The US is reportedly leveraging health aid to gain access to Zambia's critical minerals. Millions depend on US funding for HIV, tuberculosis and malaria treatment. Yet Zambia is hesitant to agree.
https://p.dw.com/p/5BsZEZambia is the second largest copper producer in Africa, and the US is seeking greater access to the country's mineral resourcesImage: Damian Gillie/Construction Photography/Photosh/picture allianceAdvertisementAround 1.3 million people in Zambia are living with HIV. Many depend on aid for treatment, largely delivered through the United States' PEPFAR program (the President's Emergency Plan for AIDS Relief).
Between 2010 and 2025, new HIV infections in Zambia dropped from 63,000 to 30,000, according to the United Nations. But the southern African nation is reportedly reluctant to sign a new deal with the US, which is demanding greater access to Zambia's critical minerals.
In late March, The New York Times reported it had obtained a memo prepared for Secretary of State Marco Rubio, which shows how the US could withdraw health support "on a massive scale" to force Zambia and other countries to accept US terms.
After dismantling USAID last year, the Trump administration has sought to replace decades of aid with bilateral deals, called Memorandums of Understanding (MOUs), as part of the America First Global Health Strategy.
In a written statement to DW, the US State Department said it sought to partner "with select countries" to "transition from a foreign assistance paradigm to an investment and growth paradigm."
Details on many remain undisclosed, but the State Department said MOUs represented over $20.6 billion (€17.6 billion) in new health funding to fight HIV/AIDS, malaria, tuberculosis and other infectious diseases. Across Africa, 23 countries have so far signed bilateral deals with the US.
But two countries are pushing back: Zimbabwe and Zambia.
"We are fundamentally adopting a radically different approach to this than the US government has used in the past," said Conor Savoy, a visiting fellow at the Center for Global Development and formerly a foreign policy engagement lead at USAID.
Zimbabwe walked away from negotiations, calling US demands on data and biological samples "lopsided" and an "intolerable infringement on sovereignty."
Kenya's government accepted a deal; however, activists with similar data privacy concerns have taken it to court.
For months, the US has been trying to reach a deal with Zambia. In February, Zambia said the US proposal did not align with the country's interests. The US is proposing $1 billion in health funding over five years, less than half of what Zambia received before Trump took office. Zambia must also commit $340 million in new health spending, and the US has demanded biological and specimen data for 25 years. Zambia has reportedly until May to sign or lose funding.
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Meanwhile, Zambia has been increasing its own health contributions, including some HIV programs. However, scaling up health spending cannot happen overnight, according to Savoy.
"Their systems are simply not at a place where they can take on the entire challenge of health funding," he told DW.
Another demand from the US is reportedly access to Zambia's critical minerals. Zambia has significant reserves of nickel and cobalt, and is one of the world's largest copper producers.
Earlier this year, the Trump administration launched Project Vault, aiming to counter China's dominance on rare earth minerals. But reports of trading health aid for minerals is concerning to experts.
"We're playing with fire here ultimately and it could further erode confidence and credit and our credibility on the continent," said Savoy.
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HealthGAP, a health advocacy organization working in Zambia, reported that activists are "demanding a rejection of deals conditioning funding access to mining."
Many African nations have already signed MOUs with the US.
"There are countries that want these types of investments and they're going to be open to them," said Savoy.
He adds it is difficult to confirm whether critical minerals have been a condition in other deals. For instance, the Democratic Republic of Congo has signed both a health agreement and a separate minerals deal with the US.
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Some countries may even welcome mineral agreements with the US.
"A lot of countries in the region have tried to look at diversifying away from China," Savoy said. But he argues health and economic deals with the US should be kept separate.
"This effort, especially in Zambia, could seriously undermine our credibility. At the end of the day we're doing essentially what the US government has accused the Chinese of doing for the past two decades in Africa," he told DW.
If a deal is not reached and the US reduces support on "a massive scale," the effects could be felt quickly.
Oxfam recently warned the deals are "effectively threatening the health and well-being of thousands by turning humanitarian assistance into a bargaining chip."
For 1.3 million Zambians that means losing daily life-saving HIV treatment, which had helped cut AIDS-related deaths in the country by over 70% in the last 15 years.
Zambia's health ministry was contacted for this article, but had not responded at the time of publishing.
