The diplomatic clash burst into the open Monday when Zambia’s foreign minister, Mulambo Haimbe, issued a statement accusing the United States of tying a $2 billion health assistance deal to preferential access to Zambia’s mineral wealth. The accusation drew an immediate and sharp contrast between the two governments: Haimbe described remarks by outgoing U.S. Ambassador Michael Gonzales — who last month charged Zambian leaders with corruption and “abdicating their responsibilities” — as “mischievous,” “deeply regrettable, undiplomatic and inconsistent with the spirit of mutual respect.”
Gonzales had previously dismissed the idea that the U.S. was linking minerals to the health package as “alarmist allegations” that he called “disgusting” and “absolutely and patently false.” But Haimbe insisted Monday that the negotiations had stalled over two “unacceptable” conditions: sweeping data-sharing requirements that he said would violate Zambian citizens’ right to privacy, and “the insistence on preferential treatment of U.S. companies over Zambia’s critical minerals.” Zambia, he said, “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 standoff is the most public rupture yet in a broader Trump administration push to replace decades of aid architecture — anchored in the now-dismantled U.S. Agency for International Development and the President’s Emergency Plan for AIDS Relief — with bilateral, transactional agreements. Washington has struck country-by-country deals with about 30 nations, many in Africa, that tie funding to commercial provisions, domestic financing commitments, disease surveillance, pathogen sharing and, in some cases, religious conditions. U.S. officials argue the model reduces donor dependency and safeguards American interests, particularly against China, which dominates African trade but contributes less aid. Yet the approach has generated significant resistance.
Ghana last week said it rejected a proposed deal because of 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 Lesotho, draft U.S. proposals initially sought 25 years of access to health data and biological samples before local officials secured a shorter five-year term.
Health advocates say the data-sharing demands are heavily one-sided. Asia Russell, executive director of the advocacy group Health GAP, said the agreements aim to secure disease surveillance data and biological samples through bilateral channels now that the U.S. has withdrawn from the World Health Organization. “They want to understand what’s actually happening,” said Jen Kates, a senior vice president at KFF, “but they are trying to do it in a very different way.” Critics warn that this risks creating a parallel global health system outside the WHO’s coordination, reviving memories of the COVID-19 pandemic when African countries contributed data and samples but were largely last in line for vaccines.
The lack of transparency is another flashpoint. “Secrecy is at the center of this. That puts accountability for results at risk,” Russell said. “It’s impossible to evaluate these deals properly without seeing the full terms.” A government spokesperson in Zimbabwe said negotiations were terminated partly 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.” Atilla Kisla of the Southern Africa Litigation Center said that unilateral structure “raises serious concerns about who benefits.”
Many of the new agreements also come with reduced funding compared to previous U.S. assistance levels while requiring countries to increase domestic health spending, with aid at risk if targets aren’t met. “These are going to be very heavy lifts,” Kates said. “Countries are already under strain.” Russell added a broader warning: “When health becomes a bargaining chip, everyone becomes less safe.”