WHEN US President Donald Trump dismantled USAID and ordered the reconstruction of America’s global health architecture, his administration offered African governments a simple proposition: accept Washington’s terms, and the money would flow again. Sixteen countries said yes. Then the pushback began.
This week, Zimbabwe became the most dramatic casualty, formally rejecting a $367 million five-year agreement and triggering a US announcement that it would begin “winding down” health assistance in a country where 1.2 million people currently receive HIV treatment funded by Washington. In Zambia, a $1 billion deal that was meant to be signed in November remains stalled, with the government publicly acknowledging that parts of the agreement “did not align with the position and interests” of the state. In Kenya, a landmark $2.5 billion deal – the largest on the continent – sits suspended under a court order after a consumer rights group raised alarm over what it described as an unconstitutional transfer of citizens’ personal health data.
Together, the three cases represent the most coordinated resistance any region has mounted against the Trump administration’s overhaul of global health financing — and they expose a fundamental tension at the heart of the new American model.
Data for Dollars
The objections raised by Zimbabwe, Zambia and Kenya are not incidental. They target the same provisions: sweeping data and specimen-sharing clauses that critics say transform health aid into a vehicle for extracting biological resources and sensitive medical information from some of the world’s poorest populations.
Each bilateral memorandum of understanding negotiated by the State Department comes attached to a decade-long specimen-sharing agreement. Under these terms, recipient countries are required to give the United States rapid access to pathogen data, biological samples and national health surveillance information. What they receive in return, critics argue, is considerably less clear.
Zimbabwe’s government, in a leaked memo from December, described its proposed deal as “lopsided.” In a subsequent public statement, government spokesperson Nick Mangwana said the US was demanding access to biological resources “for research and commercial gain” while offering no corresponding guarantee that any resulting vaccines, diagnostics or treatments would ever reach Zimbabwean patients. The country would be providing, he said, “the raw materials for scientific discovery without any assurance that the end products would be accessible to our people should a future health crisis emerge.”
In Nairobi, the High Court agreed to bar implementation of Kenya’s deal “insofar as it provides for or facilitates the transfer, sharing or dissemination of medical, epidemiological or sensitive personal health data.” Kenyans had raised fears that the agreement could expose HIV status records, tuberculosis treatment histories and vaccination data to American authorities.
In Zambia, civil society has been more explicit. Owen Mulenga of the Treatment, Advocacy and Literacy Campaign, a local non-governmental organisation, told Reuters: “The data sharing will be one way from Zambia to the US and the information will benefit the US. We need support from the US, but there should be transparency.”
Copper, Cobalt and Conditionality
In Zambia’s case, a second and more geopolitically charged dimension has emerged. In December, the United States announced that it had committed with Zambia to “a plan that aims to unlock a substantial grant package of US support in exchange for collaboration in the mining sector and clear business sector reforms.” Three sources told Reuters that the bilateral compact conditioning Zambia’s health agreement was tied to that mining arrangement.
Zambia is Africa’s second-largest copper producer and also holds significant reserves of cobalt, lithium, graphite and rare-earth elements — resources central to the United States’ ambitions in clean energy and defence supply chains. The Zambian government denies any connection between the health deal and mineral access, insisting the agreement “has no relation whatsoever to minerals, mining, or any natural resources.” But the April 1 deadline written into the draft agreement — after which funding will be terminated if a broader bilateral compact is not agreed — is creating acute pressure on Lusaka to decide.
A similar dynamic appears to be playing out with the Democratic Republic of Congo, which has the world’s most significant deposits of cobalt and other critical minerals. Despite signing a peace deal with Rwanda in Washington in December — in Trump’s presence — the DRC has yet to conclude a health agreement with the US. Instead, the two countries signed a “strategic partnership agreement” focused on critical mineral flows. China currently dominates the purchase and processing of the DRC’s mineral output.
Asia Russell, executive director of Health GAP, a global HIV advocacy organisation that has tracked the negotiations closely, was direct in her assessment. The Zambia deal, she said, would “slash US government funding to life-saving programs while prioritising the interests of mining corporations over the needs of Zambians with HIV.”
Sixteen Countries That Said Yes
The resistance from Zimbabwe, Zambia and Kenya should not obscure the scale of what the Trump administration has achieved. By the end of December, 14 African nations had signed memorandums of understanding, including Nigeria, Uganda, Rwanda, Botswana, Ethiopia, Mozambique and the Ivory Coast. According to the US Embassy in Harare, 16 countries across Africa have now signed health pacts representing more than $18.3 billion in new funding commitments.
For many of these governments, the calculation was stark: the risk of losing funding for HIV treatment, malaria control and maternal health programs — which in some cases sustain millions of patients — outweighed the concerns over data terms that remain largely untested in practice. The MOUs are frameworks; the actual grant agreements that flow from them are still being drafted.
South Africa, Tanzania and the DRC remain outside the framework, each for distinct political reasons. The US has said it is “still deliberating future health assistance to South Africa pending broader bilateral discussions,” amid ongoing diplomatic friction over Israel, the status of Afrikaner communities and South Africa’s G20 presidency.
A Collision With the World Health System
Beneath the bilateral negotiations runs a deeper structural conflict. African nations have spent years building a Pathogen Access and Benefit Sharing framework within the World Health Organisation, designed to ensure that when countries contribute disease data to global surveillance, they receive an equitable share of any resulting medical innovations. The continent’s experience with COVID-19 — where South Africa was the first country to share the Omicron variant sequence globally, yet struggled to access vaccines for its own population — made this a matter of acute political principle.
The US bilateral agreements, with their unilateral data-sharing demands and absence of reciprocal benefit guarantees, cut directly across the principles of that multilateral framework. In December, Zimbabwe spoke on behalf of 51 African countries at the WHO negotiations in Geneva, affirming the continent’s commitment to the global system. The United States, which has withdrawn from the WHO entirely, is not a party to those talks.
Secretary of State Marco Rubio has been explicit about the governing philosophy. Foreign assistance, he has said repeatedly, “is not charity; it is designed to further the national interests of the United States.” The deals he has championed reflect that commitment precisely — trading public health investment for pathogen surveillance access, data rights and, in some cases, preferential positioning in critical mineral supply chains.
What Comes Next
For Zimbabwe, the immediate consequences are already playing out. The US Embassy in Harare has announced the commencement of a wind-down, and the Zimbabwe College of Public Health Physicians has called urgently for resumed dialogue, warning that much of the country’s HIV programme depends on external financing. “Where technical issues exist,” the college said, “these can often be addressed through technical clarification and negotiated safeguards.” Whether either government has the political appetite to restart talks is uncertain.
In Zambia, the clock is ticking toward April 1. Advocates are watching whether a government that has publicly said the deal does not align with its interests will ultimately sign anyway, under the pressure of a looming funding cut-off for programs serving hundreds of thousands of HIV patients.
In Nairobi, Kenya’s court case offers a third trajectory: a legal process that buys time without forcing an immediate rupture, but leaves the country’s health funding in limbo.
What is clear is that Washington’s effort to remake global health financing on an America-first, bilateral model has generated a more principled and sustained resistance than its architects appeared to anticipate. The question now is whether the Trump administration will treat that resistance as a reason to reconsider the terms on offer — or simply as the price of doing business with sovereign states that, for the first time in decades, are reading the fine print.
