US-Rwanda MoU for Health Records $1.5 billion in Soft Commitments from Private Investors

Cracking the code on Project Vault and the Art of the (America First Global Health Strategy) Deal

Last week, the US-Rwanda Memorandum of Understanding signed in December 2025 slipped into public circulation. The 23-page agreement is so qualitatively different from the other four MoUs in public circulation that it fried the circuits in my ‘how is this MoU different from the others and the template’ machine. That handy little device is great for whipping up insights about small adjustments in the few key areas where they’re usually concentrated including: data and specimen sharing duration and terms, and country legal reform to recognize FDA.

But my analytic appliance was no match for the Rwandan MoU, which fairly bristles with bespoke language and an entirely new section that has no comparator in any of the other documents, including those from Rwanda’s neighbors Kenya and Uganda. Nope, I fed that MoU in and the machine jammed, smoked and died.

Am I over-working a metaphor here? Yes. Yes I am. Here’s why: I am about to go on at some length about how both the Rwandan Memorandum of Understanding and this week’s news that Zimbabwe has walked away from it’s MoU negotiations can only be properly understood in the context of the Trump Administration’s active, strategic and country-specific negotiations for access to critical minerals and rare earth.

I am going to come close to saying that any analysis, news coverage or strategizing that omits this context is bringing knives to a gun fight.

But I am not going to say that because there’s too much violence in our language and lives.

Instead, having introduced my wee MoU comparison machine, and having gotten you thinking about kitchen appliances, I am going to say that trying to advance impact via work on the America First Global Health Strategy without deeply, carefully and doggedly tracking mineral and rare earth negotiations in the same countries is like bringing a hand mixer to a Vitamix fight. The analytic tools aren’t up to the task. But with adjustments in approaches to Congressional oversight and information requests, they can be. We all can have power blenders if we try. And we need to try.

Alt text: A pair of pictures side by side. On the left side a red hand mixer is tipped on its side resting against an empty bowl with white residue inside and on the mixer attachments. That is a hand mixer. On the right side there is a big blender with a black base and a tall container filled with orange slices, pineapple and other fruit. I don’t own a power blender and receive no promotional support from any appliance company. Also no promotional support from any funding source. Please consider upgrading to paid subscriber OR posting on LinkedIn or your platform of choice that you are a paid subscriber—or wish you could be — and suggesting folks add financial support. This has been THE most effective source of new subscriptions. I will not use the funds to buy fancy kitchen appliances.

Launched at the start of February, a Trump Administration initiative called Project Vault is the frame for every single thing about America First Global Health Strategy and other decisions related to which sub-Saharan African countries that will no longer receive other humanitarian aid.¹ Project Vault is a systematic initiative to build a US stockpile of critical minerals and rare earths required for advanced technology. China controls the lion’s share of these natural resources and has exercised export controls and other strategies to restrict US access to them over the course of the past year’s geopolitical jousting.²

Sub-Saharan African countries hold or control access to deposits of the resources that the US government desperately wants. More specifically, Rwanda and Zimbabwe hold or control access to deposits of these resources, and Project Vault-driven negotiations for this access are almost certainly shaping the outcomes of health-related talks.

Let’s look at Rwanda first.

Rwanda became the second country to co-sign an MoU on December 5th 2025³, one day after it signed on to the US-brokered “Washington Accords for Peace and Prosperity,” that further concretized a US-brokered “peace” agreement between Rwanda and Democratic Republic of the Congo in June. The accords included signing of “Regional Economic Integration Framework⁴” that explicitly seeks to “establish resilient and secure global critical minerals supply chains vital to the future of U.S. industry.”

Rwanda does not have a huge quantity of critical minerals and rare earths. The Democratic Republic of the Congo does. While China has secured ignificant portions of Congo’s natural resources, state-owned and -run sites, including several in rebel-held regions, are available for potential US use.

At the end of January, the Democratic Republic of the Congo presented the US with a shortlist of state-owned mineral assets for US investors to assess and potentially invest in. A couple of weeks later, it added the world’s largest deposit of tantalum (a highly heat-resistant metal made from coltan) to this list. The Rubaya site sits in territory controlled by the M23 rebel group reportedly supported by Rwanda. Short-listed or not, the US cannot access Rubaya—or any of the other DRC sites—without an end to the conflict in the region. To the extent that Rwanda can determine whether this conflict ends or not, it also controls US direct access to DRC’s resources.

This leverage is reflected in the unique text in Rwanda’s MoU. In the list that follows, I’ve enumerated some of the instances of language that have no counterpart in the other MoUs released to date. (This is in contrast to modifications of template language). At a top-line level, the differences cluster around (1) Rwanda’s role as a regional biosurveillance hub, (2) Commitments between US and Rwandan government to advance joint commercial interests and (3) Documentation of soft promises for more than USD$1.5 billion in US private sector funding for specific Rwandan initiatives

Rwanda’s role as a regional biosurveillance hub

• In the last paragraph on page 11, the MoU refers to “Rwanda’s existing US collaboration on bio surveillance systems,” declares that “Rwanda’s strategic position at the crossroads of several borders and major travel routes makes it well-positioned to serve as a regional front line against biological threats,” and specifies a USD$ 10 million investment to scale a national biosurveillance radar system to “create a powerful early-warning mechanism for East and Central Africa.” No public MoU positions a country as a focal point for regional surveillance—but if the US government is going to make a shadow WHO, that’s precisely the kind of arrangement it’s going to need.⁵ This paragraph alludes to Gingko Bioworks, a Boston-based company that established an MoU with Rwanda in 2022⁶ and launched a pilot for airport-based surveillance the following year.⁷ We know this because the Department of State press release specified that Gingko would receive USD$ 10 million.

Commitments between US and Rwandan government to advance joint commercial interests (all on page 14 of the pdf)

• A commitment to “promote commercial partnerships and US business opportunities to introduce or expand innovative health market products and services” through the US embassy⁸

• A commitment to “joint efforts to remove trade and customs barriers (including tariffs and tax implications)” related to health products

• Plans for establishment of “coordinated mechanisms to attract U.S. private-sector investment in health innovation, manufacturing, and infrastructure

• Plans for a “shared communication platform” that would, among other things, highlight US-Rwanda health-sector partnerships

Documentation of soft promises for more than USD$1.5 billion in US private sector funding for specific Rwandan initiatives

This MoU contains a wholly new section entitled “Future Strategic Opportunities in the US-Rwanda Partnership Beyond the Scope of the MoU” that specifies makes note of more than USD$1.5 billion in potential funding from unnamed “interested parties” for various initiatives, including:

• A “multi speciality hospital” that will “position Rwanda as a premier regional hub for medical tourism.”⁹ This section notes that “Preliminary discussions have been initiated with leading U.S. clinics….” and “With an estimated annual investment of USD$1.5 billion from interested parties, the hospital could serve 55,000-60,000” people from across Africa. The wording leaves an open question as to whether the USD $1.5 billion is committed by said parties, or whether this is effectively a pitch inside the MoU, or a statement for the record that the US government would like to see this annual level of investment, which is 47 times higher than an annualization of the five-year US commitment of USD$ 138 million.

• A partnership to advance the Government of Rwanda’s vision to become “the most advanced AI-powered society in Africa” that references that Rwanda is “keen” to work with US partners and says that “initial roll out would be estimated at $40 million”—or 1.5 times higher than the USD$27.6 million that would come from an evenly annualized distribution of AFGHS funds.

I’m mighty tempted say that titling the section “Beyond the Scope” begs the question: What is it doing here, if it is indeed beyond the scope? But it doesn’t really beg any question at all. The Rwandan government, which will manage all of the investments coming in from “interested parties” negotiated to have soft commitments from US private sector firms in the MoU so that the US government is on record, the interested parties are on record, and there is a clear signal to other companies, perhaps those looking to maintain favor that these beyond-the-scope activities are viewed favorably by the Trump Administration.

It’s important to note that these agreements are non binding and that none of the text or additional projects raises red flags or is unprecedented. The Rwandan government is keen to be a regional leader in technical innovation and “Kigali Medical City” is a long-standing project with real merit. Embassies often advance US government interests. Private companies do play a role in biosurveillance.

Rwandan officials are widely-regarded as committed, experienced, savvy and strategic negotiators. Nevertheless, the final text probably can’t be chalked up to diplomatic prowess alone. The MoU reads like—and arguably effectively is—a rider to the Regional Economic Integration Framework that will help fill Project Vault.

Let’s now turn to Zimbabwe.

In early February, the US Embassy in Harare posted on social media that “The US is diversifying its sources for critical minerals around the world. We are ready to engage with Zimbabwe on mutually beneficial supply chain transactions.” The post, which has since been removed, prompted pushback and criticism from Zimbaweans who took issue with the timing and tone of the statement coming from a country that has active sanctions against the nation.¹⁰

Alt text: A screenshot of the X post from the US Embassy in Zimbabwe later removed about its readiness to engage with Zimbabwe. Because who doesn’t love the living record of a removed post?

A few days after the provocative tweet was reported, US Ambassador to Zimbabwe attended the “Mining Indaba” in Cape Town where she reportedly reached out to Zimbabwean representatives with offers to make connections with Zimbabwean and American companies.¹¹ This is a highly unusual diplomatic move for the US to make with a country that the US Treasury Department sanctioned in 2024 for corruption and human rights abuses, with mention of current President Emmerson Mnangagwa and his “criminal network.”¹²

After the Indaba, Ambassador Tremont met with Professor Amon Murwira, Minister of Foreign Affairs and International Trade on or around February 19th.¹³ About five days later, the Zimbabwean government let it be known that in December 2025, the Ministry of Foreign Affairs and International Trade had instructed the Ministries of Health and Childcare, and Finance, Economic Development and Investment Promotion to withdraw from the MoU negotiations, citing the “lop-sided”¹⁴ terms of the engagement without naming any specifics.

Alt text: A picture of the PDF of the Zimbabwean government directive to discontinue negotiations on the MoU. There is a blue stripe down the left side of the page, a handwritten blue ink signature and date stamp of 23 December 2025. The full pdf from which this is taken is at the end of this post. Kind Regards. Full stop.

On February 25 the Zimbabwean Secretary for Information, Publicity and Broadcasting services issued a lengthy clarifying statement that explained that the withdrawal was related to the data and specimen sharing agreement terms that require log in credentials for data systems and access to pathogens and genetic sequences with weak language around future access to any products developed based on those materials.¹⁵

These are legitimate concerns. It is entirely possible that the inability to come to agreement on modifications to that language—which other countries have done—is the sole explanation for the December directive from the Ministry of Foreign Affairs and International Trade to end talks that it had not been actively involved in. It is also possible that other factors were at play, including ongoing discussions about US access to Zimbabwe’s natural resources.

It is a matter of public record that throughout the period in which Zimbabwe withdrew from the health MoU and did not announce this step, the US and the same ministry have been navigating potential pathways to accessing Zimbabwean natural resources. We have some sense of what those negotiations look like when the health and mining concessions get linked—as they have, disastrously, in Zambia.¹⁶ We also have, with Rwanda, some sense of what it looks like when a country with a role in resource access signs an MoU.

Based on everything known about the America First Global Health Strategy, Project Vault and the Trump Administration, it is plausible that the decision to withdraw from the negotiations originally, and the timing of the directive making its way onto social media, were impacted by US pursuit of access to Zimbabwean lithium and other resources. There are any ways that this could have played out. Or it could be a total coincidence. But it’s a mistake not to raise the possibility at all.

If AFGHS nests within or functions as a means of advancing Project Vault, then traditional approaches to accountability and oversight of US foreign aid for health are simply not fit for the task. And we won’t know if this is the case by applying our traditional tools.

In twenty-two years of reading US agreements with other countries and studying, working on and documenting approaches to accountability, I’ve never seen mention of a country’s appeal as a tourist destination, commitments to trade negotiations, notations of private investors including the amounts they might commit—all of which are in the Rwandan agreement.

Alt text: Three electric hand mixers against a swirly beige and ochre pattern. The mixers are turquoise, red and silver. This is a really long piece. I’m trying to give it some visual punctuation.

Fortunately it’s both feasible and imperative that the US Congress and other stakeholders invested in this work build an oversight tool (or tools) for the negotiation, signing and implementation of AFGHS agreements that is up to the task. I can’t fully describe what this looks like, but here are some steps that could be a start:

• All of the documents supporting the America First Global Health Strategy work need to be made available to Congress and to the public to the extent allowable by law. The Rwandan Memorandum of Understanding makes oblique and blind references to private sector partners. At least one of these is identifiable as Gingko Bioworks—only because that company was mentioned in the Department of State press release on the MoU. There is no discernible reference in the MoU to ZipLine, the other private sector partner mentioned in the presser. The American private sector firms involved in US foreign aid agreements should be identifiable and associated with targets and metrics. All of this information should be collected in the Implementation Plan document that many countries are currently working on. The Implementation Plan narrative and tools should be available to Congress and to the public, along with quarterly progress updates against process and outcome metrics. This approach is consistent with the practices of PEPFAR and the President’s Malaria Initiative. Congress should accept no less.

• Updates on the ‘official’ process and outcome metrics should be accompanied by Congressionally-requested reports on a pre-specified list of terms, activities and partnership activities mentioned in or relevant to the agreement, and by briefings on any parallel negotiations for critical minerals and rare earths that are ongoing at the same time. Congress could justifiably ask for updates about the “interested parties” in the Rwandan MoU. Who are they? Who is on the board? What levels of investment have they made? How many followers does the US-Rwanda Instagram account have? How much tantalum is sitting in the Vault since the last time we spoke?

• Congressional notifications for spending on AFGHS-supported plans should include a line-by-line explanation of the metrics and milestones included in the tables, including assumptions about numerators and denominators, clarity about whether a given figure is a ceiling or a floor, a narrative explaining confounding or unusual figures, and an explanation of how the relevant targets and baselines relate to the FY2025 PEPFAR data.¹⁷ After a whole post that isn’t about the core content of the MoUs, I have to say this again. The metrics and milestones are all but meaningless in so many ways. The Bureau of Global Health Security and Diplomacy is enthusiastically embracing performance-based milestones—meaning that countries will get paid when they meet specific metrics. For countries that are too important to our critical minerals to fail, these metrics could work in favor of continued funding even if there is limited impact. (As I’ve written before—if you want the number of diagnoses of babies with HIV to go down, you can always test fewer babies.) Here are two more examples from the Rwandan MoU:

  • The number of deaths from tuberculosis rises between baseline and year 1, then goes down for the next three years. (Dropping by exactly one between Year 2 and 3). It’s quite possible that this is because Rwanda is planning to improve TB diagnosis, record-keeping on cause of death, or some combination of the two. (You can’t record a TB death if it isn’t diagnosed). That’s worthy. It needs to be explained for accountability to be possible.

  • Rwanda has about 7200 people with HIV who do not know their HIV status. (This can be calculated by using the UNAIDS estimate of the total number of Rwandan PLHIV and the percent of that total (97%) that know their status. 7200 is about 3% of the total of Rwandan PLHIV. Yet in the first alone, the target for number of people newly diagnosed with HIV is 13242. Presumably that figure includes a proportion of people who know their status and are re-testing. But how does this kind of calculation or assumption work in a performance-based payment program. If Rwanda were to improve its system for identifying re-testers versus new diagnoses, it would miss this target. It could hit its targets by only re-testing people? Will anyone know? Will a penalty be triggered? It is not possible to do oversight nor to claim that this program is actually measuring performance without this clarity.

Sharing the totality of information specific and relevant to AFGHS agreements and plans is the only way to approach accountability. To date, I’ve noticed (and participated in) a move to mention mining rights and mineral concessions as a general factor in these deliberations. As this Stack makes clear, I think it is time to get more specific. It would be hugely valuable for tracking and monitoring efforts focused on AFGHS to log a given country’s mineral and ore deposits of relevance to Project Vault alongside, along with the status of negotiations around this access. Private sector firms making new or expanded investments in these countries should be tracked. And groups tracking resource extraction as part of work on illicit financial flows, regional or national economic growth or climate issues should track these health MoUs. Because sometimes that money is also going to sway decisions. Finally, all of the information about the health-focused work should also be made available and the milestones and metrics associated with these agreements should be pressure-tested and discarded if they’re as useless as some seem.

This assemblage of information will not necessarily condemn either the US or the countries signing the agreements. It could yield some interesting insights about what the future might hold. Maintaining a narrow focus on health alone, or even health in the context of the MoU metrics just won’t cut it. It’s time to get the right tools for this particular fight.

Rwanda US MoU

4.93MB ∙ PDF file

Download

Download

Government of Zimbabwe Discontinuation Notice

1.27MB ∙ PDF file

Download

Download

1. https://www.state.gov/releases/office-of-the-spokesperson/2026/02/2026-critical-minerals-ministerial/

2. https://www.nytimes.com/2025/10/27/business/china-rare-earth-export-controls.html

3. https://www.state.gov/releases/office-of-the-spokesperson/2025/12/continuing-to-deliver-on-the-america-first-global-health-strategy-with-the-signing-of-the-united-states-rwanda-bilateral-health-cooperation-memorandum-of-understanding

4. https://www.state.gov/releases/office-of-the-spokesperson/2025/12/the-regional-economic-integration-framework-between-the-democratic-republic-of-the-congo-and-the-republic-of-rwanda

5. https://www.independent.co.uk/news/world/americas/us-politics/trump-who-replacement-cost-hhs-b2923875.html Nope, it does not appear that the alternative to WHO prequalification that may be in the works was included in the document that was the basis for this news story. I wrote about that in my last full length post, then followed up with information that GHSD disputed attribution to a senior official of the plans for this work, but not the plans themselves. That’s still the state of play.

6. https://rdb.rw/ginkgo-bioworks-and-the-rwanda-development-board-announce-plans-to-develop-and-implement-new-biosecurity-capabilities-in-rwanda/

7. https://rwandadispatch.com/ginkgo-biowork-to-monitor-pathogens-at-kigali-international-airport/

8. The precise wording of this text is “The US Government, through the U.S. Embassy in Kigali intends to will promote commercial partnerships…” That’s an interesting typo - as “intends to” and “will” have different levels of commitment attached to them. I intend to will keep following this.

9. “Kigali Health City” is a longstanding project of the Rwandan government that could be a boon to the region—as many residents travel outside of Sub-Saharan Africa to obtain high quality services. https://www.newtimes.co.rw/article/11612/news/health/masaka-kigalis-emerging-medical-city

10. https://newz.africa/2026/02/07/us-embassy-harare-public-pushback-minerals/

11. https://www.miningindex.co.zw/2026/02/12/us-signals-strong-interest-in-zimbabwes-mining-sector/

12. https://home.treasury.gov/news/press-releases/jy2154

13. https://thezimbabwemail.com/zimbabwe-deepens-us-engagement-amid-global-critical-minerals-race/

14. OMG I have been trying SO HARD not to make note of the truly fascinating relationship that the authors of the documents in today’s Stack have to hyphens, EM dashes and compound words. Like, for example, “bio surveillance” and “roll out” in the Rwandan MoU. (Pretty sure those are both single words) And the “US—Rwanda health-sector partnerships” which pops an EM dash and a hyphen into THE SAME sentence. Truly I thought I could get to the end of the Stack without any sidebars. But then came “lop-sided” and I was filled with such delight I simply had to take a little detour down here to talk about it. And so, apparently, did you.

15. https://www.heraldonline.co.zw/clarification-on-zimbabwes-health-diplomacy1/

16. https://www.theguardian.com/global-development/2026/feb/25/zambia-us-health-aid-deal-exploitation-mining-concessions-data-sharing-targets

17. Earlier this week, an Excel file’s worth of this data was published along with topline analyses by CGD. This development in no way replaces—and in fact increases the need for—official US government publication of the numbers, along with explanatory text, in alignment with past practices and in order to support transparent, effective implementation planning in all countries. I’ll come back to the data question in subsequent posts—it’s never far from my mind—and there are all sorts of complexities in interpretation. But the top priority, in my mind, remains a US government-endorsed data set including data from the Bridge Plan period that can be fed into our marvelous accountability machine.