Minerals for aid: Are new US health deals ‘exploiting’ African countries?

In late 2025 after the United States shocked the world by suspending global health aid and experts said it would lead to 700,000 more deaths, mostly of children, each year, Washington began proposing unusual bilateral health agreements to developing countries that have infuriated officials and health activists alike.

Critics said the deals, mostly made with African nations, smack of “exploitation” while at least two of the countries in dire need of health aid have pushed back against them.
In November, the US approached Zimbabwean authorities, promising more than $300m in funding in return for sensitive health data in negotiations that Harare felt were “lopsided” and promptly pulled out of, according to memos leaked in recent weeks.

About the same time, the US publicly announced $1bn in funding for neighbouring Zambia pending talks. However, Lusaka, too, called out “problematic” clauses in the US proposal that sought access to the country’s minerals and has since requested a review, according to statements from officials in early March.

Several other countries, though, such as Nigeria and Kenya, have gone on to sign the health pacts. The terms agreed remain unclear because the agreements have not been fully published.

Data or mineral demands in return for health aid are unprecedented in the history of the US, which is Africa’s largest health assistance provider. Policy experts said tying crucial funding to sensitive national assets could have negative consequences for African nations and also for the US itself.
“Supporting global health has clear benefits to the United States in terms of prevention of pandemics that can affect Americans too,” Sarang Shidore, Africa director at the US think tank Quincy Institute for Responsible Statecraft, told Al Jazeera.

“Linking such aid to payoffs in the extraction of critical minerals smacks of exploitative practices. Reform in the foreign aid sector is badly needed, but this is not the way to do it.”
“Supporting global health has clear benefits to the United States in terms of prevention of pandemics that can affect Americans too,” Sarang Shidore, Africa director at the US think tank Quincy Institute for Responsible Statecraft, told Al Jazeera.

“Linking such aid to payoffs in the extraction of critical minerals smacks of exploitative practices. Reform in the foreign aid sector is badly needed, but this is not the way to do it.”

However, it’s the clauses that Washington is demanding to leverage its aid for data, rare earth elements and other minerals that have caused widespread outrage in some countries.

In the case of Zambia, the US reportedly asked the major copper, cobalt and lithium producer for access to its critical minerals in return for $1bn over five years on the condition that Zambia would cofinance the aid with $340m in new health funding. The US also asked for a one-way data-sharing agreement for 10 years.

When Zambian officials did not immediately sign, leaked internal memos prepared for US Secretary of State Marco Rubio said Washington would only “secure our priorities by demonstrating willingness to publicly take support away from Zambia on a massive scale”, according to reporting by The New York Times.

If Lusaka fails to ink a deal by this Wednesday, Washington will call off negotiations, and US aid funding to the country will be discontinued, according to a draft proposal seen by the Reuters news agency.

That could mean losing the remnants of funding Zambia still receives from the PEPFAR programme, the US government’s flagship global health initiative, which has helped countries around the world battle HIV.

Lusaka relies on PEPFAR for more than 80 percent of its HIV funding, which provides free treatment for 1.3 million people, about 6 percent of the population. Although Zambia received $367m from the programme in 2025, funding pauses have severely disrupted drug deliveries across the country.

Reuben Silungwe, a Zambian development analyst with a focus on HIV, said the US terms focus on mining, which represents 70 percent of Zambia’s export revenues, to aid funding and would undermine the country’s long-term fiscal independence.

Lusaka has adopted a “tactical and pragmatic approach” that could still secure US funding, but Zambia also allowed itself to be caught on the back foot, he said.

“The issue is not [about receiving] aid itself. It’s the need to transition towards sustainable, domestically financed systems while maintaining lifesaving services,” Silungwe said, highlighting a general failure among African countries to fulfil their healthcare pledges.