In February 2026, reports emerged that the Zambian and US governments were in talks over a health agreement that would see continued funding to Zambia’s health sector for 5 years. However, the agreement quickly became controversial after its leaked draft revealed that the US was demanding access to Zambia’s health data for 10 years and preferential access to Zambia’s critical minerals.
Although in a later statement, the outgoing US Ambassador to Zambia, Michael Gonzales, refuted claims that the US government had threatened to withhold critical lifesaving support if not given access to Zambia’s critical minerals, in December 2025, the US Embassy in Zambia confirmed that the health financing agreement was dependent on collaboration in the mining sector. In February 2026, the Zambian president, Hakainde Hichilema, fired Elijah Muchima, the then Minister of Health, three days after the cabinet minister denied that the proposed financial support was tied to mining concessions.
Negotiations over this deal have been shrouded in secrecy, with government officials declining to give further details to human rights groups and other activists who have expressed concern over the lopsided nature of the agreement. The deadline for signing the agreement has passed, according to a statement released by Michael Gonzales. The consequences of such failure to reach an agreement may include substantial cuts to life-saving medicines for people living with HIV.
In this article, driven by a desire to help the Zambian government find a lasting solution to health inequalities, I propose some solutions that, if implemented, could strengthen Zambia’s capacity to provide life-saving medicines to its people without heavy dependence on foreign aid.
Massive investment in drug and vaccine research and development (R&D)
While some terms and conditions of the controversial health deal between the US and the Zambian governments are disturbing and clearly do not serve Zambia’s interests, what is equally disappointing is the Zambian government’s lack of strategic thinking and foresight. You see, we need medicines and vaccines discovered and developed on Zambian soil for two very important reasons. The first, which is related to the controversial agreement, is the obvious need to meet the local demand for medicines. Since gaining independence from colonial Britain in 1964, Zambia has not discovered and developed a single medicine or vaccine using the conventional drug discovery and development paradigm.
Moreover, clinical trials on its traditional medicines have not happened to any significant extent. As a result, the use of traditional medicines to treat different diseases in Zambia remains scientifically unproven. Medicines and vaccines do not just become available overnight – there is a very time-consuming discovery and development process which takes a medicine/vaccine from the discovery phases, through clinical testing to clinical application.
The pharmaceutical companies or academic institutions that discover and develop medicines/vaccines ultimately hold intellectual property rights and patent protections as the sole manufacturers. Patents can take up to 20 years before expiry. This explains why some medicines are not immediately available to the wider public upon being launched. The pharma companies behind their development are allowed to exclusively manufacture and charge premium prices under patent laws. African governments, in most cases, fail to buy such medicines/vaccines for their public health care due to high costs.
In fact, I recently attended a meeting in which a cabinet minister of an African country complained that a named Western pharmaceutical company refused to grant them a license to manufacture a life-saving anti-HIV drug. Ironically, the clinical trials, whose data led to the regulatory approval of this anti-HIV medicine, were conducted in this African country. However, drug discovery research was conducted elsewhere – in pharmaceutical R&D, where the drug or vaccine is researched, matters most. The innovator of a medicine or vaccine holds enormous power and influence over who manufactures it.
At this critical point, Zambia needs to act strategically. While clinical research (such as clinical trials on new medicines) should be encouraged, there is also a need to create basic research capacity so that the medicines that are eventually tested in clinical trials are a product of R&D efforts conducted in Zambia. In simple terms, the government should finance the discovery of new medicines and vaccines by Zambian scientists.
Since disagreements arose over the US-Zambia health agreement deal, I expected the Zambian government to convene an urgent meeting to strategize on how the discovery and development of medicines by Zambian scientists can be promoted. Such a meeting should go beyond mere discussions that yield nothing but workshop attendance registers. The government should create tangible capacity for Zambian scientists to carry out world-class drug discovery and development. Financial resources should be mobilized to renovate existing laboratories and equip them with human resources, modern instrumentation, reagents, and chemicals. This capacity is what will, ultimately, deliver medicines whose intellectual property and patents Zambia owns. This capacity is critical in reducing dependence on foreign aid to sustain local health care.
The second reason why Zambia needs to discover and develop its own medicines is less obvious. You see, while some medicines can be discovered and developed elsewhere and still be used to
treat Zambian patients, this is not universally true. Some medicines discovered and developed elsewhere (e.g., with discovery and clinical studies having been conducted on the Caucasian population) may be ineffective or even harmful on an African population. Such differences arise because the response to some medicines may be affected by genetic differences. Therefore, in addition to the health sovereignty advantages associated with developing medicines within the boundaries of Zambia, such efforts will also enhance the treatment outcomes for Zambian patients.
Investment in drug and vaccine manufacturing capacity
While some drug manufacturing capacity exists in local pharmaceutical companies, this remains inadequate for the reasons I will explain in this section. Moreover, vaccine manufacturing in Zambia is nonexistent. Zambia’s drug manufacturing capacity remains inadequate and vulnerable to external shocks for one very important reason. Firstly, while several Zambian pharmaceutical companies do make different formulations of medicines such as tablets, capsules, oral liquids, injections, and creams, none make the active pharmaceutical ingredients (APIs), i.e., the actual drug molecules responsible for the pharmacological effects in the body.
These, including additives for formulating medicines, are imported from other countries, mainly China and India. There are no chemical reactors in Zambian pharmaceutical companies to synthesize APIs. Obviously, the importation of APIs and excipients undermines Zambia’s economic growth while hampering job creation for Zambia’s locally trained chemists, chemical engineers, and pharmaceutical science experts. This leaves Zambia exposed to external supply chain shocks. As the government champions the creation of local manufacturing capacity, it should not forget the need to create such capacity across the entire value chain – i.e., starting from the synthesis of APIs to their formulation.
To catalyze growth in this sector, the government should inject substantial financial resources into creating government-owned or Zambian-owned pharmaceutical companies with the capacity to synthesize APIs. While foreign investment should also be encouraged, the government should take the lead in establishing a pharmaceutical manufacturing ecosystem that should deliver affordable medicines to its population. In an environment dominated by foreign investment, achieving universal access to affordable medicines may be a challenge.
In conclusion, the Government of Zambia needs to think strategically as it faces an uncertain future regarding foreign support to the health sector. The funding cuts to the health sector must be seen as an opportunity to create a coordinated pharmaceutical R&D ecosystem that churns out medicines researched, developed, and manufactured on Zambian soil. Capacity should be created in academic institutions and centers of excellence to discover new medicines and vaccines that feed into local pharmaceutical manufacturing. With its central location, Zambia can transform itself into a pharmaceutical R&D and manufacturing hub that exports medicines to the region and beyond, resulting in a more diversified economy.
About the author:
Peter Mubanga Cheuka is a medicinal chemist and drug discovery expert. He is also a lecturer at The University of Zambia, where he teaches general chemistry, organic chemistry, medicinal chemistry, and drug discovery and development science.
For any comments and responses, email: peter.cheu
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