US Considering to Hold Zambia's HIV, TB, Malaria Programmes Hostage over Minerals Deal : Shared by Tom McDermott

Stephanie Nolen, The New York Times, 16 March 2026
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Additional analysis: Asia Russell, Health GAP (Global Access Project), 16 March 2026
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Summary

For  1.3 million people living with HIV in Zambia, the question of whether the United States will continue its PEPFAR-funded HIV treatment programme has become a matter of immediate survival.

A leaked draft memorandum prepared by the US State Department's Africa Bureau for Secretary of State Marco Rubio reveals that the Trump administration is considering withholding lifesaving HIV, tuberculosis, and malaria assistance from Zambia as early as May 2026 unless the Zambian government signs a deal granting American companies preferential access to the country's copper, cobalt, and lithium deposits. The document states that the United States “will only secure our priorities by demonstrating willingness to publicly take support away from Zambia on a massive scale.” The State Department declined to comment on what it described as a leaked document.

Separately, health activists have released the text of Zambia's draft Memorandum of Understanding (MOU) with the US government — the first such MOU known to explicitly link health funding to mining concessions. The full draft MOU can be read here. The MOU contains a termination clause: if Zambia fails to agree to a separate Bilateral Compact governing mineral access by 1 April 2026, all MOU funding is immediately discontinued. The Bilateral Compact itself remains secret.

The proposed deal offers Zambia $1.012 billion in health funding over five years — a 53 per cent reduction on FY2024 PEPFAR levels, and $488 million less than the $1.5 billion Washington had previously pledged. Zambia has received more than $6 billion from PEPFAR over the past two decades. When the programme began, approximately 90,000 Zambians were dying of HIV each year; by 2024, that figure had fallen to 16,000.

The MOU terms are among the most onerous of any bilateral deal negotiated thus far. Zambia would be required to hire 40,000 additional health workers by 2030 — a 50 per cent increase over the country's entire current funded health workforce of 81,000 — on pain of funding cuts or termination. Zambia would also be required to share biological specimens and pathogen data with the United States for 25 years, longer than any other country's agreement, with no guarantee that Zambia would benefit from any resulting research or vaccine development. Independent civil society organisations have been excluded from the oversight body governing MOU implementation, breaking with years of established PEPFAR practice.

Zimbabwe declined a comparable deal and has already had its US health aid terminated. Zambia now faces the same choice. An abrupt withdrawal of support, Julius Kachidza warned, would be catastrophic: “Government has got no capacity to respond to that immediate impact.”

Quotes

“We will only secure our priorities by demonstrating willingness to publicly take support away from Zambia on a massive scale.” — Draft State Department memo to Secretary of State Marco Rubio, reported by the New York Times

“If this agreement is not signed, if the funding is not here for the next five years, government has got no capacity to respond to that immediate impact. It could be quite a disaster, especially to me. And the majority of people living with HIV in Zambia.” — Julius Kachidza, chair of Zambia's Civil Society Self-coordinating Mechanism and HIV advocate, Chongwe, Zambia

“If they told me to be buying ARVs — the fifty kwacha, or a hundred, that's four or five dollars per month, even three dollars — where am I going to get it? I barely eat a meal a day.” — Julius Kachidza