The deal in Zambia was considered particularly controversial and sparked months-long domestic outrage. 

“The sharing of data is in violation of our citizens’ right to privacy. These matters are the subject of litigation in the Zambian courts, and this must be respected,” Foreign Minister Mulambo Haimbe said in May. 

Zambia’s successful renegotiation of the terms in the health package represents significant concessions from Washington and has called into question the dozens of others made between the US and African countries. 

Several other countries, including Namibia, South Africa, Ghana and Zimbabwe, have resisted signing health deals with the US – even though many of them historically relied on its aid funding – over sovereignty concerns. 

“I suspect there’s a lot of observation going on in terms of some countries learning lessons from the fact that perhaps it is possible and important to stand your ground,” Dr Khan said. 

Zimbabwe pulled out of a $367 million agreement with the US in February over concerns about data sharing, with all US funding pulled out of the country at the end of September. 

The withdrawal is expected to have catastrophic consequences for Zimbabwe, where the US has historically been the largest health donor and has supported programmes on HIV prevention and treatment, tuberculosis, malaria, and the supply of critical medicines. 

Global health funding has dropped by roughly 24 per cent since 2025, driven in large part by the US’s new aid policies as well as cuts made by other Western donor countries, including the UK. 

Some analyses have suggested that aid cuts could result in 22 million avoidable deaths by 2030. 

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