The US State Department is threatening to withhold lifesaving health support to Zambia as a negotiating tactic to force that country’s government to sign a deal giving America more access to its critical minerals, reports The New York Times.
Zambia, though, is stubbornly digging in its heels.
“We will only secure our priorities by demonstrating willingness to publicly take support away from Zambia on a massive scale,” according to the draft of a memo prepared for Secretary of State Marco Rubio by the department’s Africa Bureau staff.
Around 1.3m people in Zambia rely on daily HIV treatment provided through the decades-old Pepfar deal, and on TB and malaria medications that save tens of thousands of lives in that country each year.
However, the Trump administration may “significantly cut assistance” as soon as May, to increase pressure on Zambia, the memo suggests.
Since America’s wide-ranging cut to foreign aid last year, the State Department has been pushing countries to sign new agreements pledging to meet certain conditions to receive US funds.
Twenty-four countries have signed agreements so far, worth a total of $20bn in health aid over five years. In most cases the main requirement on the recipient country is that its government commits to increasing its own health spending.
While most countries have signed, Zimbabwe’s Government backed out of negotiations, saying demands about data and biological sample sharing were an intolerable infringement on sovereignty. And in Kenya, activists have taken that country’s deal to the courts over similar concerns.
Unlike the other agreements, which are limited to funding for health programmes, the United States wants to use the deal it is negotiating with Zambia to address a long-time source of frustration: China’s access to the country’s mineral wealth.
Zambia is one of the world’s major copper producers, and also has huge reserves of minerals like lithium and cobalt, all key to the green energy transition.
While the terms of the deal have not been made public by either government, a draft of the health component seen by The New York Times says America proposes to give Zambia $1bn in health funding over five years if Zambia commits $340m in new health spending of its own.
This is less than half the amount of health assistance Zambia received before the Trump administration took office.
The second piece is an agreement on steps that would give American businesses more access to Zambia’s vast mineral deposits, and end what the United States sees as China’s preferential access to Zambian mines.
The third is a renegotiation of a contract with the Millennium Challenge Corporation, an American foreign assistance agency focused on economic governance. The original contract, signed in 2024, gave Zambia a $458m grant to support its agricultural sector.
The Trump administration wants it restructured to require regulatory changes in mining and other industries.
If Zambia wants to keep a portion of the health aid it now receives through Pepfar, it will have to agree to all three by May, the draft memo suggests.
The State Department declined to comment, its press office, in an unsigned email, saying it would not comment “on purportedly leaked documents or on deliberative diplomatic discussions”.
The draft memo was prepared by the Zambia desk in the Africa Bureau and circulated among, and approved by, a number of officials who are informing the American side of the negotiations.
Cornelius Mweetwa, Zambia’s Minister of Information and its chief government spokesman, declined to comment.
The US had expected Zambia to sign late last year, when other African countries were agreeing to contracts, but the deal remains unfinished, and US frustration with Zambia has escalated.
The draft memo prepared for Rubio says that getting the deal signed would involve “the potential use of sticks” and warned that Zambia could not be allowed to backtrack because other countries are watching.
If Zambia won’t sign, “sharp public cuts to American foreign assistance would significantly demonstrate to aid-receiving countries the seriousness of our interest in collaboration and our insistence on tangible benefits under our America First foreign policy”, the memo says.
Zambia has been one of the largest recipients of Pepfar assistance – more than $6bn – for the past two decades. When the assistance began, some 90 000 people a year were dying of HIV in the country, overwhelming the health system.
And while the Zambian Government has been taking over some of the HIV programmes since the US cuts to aid began last year, nevertheless, everything, from the essential medicines supply chain to the medications stopping babies from being infected with HIV at birth, still relies on American financial and logistical support.
The Trump administration has already initiated prompts to advance the talks, according to the memo.
In December, it suspended the health funding talks when Zambia wasn’t engaging on the minerals issue, and it has repeatedly “needed to threaten or actually withdraw assistance important to the government to elicit progress on our priorities”.
More recently, the State Department notified the Zambian Government that it would cancel a planned deal that would have relieved Zambia of hundreds of millions of dollars in foreign debt payments, an amount roughly equivalent to half of what the country receives in health aid.
“Within days, the Zambian Mines Minister explicitly reversed course, telling US officials it was amenable to negotiating preferential access, and giving US technical experts unprecedented access to their mining database,” the draft memo says.
Despite its extensive mineral wealth, and the long-time role of the United States as the country’s largest donor of foreign aid, there is only a limited presence of American companies in Zambia, a country which is rife with corruption.
The proposed new bilateral compact would require Zambia to undertake significant reform of the governance of the minerals and other key sectors.
Transparency and human rights organisations are using the country’s freedom of information system to try to make the proposed health agreement public, mainly concerned about a clause requiring Zambia to share citizens’ health data with the United States for 10 years, although the US pledges health funding for only five; and to share biological specimens collected through disease surveillance for 25 years, with no guarantee Zambia would have access to any product of research done with those samples, such as development of a vaccine.
See more from MedicalBrief archives:
US health deals stall in Africa
Zimbabwe rejects $350m US health deal
US seeks Africa data access in new aid agreements
Washington launches billion-dollar health pacts in Africa – with provisos