This
story
was
originally
published
by
ProPublica.
What
Happened:
Citing
reporting
by
ProPublica,
eight
Democratic
U.S.
senators
have
criticized
the
Trump
administration’s
demands
to
access
the
health
data
of
millions
of
people
as
a
condition
of
giving
lifesaving
aid
to
other
countries.
In
a
letter
to
Secretary
of
State
Marco
Rubio,
the
senators,
including
minority
leader
Chuck
Schumer
of
New
York,
said
the
U.S.
demands
were
“unprecedented
and
at
odds
with
U.S.
policy
concerning
the
data
of
American
citizens.”
The
inquiry
into
the
administration’s
approach
to
foreign
health
data
referred
to
a
ProPublica
story
published
in
June
about
agreements
the
U.S.
struck
with
African
countries
—
and
the
risks
they
posed
to
people
there.
Experts
told
ProPublica
that
the
deals
are
vague
and
lack
language
used
in
most
data-sharing
agreements
to
adequately
limit
what
information
is
collected
and
how
it
can
be
used.
As
a
result,
they
said,
there
is
an
increased
risk
that
individuals’
personal
data
could
be
exposed,
misused,
or
commercialized
without
their
consent.
The
senators
—
who
include
Tim
Kaine
of
Virginia;
Chris
Van
Hollen
of
Maryland;
Brian
Schatz
of
Hawaii;
Amy
Klobuchar
of
Minnesota;
Christopher
Coons
of
Delaware;
Jeff
Merkley
of
Oregon;
and
Raphael
Warnock
of
Georgia,
who
led
the
effort
—
requested
a
briefing
on
the
healthcare
agreements’
data
requirements.
They
also
asked
Rubio
to
respond
in
writing
to
a
list
of
questions
by
the
end
of
August.
What
They
Said:
In
the
letter,
which
was
sent
last
week,
the
senators
expressed
concern
that
the
requirement
to
access
foreign
health
data
might
reverberate
beyond
the
countries
where
the
aid
agreements
were
struck
and
“set
international
precedents
that
ultimately
harm
Americans.”
They
noted
that
the
demands
for
data
appear
to
be
at
odds
with
the
Trump
administration’s
National
Cyber
Strategy,
which
emphasizes
the
right
to
privacy
for
Americans
and
their
data.
“These
new
demands
set
an
alarming
precedent
that
is
seemingly
contrary
to
the
Administration’s
longstanding
support
for
the
privacy
of
U.S.
citizens’
data,”
they
wrote.
The
senators
also
laid
out
the
details
of
a
data-sharing
agreement
between
the
U.S.
and
Uganda
that
were
first
reported
by
ProPublica.
The
deal
demanded
that
Uganda
provide
the
U.S.
—
and
its
contractors
—
with
logins
“or
other
secure
access
mechanisms”
to
directly
enter
the
nation’s
health
data
systems.
“While
global
health
programs
have
historically
included
data
sharing
components,”
the
senators
wrote,
“they
have
never
required
direct
access
to
privileged
electronic
systems
for
U.S.
government
representatives.”
The
letter
ends
with
more
than
a
dozen
questions
for
Rubio,
including
why
the
State
Department
has
not
made
the
healthcare
agreements
public,
as
federal
law
requires,
and
whether
any
of
the
data
will
be
shared
with
“U.S.-based
third
parties
for
any
commercial
purpose,
including
to
train
any
artificial
intelligence
models.”
The
senators
also
asked
what
privacy
rights
foreign
citizens
will
have
over
data
that
is
transferred
to
the
U.S.
and
how
those
rights
will
be
enforced
in
the
case
of
a
data
breach
or
another
unethical
use
of
their
personal
information.
Background:
After
the
Trump
administration
dismantled
the
U.S.
Agency
for
International
Development
and
drastically
reduced
funding
for
international
health
work
done
by
the
CDC,
Congress
required
the
executive
branch
to
continue
providing
foreign
aid.
The
State
Department
has
since
faced
the
challenge
of
finding
new
ways
to
get
the
funding
to
countries,
ensure
that
it
was
being
spent
wisely,
and
address
potential
pandemics.
The
task
has
been
especially
challenging
because
the
administration
cut
ties
with
most
of
the
international
partners
and
fired
staff
the
government
had
previously
relied
on
to
carry
out
this
complex
work.
In
the
past,
PEPFAR,
the
U.S.
program
that
provides
aid
for
treating
and
preventing
HIV
around
the
world,
built
its
own
systems
to
handle
anonymized
data,
separate
from
foreign
government
health
records.
In
contrast,
the
Ugandan
agreement
provides
the
U.S.
with
direct
access
to
the
government’s
own
health
data
systems.
Through
separate
agreements,
the
U.S.
has
also
arranged
for
countries
to
provide
it
with
specimens
of
pathogens
that
could
cause
pandemics,
along
with
related
information.
The
effort
to
establish
these
new
aid
arrangements
was
led
by
Brad
Smith,
an
entrepreneur
who
founded
three
healthcare
companies,
one
of
which
sold
for
a
reported
$2.7
billion.
Before
joining
the
State
Department,
Smith
led
the
government
efficiency
panel
that
would
become
the
Department
of
Government
Efficiency
and
oversaw
some
$67
billion
in
cuts
to
the
Department
of
Health
and
Human
Services.
The
U.S.
agreement
with
Uganda
provides
up
to
$1.7
billion
in
aid
for
HIV,
tuberculosis,
and
malaria,
among
other
diseases.
As
a
condition,
the
deal
calls
for
the
sharing
of
aggregated
data
with
all
personally
identifiable
information
removed
and
specifies
that
the
information
should
be
used
for
delivering
and
auditing
healthcare
services.
But
experts
told
ProPublica
that
it
is
possible
to
reverse-engineer
data
that
have
been
anonymized.
The
shift
in
the
approach
to
health
data
is
part
of
the
America
First
Global
Health
Strategy,
which
is
intended
to
make
America
“more
prosperous”
and
“promote
American
health
innovations.”
Rubio
explained
in
September
that
under
this
new
strategy,
aid
will
be
given
“in
a
way
that
directly
benefits
the
American
people
and
directly
promotes
our
national
interest.”
Why
It
Matters:
Privacy
experts
say
that,
if
health
data
is
mishandled
under
the
agreements,
it
could
have
serious
consequences.
Revealing
healthcare
histories,
including
whether
someone
has
had
an
abortion,
a
mental
health
condition,
substance-use
treatment,
or
a
sexually
transmitted
disease
can
be
devastating
anywhere.
In
Africa,
research
has
shown
it
can
lead
to
discrimination
and
violence.
In
the
age
of
artificial
intelligence,
health
data
has
become
especially
valuable.
But
the
agreements
reviewed
by
ProPublica
provide
no
guarantee
that
Africans
subject
to
them
will
have
a
say
in
how
their
data
are
used
or
whether
they
would
receive
any
potential
financial
benefits.
Response:
The
State
Department
declined
to
answer
specific
questions
about
the
senators’
letter,
saying
that
it
does
not
respond
to
questions
about
congressional
correspondence.
In
a
statement
sent
to
ProPublica,
a
State
Department
spokesperson
defended
the
data
requirements
in
the
health
agreements.
“Neither
the
U.S.
government
nor
any
private
American
companies
receive
or
review
any
personally
identifiable
information
(PII)
under
these
data
sharing
agreements,”
the
statement
said,
going
on
to
note
that
the
new
deals
“share
only
the
same
kinds
of
aggregated,
de-identified
data
that
has
been
shared
and
used
for
years
in
the
fight
against
HIV/AIDS,
malaria,
tuberculosis,
and
other
diseases.
All
data
sharing
is
consistent
with
each
country’s
laws
and
approvals.”
The
spokesperson
also
said
no
country
has
been
coerced
to
sign
the
agreements
with
the
U.S.
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