Zambia and Zimbabwe Back Away From ‘Prescriptive’ US Health Deals
Health Systems 26/02/2026 •
A Zimbabwean health worker administers an HIV test.

The government of Zambia acknowledged this week that it is unhappy with part of a proposed health aid deal with the United States that “does not align with the country’s interests”.

The Zambia-US bilateral deal was due to be signed last December, but it faltered after the US linked the billion-dollar deal to access to Zambian minerals, particularly copper and cobalt.

Just four days before the Memorandum of Understanding (MOU) was due to be signed, the US announced that two countries had committed to a plan to unlock “a substantial grant package of US support in exchange for collaboration in the mining sector and clear business sector reforms that will drive economic growth and commercial investment that benefit both the United States and Zambia”.

“We want to leverage US assistance to bring about reforms that will unleash business investment that enhances US access to critical supply chains and creates great jobs for the Zambian people,” said Caleb Orr, US Assistant Secretary of State for Economic, Energy, and Business Affairs.

However, Zambia indicated this week that it has requested “revisions” to the MOU, and that it is still in negotiations with the US.

A leaked version of the agreement indicates that the US has reduced its commitment from $1.5 billion over five years it offered last year, to $1.012 billion.

According to the draft MOU, Zambia would also commit to providing information about pathogens with pandemic potential to the US for 25 years and data-sharing for 10 years – although the MOU would only be in place for five years.

Zambia has increased domestic financing for medicines and medical supplies by 30% since the US started to cut aid.

Zimbabwe says no to ‘lopsided’ deal

This week, it emerged that Zimbabwe had also halted its bilateral health negotiations with the US, rejecting the terms of an MOU worth $367-million over five years.

A leaked letter from Albert Chimbindi, Zimbabwe’s Secretary for Foreign Affairs, told officials involved in the US talks that the President directed them to “discontinue any negotiations with the USA”.

The letter describes the MOU as “clearly lopsided” and “blatantly compromises and undermines the sovereignty and independence of Zimbabwe”.

The stumbling block for Zimbabwe was the US insistence on instant access to information about pathogens causing outbreaks, while refusing to agree to benefit-sharing of any products developed as a result of this access.

Zimbabwe is currently one of the leaders of the African region in its negotiations on a Pathogen Access and Benefit-Sharing (PABS) system at the World Health Organization (WHO).

The PABS system, the final piece of the Pandemic Agreement still to be negotiated, will set out how information about pathogens with epidemic potential should be shared – and how the products (benefits) derived from this information, including medicines and vaccines, should also be shared.

Zimbabwe, representing Africa, at the WHO meeting negotiating a PABS system.

This week, the US Embassy in Zimbabwe announced that the government of Zimbabwe “has communicated its decision to withdraw from negotiations” on the proposed bilateral health MOU.

“We believe this collaboration would have delivered extraordinary benefits for Zimbabwean communities – especially the 1.2 million men, women, and children currently receiving HIV treatment through U.S.-supported programs,” said US Ambassador to Zimbabwe Pamela Tremont. “We will now turn to the difficult and regrettable task of winding down our health assistance in Zimbabwe.”

The Zimbabwe College of Public Health Physicians (ZCPHP), which represents doctors and specialists, urged its country to re-engage with the US this week.

While acknowledging the progress Zimbabwe has made to improve health services and the importance of protecting national sovereignty, the ZCPHP warned that the country’s HIV programme – including antiretroviral treatment, laboratories and supply chains – is still heavily reliant on external funds.

“An abrupt discontinuation of such support could risk treatment interruption, increased transmission, the emergence of drug resistance, and additional strain on the health system,” the ZCPHP warned in a statement.

“Continued dialogue between both governments offers an opportunity to resolve outstanding concerns while ensuring that essential commodities and services remain uninterrupted as Zimbabwe gradually strengthens domestic financing mechanisms,” the College said.

This year, the Zimbabwean government committed to increasing its health spending to 15% of its budget, a substantial increase from previous years and it has also introduced an AIDS Levy to raise funds.

However, donors – particularly the US President’s Emergency Plan for AIDS Relief (PEPFAR) – have picked up three-quarters of the tab for its HIV spending in the past.

Between 2018 and 2020, PEPFAR covered 32% to 42% of Zimbabwe’s HIV spending, the Global Fund 26% to 41%, while the government’s contribution was 2% to 12%, according to UNAIDS. 

Meanwhile, Kenya’s High Court has frozen implementation of its US MOU after two separate court challenges by the Consumer Federation of Kenya (COFEK) and local Senator Okiya Omtatah over concerns about patients’ data privacy and the bypassing of Parliament.

Africa CDC offers support

Dr Jean Kaseya, Director-General of Africa CDC.

Dr Jean Kaseya, Director-General of the Africa Centre for Disease Control and Prevention (Africa CDC), told journalists on Thursday that the body would support Zambia and Zimbabwe – and the 17 African countries that have signed MOUs with the US.

“There are huge concerns regarding data, regarding pathogen sharing,” Kaseya acknowledged. “We want to own our data in Africa. We want to own our future. We cannot accept not owning our data.”

He added: “I’m supporting Zimbabwe if they want to have further negotiations. I’m supporting Zambia and other countries. But more than that, for countries who decided to sign, we’ll support them for the implementation because we don’t want to be accused of failure in terms of implementation of the programme.’

With the MOUs, the US is winding down previous support for African countries’ priority health programmes, particularly PEPFAR support for HIV and tuberculosis. All the MOUs have five years of US waning aid alongside increasing domestic investment.

The MOUs, concluded in terms of the new US “America First Global Health Strategy”, make access to information about dangerous pathogens a priority.

Meanwhile, earlier this month, The Atlantic reported on a leaked memo from the US State Department that indicated that seven African countries would soon lose all US humanitarian aid, as there is “no strong nexus between the humanitarian response and US national interests.”

These countries are Burkina Faso, Cameroon, Malawi, Mali, Niger, Somalia, and Zimbabwe.

Panama first non-African state to sign MOU

This week, Panama became the first non-African country to sign an MOU in terms of the “America First Global Health Strategy”.

So far, the State Department has signed 18 bilateral global health MOUs with Botswana, Burkina Faso, Burundi, Cameroon, Cote d’Ivoire, Eswatini, Ethiopia, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mozambique, Nigeria, Panama, Rwanda, Sierra Leone, and Uganda.

Image Credits: DFID, UNICEF Zimbabwe.

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