributed about 41.5 percent, delivering $120–185 million per year for HIV programs, with domestic co-financing at roughly 17.7 percent.
“If annual support is effectively lower and less diversified, Malawi becomes more exposed,” Kaomba said. “Multilateral pooling spreads risk. Bilateral concentration increases vulnerability, especially without WHO coordination.”
He warned that the agreement also shifts Malawi away from its traditional multilateral approach. “Our health system has been built on collaboration with WHO and UN agencies to ensure scientific neutrality and equitable access. A parallel bilateral system risks fragmenting coordination and weakening these gains.”
Kaomba further expressed concern over the centralisation of HIV commodity procurement through U.S. channels. “When procurement is controlled externally, foreign pharmaceutical companies gain leverage. It sidelines local and regional suppliers and undercuts efforts to build Malawi’s pharmaceutical capacity. The deal benefits one side more than the other.”
Regional examples validate these concerns. In Zimbabwe, negotiations on a similar 367 million dollar arrangement were terminated after authorities rejected clauses requiring access to national health data, pathogen samples, and epidemiological information without reciprocal guarantees. Zambia has also pushed back on similar U.S. health funding arrangements over extensive data-sharing requirements and linked economic provisions.
“It is not clear what Malawi gains from sharing biological specimens or sensitive health data,” Kaomba said. “The WHO Pandemic Access and Benefit Sharing framework was designed to ensure fairness. Moving outside that system defeats the purpose of equitable benefit sharing and leaves us vulnerable.”
Mithi emphasised the lack of public accountability in Malawi. “Civil society and communities were completely excluded from the negotiation process,” he said. “There has been no transparent engagement. Agreements of this magnitude require public scrutiny.”
Both Kaomba and Mithi are now calling for renegotiation. “The Malawi Government must revisit this deal,” Kaomba said. “There must be clear financing guarantees and safeguards to ensure funding cannot simply be withdrawn if conditions are not met.”
Mithi added, “Partnerships should strengthen Malawi’s systems, protect our data, and build long-term sustainability. Transparency and reciprocity are not optional—they are essential.”
Taken together, activists warn that Malawi may be trading lower annual funding, reduced procurement autonomy, weakened data sovereignty, and limited multilateral collaboration for short-term fiscal relief, highlighting the importance of transparent, equitable, and accountable international health agreements.
