Keypoints:
- Ghana rejected disputed US health compact
- Mahama ties sovereignty directly to capacity
- Ghana’s 2027 AU role provides policy test
GHANA’S rejection of a proposed United States health compact produced one of the most revealing moments of President John Dramani Mahama’s conversation at the Council on Foreign Relations in New York on September 25.
But the bigger story was not simply the deal Ghana turned down.
Over the course of the discussion, Mahama moved from healthcare and Sahel security to African trade, debt, cultural restitution and reform of global institutions. Running through those seemingly different subjects was one argument: political sovereignty means considerably less when a country lacks the economic and institutional capacity to exercise it.
It was a case for greater room to choose — not for Africa to withdraw from the world.
Ghana draws a line on health deal
That argument became concrete when CFR’s Michelle Gavin asked Mahama why Ghana had declined to sign a bilateral health agreement proposed by the Trump administration.
Mahama said the Health Ministry studied the compact before sending an information paper to Cabinet.
‘Ghana is a sovereign nation and we have our processes. We’re a democratic country,’ he said.
Cabinet, according to Mahama, objected to several provisions.
‘One, it says that we shall give the United States our pathogen profile,’ he said.
He then raised another concern: ‘It also says we should give our medical records. I mean, who takes another country’s medical records?’
Mahama said the proposal required Ghana to contribute funding and, more controversially, would have restricted the Food and Drugs Administration’s authority over medical products entering Ghana under the arrangement.
‘Our Food and Drugs Administration has absolutely no right to inspect,’ he said. ‘I mean, it was humiliating.’
The Cabinet response, he recalled, was unusually swift.
‘It was the compact that was thrown out in record time in our Cabinet. I’ve never seen anything thrown out as fast as that.’
The complete compact offered to Ghana has not been published, so those provisions remain Mahama’s account of the proposal his government received. Nor should they automatically be assumed to be identical to agreements signed by other African governments.
There is, however, a wider debate over the new US approach.
Human Rights Watch reviewed seven agreements involving African countries and found provisions covering access to health information and, in five cases, commitments concerning specimens, samples and sequencing data linked to emerging infectious diseases. The organisation has also questioned whether the arrangements provide sufficient guarantees on privacy and equitable access to products developed from biological resources.
Africa Briefing previously examined the dispute in its report on why Ghana rejected the US health data deal.
Aid cuts sharpen health debate
For Mahama, the disagreement cannot be separated from the wider upheaval in US development assistance.
He said the withdrawal of USAID funding left Ghana facing a $174m shortfall, including roughly $74m in annual health support for programmes covering medical research, laboratories, HIV testing and antiretroviral treatment.
That experience, he said, helped accelerate thinking behind the Accra Reset.
‘Africa must learn to break this dependency syndrome,’ Mahama said.
His answer is not to dispense with international partners. It is to reduce the danger of essential services becoming overly dependent on decisions taken in foreign capitals.
That includes producing more medicines and vaccines in Africa.
‘After what happened in Covid, we were the last in the queue to get vaccines,’ he said.
‘Africa doesn’t want to be last in the queue again.’
The language of sovereignty can sound abstract. In this context, Mahama was giving it a practical meaning: who finances essential services, who controls sensitive information, who makes medicines and who has the authority to regulate what enters a country.
Sahel crisis goes beyond the coups
The same instinct to look behind an immediate crisis shaped Mahama’s discussion of the Sahel.
Asked about military rule, violent extremism and the split between ECOWAS and Burkina Faso, Mali and Niger, he began not with the coups but with Libya.
‘The destabilisation of the Sahel started as a result of the actions of America and France when Gaddafi was taken out,’ Mahama said.
That is his interpretation of a crisis with many causes.
There is evidence that the collapse of the Libyan state after 2011 accelerated the movement of weapons and fighters into the region. But insecurity in the Sahel also reflects longstanding problems including weak governance, marginalisation, competition over land and resources, local conflicts and the expansion of jihadist organisations.
Mahama’s immediate concern was what should happen now.
Despite the political rupture between ECOWAS and the three Alliance of Sahel States countries, he argued against isolation.
‘We must create a bridge where at least we are talking,’ he said.
Ghana’s borders remain open to regional commerce, he added, while Ghanaian and Burkinabè intelligence agencies continue exchanging information.
Mahama also offered one of his starkest assessments of Ghana’s exposure to the insurgency.
‘I don’t kid myself that Ghana is not vulnerable to attack, and maybe it’s a question of when, not if,’ he said.
That risk is already carrying a price. Mahama said resources that could otherwise go into education and health are being directed towards surveillance and defence.
His conclusion on the AES states was equally clear: ‘The world should not give up on those three Sahelian states.’
AfCFTA needs more than agreements
When the discussion shifted to African integration, Mahama reached for a much simpler example.
Tea.
‘If I order two containers of tea from Kenya, that tea shouldn’t come to UK before it’s shipped back to me in Ghana,’ he said.
The African Continental Free Trade Area may have created a framework for a much larger single market, but commerce still runs into poor transport links, difficult border procedures and trading networks designed historically to connect African economies with markets outside the continent.
Africa Briefing has reported that intra-African trade is approaching $230bn, although its share of Africa’s total trade remains comparatively modest.
Mahama’s point was straightforward. AfCFTA becomes meaningful only when goods can actually move efficiently between African markets.
The roads, railways, shipping routes and logistics systems are as important as the agreement itself.
He applied a similar argument to cultural restitution, saying the return of African artefacts should not be viewed only as an act of historical justice.
Returned works could also support museums, tourism, cultural industries and jobs in the societies from which they were taken.
Debt debate starts before restructuring
Mahama was perhaps most forceful when the conversation turned to Ghana’s experience under the G20 Common Framework.
He rejected the idea that the important story begins when a country finally restructures its debt.
‘Actually, debt treatment is the end, not the beginning,’ he said.
Then came the claim at the heart of his criticism of the global financial system.
‘Africa borrows eight times more expensive than the rest of the world. That’s where it starts. That’s where the debt trap starts.’
The ‘eight times’ comparison is Mahama’s formulation and should not be read as a uniform ratio applying to every African borrower.
The broader concern about financing costs is well established, however. ONE Data found that the average cost of borrowing for African countries increased by 91 percent between 2020 and 2024, rising from 2.7 percent to 5.1 percent across creditors.
Mahama also pointed to illicit financial flows, debt servicing and risk premiums as pressures that drain resources from African economies.
‘Debt treatment is actually palliative,’ he said.
The cost, he added, can be measured in what governments cannot finance.
‘That’s money I could have put in education. That’s money I could have put in healthcare. That’s money I could have put in infrastructure.’
None of this removes domestic responsibility.
Poor borrowing decisions, corruption, hidden liabilities, weak public investment and fiscal mismanagement can also push African states towards debt distress. A more balanced reading is that domestic governance failures can coexist with an international financing system in which many African governments face unusually expensive capital.
The real test comes in 2027
The significance of Mahama’s New York argument will become clearer when Ghana assumes the rotating chairmanship of the African Union in 2027.
Ghana has already completed substantial preparations. Its Foreign Ministry says the agenda under discussion includes peace and security, regional integration and trade, reparatory justice, institutional reform and more sustainable African financing of the AU itself.
Africa Briefing has followed those preparations in Mahama’s developing 2027 AU leadership agenda.
The chairmanship will provide a practical test of what Mahama outlined at the CFR.
It is easier to call for African integration than to build the infrastructure that makes it work. Easier to demand affordable finance than to strengthen domestic revenue systems and public financial management. Easier to speak of health sovereignty than to establish pharmaceutical industries, laboratories and reliable national financing.
And easier to invoke sovereignty than to create the conditions that allow governments to make difficult choices without essential services being put at risk.
That is what made the health compact such a revealing part of the conversation.
Mahama says Ghana examined the proposal, found provisions it could not accept and walked away.
His broader argument in New York was that African countries need the economic, institutional and political room to make such decisions on their own terms.
Political independence gave African states the formal authority to choose.
The harder question — and the one Mahama left hanging over the room — is whether they have built enough capacity to make that choice truly meaningful.
