Zambia is accusing the United States of tying a $2 billion deal for critical health assistance to access to the southern African nation's rich mineral assets, exposing how President Donald Trump's "America First" strategy is reshaping aid to Africa into transactional agreements that prioritize U.S. commercial interests over public health needs.
Zambia's foreign affairs minister, Mulambo Haimbe, on Monday called outgoing U.S. ambassador Michael Gonzales's allegations of corruption "mischievous" and "undiplomatic," bringing into the open simmering tensions over the new U.S. approach. The comments revealed that negotiations have stalled over what Haimbe described as "unacceptable" data-sharing demands "in violation of our citizens' right to privacy" and "the insistence on preferential treatment of U.S companies over Zambia's critical minerals."
Data Privacy and Sovereignty Concerns
Haimbe said Zambia "takes the view, first and foremost, that Zambians must have a say on how her critical minerals are used, and second that no one strategic partner is to be treated preferentially to others." The minister described Gonzales's accusations of Zambian graft and negotiation inertia as "deeply regrettable, undiplomatic and inconsistent with the spirit of mutual respect."
Gonzales had dismissed allegations that the U.S. was tying access to critical minerals to the health deal as "alarmist allegations" that he called "disgusting" and "absolutely and patently false." In late April, he said Zambian leaders had "abdicated their responsibilities, letting the United States pay for healthcare while officials diverted government funds to their own pockets" and claimed Zambian authorities had "ignored" U.S. overtures to conclude a new deal.
Growing African Pushback
Zambia is not alone in resisting the new U.S. approach. Ghana last week said it had rejected a proposed deal over provisions granting broad access to sensitive health data without safeguards. Zimbabwe walked away from a $367 million package over similar concerns. In Kenya, a $2.5 billion agreement signed in December has been put on hold after a court challenge arguing it violates data protection laws.
In Zimbabwe, a government spokesperson in February said the government terminated negotiations because the U.S. was not offering a "corresponding guarantee of access to any medical innovations — such as vaccines, diagnostics, or treatments — that might result from that shared data." "That raises serious concerns about who benefits," said Atilla Kisla of the Southern Africa Litigation Center.
Replacing PEPFAR with Transactional Diplomacy
The U.S. approach replaces decades of engagement anchored in the now-dismantled United States Agency for International Development and the President's Emergency Plan for AIDS Relief, or PEPFAR. In their place, U.S. officials are negotiating country-by-country agreements that recast aid as a transaction, tying funding to conditions including commercial provisions, domestic financing commitments, disease surveillance, pathogen sharing and even religion.
Since late last year, the U.S has signed agreements with about 30 countries, many in Africa. Washington says the approach is meant to reduce donor dependency, promote local ownership and safeguard American interests, including against an aggressive China that dominates trade in Africa but contributes less aid. The U.S. is seeking to challenge China, a dominant player in Zambia and much of Africa, whose minerals are critical to the green energy transition, including inputs for solar panels, electric vehicle batteries and energy storage systems.
Transparency and Accountability Erosion
The new agreements aim to ensure the flow of disease surveillance data and biological samples, but through bilateral channels, after the U.S. withdrew from the World Health Organization in January, said Asia Russell, executive director of advocacy group Health GAP. Countries currently report disease outbreaks primarily through the WHO, which coordinates responses and is negotiating new frameworks on pathogen-sharing and equitable access to vaccines. The U.S., now outside those talks, is pursuing direct access instead.
"They (the U.S.) want to understand what's actually happening," said Jen Kates, a senior vice president at the Washington-based non-profit KFF. "But they are trying to do it in a very different way." Health advocates say this risks creating a parallel global health system.
Critics say the data-sharing demands tilt toward U.S. interests and warn the information-sharing would largely go in just one direction: toward Washington. In Lesotho, draft U.S. proposals sought 25 years of access to health data and biological samples before local officials secured a shorter five-year deal.
The agreements with the U.S. are drawing criticism for closed-door negotiations and limited public scrutiny. "Secrecy is at the center of this. That puts accountability for results at risk," said Health GAP's Russell. "It's impossible to evaluate these deals properly without seeing the full terms. Part of what made PEPFAR successful was transparency. Now that's been taken away."
Financial Strain on Vulnerable Nations
The deals also come with tighter financial conditions. Many include reduced funding compared to previous levels of U.S. assistance, while requiring countries to increase domestic health spending, with aid at risk if targets are not met. "These are going to be very heavy lifts," said KFF's Kates. "Countries are already under strain."
Some African leaders and health experts have criticized the new U.S. stance and its demands for sensitive health data in exchange for badly needed support for health systems strained by the Trump administration's dismantling of foreign aid. Some say they would not receive access to health innovations like vaccines in return.
Advocates point to the harsh experience of the COVID-19 pandemic, when African countries contributed data and samples but were largely last in line for vaccines. Critics say some agreements also advance U.S. commercial and political interests, blurring the line between aid and transactional diplomacy. "When health becomes a bargaining chip, everyone becomes less safe," Russell warned.
Why This Matters:
The dispute between Zambia and the United States reveals how the dismantling of longstanding global health partnerships threatens both public health security and national sovereignty in vulnerable countries. When health assistance—once provided through transparent, multilateral frameworks like PEPFAR—becomes conditional on commercial mineral access and one-sided data sharing, aid-dependent nations face an impossible choice: surrender control over natural resources and citizens' health information, or lose funding for healthcare systems already strained by reduced U.S. support. The lack of guarantees that shared data will lead to vaccine access repeats the inequities of the COVID-19 pandemic, when African countries contributed samples but were last in line for protection. Closed-door negotiations without public accountability undermine the transparency that made previous programs successful, while financial conditions requiring increased domestic spending from countries already under economic strain risk deepening health crises. The shift from cooperative global health frameworks to bilateral transactions prioritizing U.S. commercial and geopolitical interests over disease prevention makes everyone less safe by fragmenting the coordinated response systems needed to address pandemics and other health emergencies.