AVAC: Trade for aid: Zambia rejects deal with US

AVAC analysis

Zambian government officials rejected a proposed bilateral Memorandum of Understanding (MoU) with the US offering up to $2 billion over the next five years under certain terms, including access to sensitive health data and to the country’s critical minerals. The deal was rejected due to the “incorporation of terms that the Zambian government considers unacceptable.” Ghana and Zimbabwe are also reported to have rejected bilateral MoUs.

These decisions come alongside the broader shift in US global health policy, with new Global Health Security and Diplomacy (GHSD) implementation guidance outlining an “America First” transactional approach that prioritizes bilateral agreements, co-financing, and alignment with US strategic interests. Scripps News reports on this “trade for aid” theme, raising concerns that access to HIV treatment and prevention could hinge on geopolitical and/or commercial interests.

IMPLICATIONS: The Zambian bilateral MoU experience illustrates the dangers of the country-by-country, transactional model for global health and foreign assistance, which effectively will make it harder to see and measure the true scale of the HIV epidemic in the wake of funding cuts and politicization of health. Referring to the recent PEPFAR data that was released last month, AVAC’s Mitchell Warren notes that “we’re [already] seeing a decrease in people accessing prevention services, and we’re seeing a decrease in those accessing the community-based programs that were really critical because those programs have been taken offline.” This “thinning at the margins” described in HIV programs signals a deeper risk: even as treatment numbers hold, the erosion of prevention and community services could lead to increased infections over time and destabilize the effectiveness of the global HIV response.

Further coverage:

• Associated Press: Zambia blasts the US over a $2 billion health deal in exchange for critical minerals
• Think Global Health: As defunded HIV programs thin, uneven resilience emerges
• The New Humanitarian: “We are going to die”: The frontline costs of Uganda’s new US health agreement
• Emily Bass Substack: America First Global Health Guidance launches fee-for-service coup against CDC
• Science: Trump administration cuts CDC’s key role in global program to stop HIV
• Devex: Africa looks inward as global health funding dries up /free registration required/
• Devex: Money Matters: Who funds global health — and by how much?
• CNN: The Trump administration is trying to divert $2 billion in global health funding to pay for USAID shutdown

AVAC publishes a weekly Global Health Watch, a curated digest of key developments in global health. Access this week’s issue (#67, 8 May) here.