The proposal, being discussed within the State Department, suggests scaling back assistance, including funding for HIV treatment, to pressure Lusaka into signing a broader agreement that would also open up its mining sector to American companies.
About 1.3 million Zambians rely on daily HIV treatment supported by the US government under the long-running PEPFAR programme, alongside funding for tuberculosis and malaria interventions. The memo indicates aid cuts could come as early as May if talks fail to progress.
The negotiations are part of a wider push by Washington to reshape foreign aid under its “America First” strategy, which increasingly ties funding to strategic and economic interests.
Across Africa, the US has been signing multi-year health compacts worth billions of dollars, requiring countries to increase domestic spending and meet specific conditions.
However, Zambia’s case has become one of the most contentious. Unlike other agreements focused mainly on health, the proposed deal links funding to mining sector reforms and access to key resources such as copper, cobalt and lithium, minerals critical to global clean energy supply chains.
Zambia has pushed back on parts of the agreement in recent weeks, saying some provisions do not align with its national interests, particularly clauses related to data sharing and broader sovereignty concerns.
The draft framework includes provisions for sharing health data for up to 10 years and biological samples for as long as 25 years, raising concerns among civil society groups about privacy, ownership and long-term benefits.
Activists have also warned that the structure of the deal, which ties health funding to a separate minerals agreement, could prioritise commercial interests over public health.
Similar concerns have emerged elsewhere on the continent, with Zimbabwe walking away from comparable negotiations and legal challenges filed in Kenya over data-sharing provisions.
The proposed package for Zambia is estimated at around $1 billion over five years, significantly lower than previous levels of US health support, despite continued reliance on donor funding for critical programmes.
The tension reflects a broader geopolitical contest over Africa’s natural resources.
Zambia, one of the world’s top copper producers with growing reserves of cobalt and lithium, has become a key battleground in competition between the United States and China for access to minerals used in electric vehicles and renewable energy technologies.
Talks between Washington and Lusaka have dragged on since late 2025, with US officials reportedly increasing pressure through diplomatic and financial levers.
Zambia, meanwhile, faces a delicate balancing act, managing a heavy debt burden and dependence on foreign aid while trying to retain control over its natural resources.
The outcome of the negotiations could shape not only Zambia’s health sector but also set a precedent for how far major powers are willing to link humanitarian assistance to strategic economic interests across Africa.
