From PEPFAR to “health-for-minerals,” Donald Trump’s Africa policy signals a shift from humanitarian leadership to extractive transactionalism
The trajectory of the United States’ Africa policy under Donald Trump increasingly reflects a shift from pragmatic engagement to a narrower, more extractive form of transactionalism. While US engagement on the continent has traditionally balanced strategic interests with developmental and humanitarian commitments, recent policy directions suggest a willingness to instrumentalise aid and diplomacy in pursuit of resource access.
A striking illustration of this shift is the evolving US approach toward Zambia. A draft State Department memo reveals that Washington has considered leveraging life-saving health assistance as a bargaining tool to secure preferential access to Zambia’s critical mineral resources. This marks a significant departure from the long-standing ethos underpinning initiatives such as the US President's Emergency Plan for AIDS Relief (PEPFAR), which has historically symbolised US humanitarian leadership and helped expand its soft power.
For over two decades, PEPFAR has played a transformative role in Zambia’s public health landscape. Millions rely on daily HIV treatment, alongside tuberculosis and malaria interventions supported by US funding. At its peak, the programme helped reverse a devastating epidemic that once claimed tens of thousands of lives annually. Yet under the current policy recalibration, this humanitarian legacy risks being sidelined by strategic bargaining. The proposal to significantly cut assistance signals a readiness to use health security as a bargaining chip.
By tying health aid to mining concessions, the Trump administration appears to be recalibrating its diplomatic toolkit, shifting from normative influence to competitive extraction.
The contours of the proposed agreement with Zambia reveal the depth of this transactional turn. First, to access US$1 billion in American funding over five years, a figure notably lower than previous assistance levels, Zambia would need to substantially increase its domestic health spending, committing approximately US$340 million. Second, and more consequentially, the deal stipulates enhanced access for American firms to Zambia’s vast mineral resources, including copper, cobalt, lithium, and rare earth elements. As Africa’s second-largest copper producer, Zambia occupies a central place in global supply chains critical to the energy transition.
This resource dimension of the deal is not an aberration. It is also in sync with Washington’s broader strategic objective of countering China’s entrenched presence in African mining sectors. For years, US policymakers have expressed frustration over what they perceive as China’s preferential and often opaque access to mineral assets across the continent. By tying health aid to mining concessions, the Trump administration appears to be recalibrating its diplomatic toolkit, shifting from normative influence to competitive extraction.
A third component of the proposed arrangement involves restructuring a prior grant from the Millennium Challenge Corporation. Originally designed to support Zambia’s agricultural sector, the grant is now being repurposed to push for regulatory reforms in mining and related industries. This layering of conditions through health financing, resource access, and governance reform underscores the increasingly bundled and conditional nature of US engagement.
So far, this transactional approach has produced successful outcomes for the US. For example, the US threat to withdraw a planned debt relief package appears to have directly influenced Zambia’s negotiating posture. Within days, Zambian authorities signalled their openness to granting preferential access to US entities and provided unprecedented access to national mining data. Such sequencing suggests that financial pressure is being effectively deployed to extract strategic concessions, at least in the short term.
While 20 African countries have signed the America First Global Health Strategy so far, there have also been a few cases of resistance. Zimbabwe has rejected the deal, calling it an unequal exchange and citing concerns over sovereignty, particularly regarding biological data sharing.
As a matter of fact, this approach is not confined to Zambia. Following the US withdrawal from the World Health Organization (WHO) and the substantial curtailment of USAID, Washington has pursued similar agreements with multiple African states, seeking commitments of increased domestic health spending in exchange for continued assistance. While 20 African countries have signed the America First Global Health Strategy so far, there have also been a few cases of resistance. Zimbabwe has rejected the deal, calling it an unequal exchange and citing concerns over sovereignty, particularly regarding biological data sharing. Kenya, despite being the first African country to sign the deal, is facing challenges in implementing it, as civil society actors have challenged the deal over data privacy concerns.
The Zambian case, however, stands apart due to its explicit linkage between health aid and resource access. Provisions requiring long-term sharing of citizens’ health data and biological samples, which extend well beyond the duration of US funding commitments, have raised serious ethical and sovereignty concerns. Critics argue that such clauses risk transforming public health cooperation into a vehicle for data extraction, with uncertain benefits for recipient countries.
More broadly, this turn toward transactionalism is recalibrating US relations with key African partners. In South Africa, bilateral tensions have often been cast in ideological terms, yet economic interdependence endures even as Pretoria deepens its engagement with China and other global actors. President Cyril Ramaphosa has actively courted Chinese investment while maintaining diversified partnerships. In January, South Africa hosted Russia, China and Iran in its waters for a joint naval exercise dubbed ‘Will for Peace’. Most recently, South Africa rejected US pressure to distance itself from Iran. Similarly, Nigeria continues to expand cooperation with China, particularly in the technology and renewable energy sectors, even as it maintains significant trade and commercial ties with the US.
The United States has historically differentiated itself through its emphasis on governance, transparency, and humanitarian values. However, the apparent shift toward “health-for-resources” deals risks eroding this distinction.
These dynamics reflect a broader structural reality. African countries increasingly recognise that their strategic importance is rising in a multipolar world marked by intensifying competition over critical resources. The continent’s substantial reserves of minerals essential to emerging technologies and the global energy transition strengthen its bargaining power. However, competition over these resources also exposes the continent to intensified geopolitical contestation.
In this context, comparisons with other external actors are instructive. Russia has been widely criticised for pursuing “security-for-resources” arrangements, often involving military assistance in exchange for mining rights. The United States has historically differentiated itself through its emphasis on governance, transparency, and humanitarian values. However, the apparent shift toward “health-for-resources” deals risks eroding this distinction.
The long-term implications of this shift are significant. US soft power in Africa has long been anchored in democratic and humanitarian values, delivering tangible social benefits, from health to education. While these coercive tactics may generate short-term leverage, they risk permanently damaging US goodwill across the continent, thereby undermining the very foundations of its influence.
Ultimately, the evolution of Washington’s Africa policy under Trump reflects a deeper tension between strategic competition and normative leadership. Pragmatism, to a certain extent, enables states to pursue their national interests while maintaining a balance between strategic imperatives and normative commitments. In contrast, transactionalism, often narrow and coercive, reduces relationships to zero-sum exchanges, eroding trust and legitimacy. If the current trajectory persists, the United States may find that in seeking to outcompete its rivals, it has inadvertently weakened the very attributes that once made it a preferred partner across Africa and beyond.
Samir Bhattacharya is an Associate Fellow at the Observer Research Foundation.
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Dr. Samir Bhattacharya is an Associate Fellow at Observer Research Foundation (ORF), where he works on geopolitics with particular reference to Africa in the changing ...
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