For all the controversy surrounding the reported health agreement between Liberia and the United States, one question rises above the rest: Why the secrecy?
This is not a military pact. It is not an intelligence-sharing agreement. It is not a matter of national defense. It is, by all indications, a health agreement--one that reportedly concerns disease surveillance, laboratory systems, electronic medical records, healthcare financing, outbreak response, workforce development, pharmaceutical regulation, and potentially the sharing of health data and pathogen samples.
According to Human Rights Watch, several similar agreements signed with African countries were initially posted on the U.S. State Department's website pursuant to disclosure requirements under the Case-Zablocki Act, which promotes transparency regarding international agreements entered into by the United States. Those agreements were reportedly removed shortly after media scrutiny intensified following a New York Times report concerning a separate agreement involving Zambia. The Liberian agreement, meanwhile, was never officially published and has surfaced only through a leaked copy whose authenticity neither government has publicly confirmed.
That should concern everyone -- not because the agreement is necessarily harmful, nor because the United States is necessarily acting in bad faith, but because important public decisions should not have to be discovered through leaks.
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The irony is difficult to ignore. The reported agreement itself appears heavily focused on accountability, audits, reporting requirements, performance benchmarks, and access to information. If authentic, it would require Liberia to provide extensive data to demonstrate compliance with agreed commitments. Yet the public has not been afforded the same transparency. The people whose healthcare system would be affected by the agreement have not been given an opportunity to review it. The healthcare workers expected to implement it have not been given an opportunity to debate it. The patients whose information may ultimately flow through the systems envisioned by the agreement have not been given an opportunity to understand it.
Transparency cannot be a one-way street.
To be clear, this newspaper does not subscribe to the simplistic narrative that foreign involvement in Liberia's health sector is inherently exploitative. The facts tell a more complicated story. Liberia's healthcare system remains heavily dependent on international support. Maternal mortality remains among the highest in the region. Child mortality remains stubbornly high. Malaria continues to exact a heavy toll. Public health infrastructure remains fragile -- even poorly managed. Many health facilities still struggle with shortages of medicines, equipment, personnel, and financing. The Ebola crisis demonstrated both the devastating consequences of health system weakness and the importance of international cooperation.
American taxpayers have contributed billions of dollars across Africa and hundreds of millions in Liberia to fight HIV/AIDS, malaria, tuberculosis, Ebola, and other public health threats. Those investments have undoubtedly saved lives. We should not pretend otherwise.
Nor should we ignore the possibility that some of the provisions reportedly contained in the agreement could produce real benefits. A healthcare system with stronger disease surveillance, modern laboratory networks, electronic medical records, better supply-chain management, and measurable performance standards is preferable to one without those capabilities. A system capable of detecting outbreaks quickly is preferable to one that discovers them too late. A system that increasingly stands on domestic financing rather than perpetual donor dependence is certainly preferable to one that collapses whenever external funding declines.
These are legitimate objectives. The question is not whether Liberia needs a stronger healthcare system. It unquestionably does. The question is whether the terms under which that system is being strengthened should be hidden from public view.
That question becomes even more important when health data enters the discussion. In the twenty-first century, data has become a strategic asset. Countries once worried primarily about control over natural resources. Today they must also think about control over information. Health data is not merely administrative paperwork. It can inform scientific research, pharmaceutical development, artificial intelligence systems, epidemiological forecasting, and public policy decisions. Pathogen samples are not merely laboratory specimens. They are scientific resources with potentially significant global value.
None of this means such information should never be shared. Scientific collaboration has been essential to combating some of humanity's greatest health challenges. But sharing and surrendering are not the same thing. Partnership and dependency are not the same thing. Cooperation and opacity are certainly not the same thing.
The absence of transparency creates unnecessary suspicion precisely because it prevents citizens from evaluating whether adequate safeguards exist. If protections are strong, let the public see them. If benefit-sharing provisions exist, let the public read them. If privacy protections are robust, let experts examine them. If the agreement genuinely advances Liberia's long-term interests, transparency should strengthen public confidence rather than undermine it.
The Government of Liberia should therefore do the simplest thing possible: publish the agreement. Publish any accompanying data-sharing arrangements. Publish any pathogen-sharing provisions. Allow the Ministry of Health, the National Public Health Institute of Liberia, civil society organizations, healthcare professionals, legislators, and ordinary citizens to examine the terms for themselves.
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There is, of course, another possibility. The leaked document now circulating publicly may not represent the complete agreement at all. It may be an unsigned draft, a strategically redacted version, or an incomplete copy that omits critical annexes, safeguards, implementation protocols, privacy protections, or benefit-sharing arrangements. That possibility cuts both ways. If the leaked document is incomplete, then neither critics nor supporters can fairly claim to understand the full scope of the agreement. But that reality only strengthens the case for transparency. The surest way to dispel speculation, correct misinformation, and build public confidence is not silence -- it is disclosure. In the absence of an official version, leaks inevitably become the basis of public debate, regardless of whether they tell the whole story.
The real issue is not whether Liberia should cooperate with the United States. It should. The real issue is not whether accountability matters. It does. The real issue is whether a healthcare partnership built on transparency can afford to remain hidden from the very people it claims to serve.
If the agreement is good for Liberia, there is no reason to keep Liberians in the dark.
