JOHANNESBURG/HARARE/LUSAKA — Zambia and Zimbabwe have pushed back against major U.S. health funding agreements, reflecting a widening dispute over Washington’s new bilateral aid model in Africa and raising concerns about sovereignty, data control and the conditions attached to life-saving health support. Reuters reported that Zambia delayed a five-year deal worth more than $1 billion, while Zimbabwe withdrew from talks on a separate $367 million agreement.
In Zambia, the proposed agreement was designed to support HIV, malaria, maternal and child health, and disease outbreak preparedness over five years, while also requiring about $340 million in Zambian co-financing, according to a draft reviewed by Reuters. The signing, initially expected in late 2025, was delayed after Lusaka requested revisions to a section the government said did not align with Zambia’s interests. Zambia’s health ministry said it remained open to engagement, but only on terms that are “clear, mutually agreed upon, and fully aligned” with national priorities.
The controversy centers on a clause in the draft that would end the health deal if Zambia and the United States failed to agree by April 1 on a separate “bilateral compact” proposed by U.S. Secretary of State Marco Rubio. Reuters reported, citing three sources, that the compact was tied to mining collaboration, including Zambia’s copper and cobalt sectors. Health advocates said that linkage risked subordinating public health priorities to strategic commercial interests.
Asia Russell, executive director of Health GAP, said the agreement would “slash U.S. government funding to life-saving programs” while prioritizing mining interests over people living with HIV in Zambia. Reuters also reported concerns from Zambian activists that the draft included a one-way health data-sharing arrangement that would mainly benefit the United States. Zimbabwe took an even harder line. Reuters reported that Harare ended talks on a $367 million U.S. health agreement over provisions requiring the sharing of sensitive health and pathogen data. A leaked letter from Zimbabwe’s foreign ministry described the draft as “lopsided” and said the terms could undermine national sovereignty because they did not provide clear reciprocal benefit-sharing safeguards.
The collapse of the Zimbabwe talks could have serious health consequences. Reuters said the funding would have supported HIV, tuberculosis, malaria and health-system programmes, while Zimbabwe’s public health community has warned that disruptions could threaten treatment access for the country’s 1.2 million people living with HIV. The backlash is not limited to those two countries. In Kenya, the High Court froze implementation of a separate $1.6 billion U.S. health pact in December 2025 pending a case over privacy and data-sharing concerns. The court barred the sharing of medical, epidemiological and other sensitive personal health data while the petition is heard.
The broader dispute has drawn support from Africa CDC, whose director-general Jean Kaseya has increasingly framed health financing and health data as part of a wider African sovereignty agenda. While Reuters did not attribute the exact wording in your draft to him in the article I found, his public position has consistently emphasized that African countries should control their own health systems, surveillance capacity and strategic data.
Together, the Zambia, Zimbabwe and Kenya cases suggest that African governments are becoming more willing to challenge aid agreements they see as intrusive or imbalanced, even when the funding at stake supports essential HIV and malaria programmes
