Liberia: Why the Secrecy About the U.S.-Liberia Health Pact?

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.

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.

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.