Zambia Finalises $1.5bn US Health Agreement After Months of Data-Sharing Disputes

Zambia has formally entered into a five-year health financing agreement with the United States, bringing an end to a prolonged public row over allegations that the southern African nation was exchanging citizens' medical data and mineral rights in return for American aid. The memorandum of understanding, signed in Lusaka on Thursday, was accompanied by a separate data-sharing arrangement between the two governments.

Under the terms of the deal, Washington is expected to contribute approximately $1.5bn (£1.1bn), while Zambia will also put forward its own financial contribution. The agreement is designed to replace support that for many years had flowed predominantly through US-funded programmes, particularly those administered by the now-defunct US Agency for International Development (USAID).

The signing follows months of intense scrutiny from civil society organisations, opposition politicians and health advocates. A draft of the agreement leaked earlier this year prompted warnings that Zambia was accepting broader data-sharing conditions than other African countries, including what critics described as long-term access to pathogen information and biological specimens. The Chapter One Foundation, a human rights group, argued that the government risked "signing away" the health data of its citizens, while HIV advocates, among them the Treatment Advocacy and Literacy Campaign, contended that the flow of information would be entirely one-way and insisted the text be made public.

Officials now say the revised wording of the agreement addresses the principal concerns surrounding privacy, intellectual property and the sharing of benefits. Health Minister Roma Chilengi stated earlier this week that clauses obliging Zambia to send biological specimens to the United States had been removed, and he insisted the agreement would not permit the sharing of individual patient records. According to the minister, any data exchange would be confined to information required for monitoring and evaluating programmes financed under the deal.

The controversy was further inflamed by reports linking health funding to preferential access for American companies to Zambia's substantial reserves of copper and other critical minerals. In May, Foreign Minister Mulambo Haimbe described the data terms as a violation of privacy and "unconscionable", and accused Washington of tying the package to mineral access. The then-US ambassador, Michael Gonzales, rejected that characterisation as false. The dispute had been sharpened by an earlier suspension of US drug funding after the American embassy alleged the theft of donated medicines, an allegation the Zambian government disputed.

The new agreement is intended to support a wide range of health priorities, including HIV/Aids, tuberculosis, malaria, maternal and child health, disease surveillance and broader health system strengthening, such as the recruitment of community health workers. The combined package covering the period from 2026 to 2030 has been estimated by officials at roughly $3.6bn, although the precise figures for Zambia's own share have varied in public statements.

Washington has portrayed the arrangement as a shift away from a traditional donor-recipient relationship towards one of shared responsibility, with US funding expected to decline over the five years as Zambia progressively increases its domestic spending on health. This approach reflects a broader policy pursued by President Donald Trump's administration after it moved to close USAID, an agency the president repeatedly accused of wasteful spending. Following the closure last year, Washington has sought similar agreements with a number of African governments, arguing that partner countries should assume a greater share of the financial burden.

Kenya, Tanzania and Uganda are among the nations that have already signed such deals. Ghana and Zimbabwe, by contrast, have rejected agreements over conditions relating to the sharing of data and specimens, signalling that the terms remain contentious across the continent. The Zambian government's decision to proceed therefore places it within a group of countries that have chosen to negotiate revised terms rather than walk away entirely.

Shortly after beginning his second term in January 2025, Trump ordered the closure of USAID, a move that severely disrupted health programmes in several African countries dependent on American funding. Critics contend that the shutdown has slowed the detection of the ongoing Ebola outbreak in the Democratic Republic of Congo and diminished the scale of the response, stressing that the humanitarian agency had been crucial in organising logistics, supplies and local outreach.

The United States denies that its funding cuts have harmed those efforts, maintaining that its assistance is now more "aligned and effective" under the new arrangement and pointing to the $270m it has donated to combat the epidemic. For Zambia, the signed agreement marks the end of a turbulent chapter of public dispute, but questions are likely to persist about transparency, the precise terms of data exchange and whether domestic health financing can realistically fill the gap left by declining American contributions.