Zimbabweans have already suffered gravely as a result of abrupt disruptions to lifesaving malaria, tuberculosis (TB), and HIV programs caused by the U.S. stop work orders and USAID award terminations in 2025.1 A new catastrophe will start to unfold September 30, when all health programs funded through the State Department will abruptly end, as announced September 22 by the U.S. Ambassador to Zimbabwe, Pamela Tremont.2 Conflict over clauses on data sharing contained in the 5-year draft Memorandum of Understanding (MOU) that would govern $367 million in U.S. health aid has been blamed publicly by President Mnangagwa for the current crisis. (Health GAP has shared the draft MOU here.) But the truth is more complicated—the clause on data sharing was only one factor, and the U.S. could have rescued the MOU negotiations at any point. This article describes why this shutdown is happening, the consequences for Zimbabweans, and civil society demands for corrective action.
What does the U.S. government fund in Zimbabwe? The decades-long health partnership between Zimbabwe and the U.S. in implementing HIV, malaria, TB and other global health programs has achieved important gains in saving lives, averting infection, and expanding health systems capacity. U.S. government contributions comprise 54% of national healthcare spending, supporting a range of clinical care, laboratory systems, health workforce, commodities, and community-based programs, such as:
What went wrong? Zimbabwe and the U.S. started bilateral negotiations in December over a $367 million MOU primarily for HIV, as well as for malaria, TB, and maternal, newborn and child health (MNCH). Negotiations were led by Ambassador Tremont. The initial MOU draft focused (like other health MOUs) on winding down U.S. support over five years, unrealistically increasing Zimbabwe’s co-financing of HIV, TB, malaria, health workforce and MNCH programs, and slashing U.S. funding to Zimbabwe.
On December 24, 2025, President Mnangagwa directed negotiations over the MOU to halt, stating that deliberations were lopsided against the interests of Zimbabweans,5 particularly because of concerns regarding U.S. access to Zimbabwe’s health data and minerals. In addition, State’s proposed co-financing requirements of Zimbabwe (a 290% increase in the first year alone) were unrealistic,6 along with harsh funding cuts (a 48% reduction in 2026 increasing to an 82% cut by 2030).7 The U.S. excludes civil society from MOU negotiations, so independent, apolitical civil society groups were unable to try to defuse conflict early on.
Civil society steps in: The halt in negotiations was revealed February 2026.8 From that time, civil society advocated behind the scenes to try to restart MOU talks—on terms that were fair for Zimbabweans. Civil society pushed for talks to resume in order to fix glaring weaknesses in the MOU. Using meetings with political leaders, media engagement, and impact analyses, civil society challenged both governments to rescue talks in the service of millions of Zimbabwean people at risk of preventable sickness and death. Zimbabwe’s repressive political environment, and the very real risk of retaliation and even violence curtailed public pressure—almost no groups were willing to speak out.
In response, Ambassador Tremont insisted talks would only restart if Zimbabwe’s government reached out to them. Because President Mnangagwa had already issued a formal communique severing talks, easy paths to compromise were unrealistic. This would have been obvious to Ambassador Tremont, a seasoned diplomat. But the U.S. refused to help Zimbabwe’s government save face. Ironically, the U.S. government was willing to soften and even remove data sharing terms in other countries’ MOUs—pointing to the value of restarting talks. Zimbabwe’s second MOU draft, for example, reduced data sharing duration from 7 to 5 years, with the Embassy claiming privately that further reductions were possible—but only if talks restarted.
None of this evidence mattered—the U.S. and Zimbabwe dug into their respective positions; in Zimbabwe, political leaders falsely claimed the national government would cover gaps in essential healthcare services left by a sweeping U.S. health program shutdown. Tremont repeated her claim she would be willing to restart talks if Zimbabwe’s government reached out to the Embassy. She must have known that without a détente she refused to pursue, there was no chance Zimbabwe’s government opposition to the MOU would dissolve.
What comes next? By the end of the U.S. fiscal year (September 30, 2026), the State Department will cease all health programs in the country. The human costs will be catastrophic. The total U.S. retreat from HIV treatment and prevention programs will result in an estimated 75,440 preventable HIV infections and 100,000 additional deaths as a result of commodities and service disruptions, clinic closures, and the mass firing of health workers.9 Roll out of long-acting lenacapavir (LEN-LA) for PrEP in Zimbabwe will end—273,000 people on LEN-LA would have been supported as part of the MOU—that will end. Ironically, the LEN-LA program was launched in Zimbabwe just two days before news of the MOU standoff was leaked.10
The cost of these lifesaving services cannot be absorbed by Zimbabwe’s government or another donor such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), which cut its allocation to Zimbabwe for the last two funding rounds.
What can be done? Zimbabwe has the 6th-highest HIV burden globally. The cessation of funding, unless corrected, will result in massive setback to efforts to achieve epidemic control in Zimbabwe and across the region. Remediation is still possible:
1. Secure an emergency allocation this financial year from Zimbabwe’s Treasury (of $68 million); organize an emergency donor conference focused on Zimbabwe’s funding cliff.
2. Global partners should push both sides to come back to the negotiating table immediately, with a commitment to resolving concerns, including regarding unrealistic co-financing targets, data sharing and specimen sharing requirements, U.S. funding cuts, and harsh consequences for failure to reach co-financing and program targets.
3. Include meaningful representation of independent civil society during MOU negotiation, MOU implementation planning, and ongoing quarterly oversight over program implementation, through the Joint Health Cooperation Steering Committee described in the draft MOU (p 22).
4. Restore peer-led, community-based service delivery mechanisms, including for PrEP and other other prevention services, that are essential for achieving epidemic control, particularly for vulnerable populations.
5. Global partners should immediately fund community-led emergency efforts to document the consequences of disruptions in U.S. funding.
6. Call for U.S. Congress to earmark appropriated global health funding for Zimbabwe, which would effectively override this decision.
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