A malnourished child is fed with Ready-to-use Supplementary Food (RUSF), at the emergency ward of Dikwa Primary Health Center, following the withdrawal of USAID support, in Borno State, Nigeria, in August, 2025.Sodiq Adelakun/Reuters
Robert Rotberg is the founding director of the Harvard Kennedy School’s program on intrastate conflict, a former senior fellow at CIGI and president emeritus of the World Peace Foundation.
Cervical cancer is a terrible scourge. More than 350,000 women die worldwide of cervical cancer every year. And sub-Saharan African countries have the highest incidence rates of the disease in the world: in Eswatini, it’s 95.9 per 100,000 women; in Zambia, 71.5; and in Malawi, 70.9.
The good news is that cervical cancer is highly preventable, and in a hot spot like southern Africa, vaccinations would rapidly reduce the scale of the crisis. Prevention comes relatively easily when women are screened, tested, and receive the human papillomavirus (HPV) vaccine, ideally when young. Since 1950, the death rate from cervical cancer has correspondingly decreased by as much as 70 per cent – mostly in higher-income countries – but it remains the number-one cause of death in women in 37 countries today, 29 of which are in sub-Saharan Africa. (The remainder are in Latin America.)
Without USAID, Ethiopia’s mothers bear the costs
What’s more, many of the African countries with high HPV death rates also have high incidence rates for HIV/AIDS. Antiretroviral therapy, which suppresses a body’s viral load to undetectable levels, is now highly effective when taken as directed, turning what was once a death sentence into a chronic malady.
Sixty-five per cent of all HIV/AIDS populations are in Africa (400,000 of 630,000 globally); 10 per cent are in the Americas, and 8 per cent are in Europe. In terms of HIV prevalence, Eswatini ranks first in the world again, with 23.4 per cent of adults aged 15 to 49 infected. South Africa (17.2 per cent), Lesotho (17.1 per cent), and Botswana (15.7 per cent) follow, with Zambia reporting 9.4 per cent. Many women and young girls are afflicted in these same countries, and the overlap in the last two with HIV and cervical cancer is palpably grave.
That is why Donald Trump’s deep cuts to funding for the U.S. Agency for International Development (USAID) and his pause of the President’s Emergency Plan for AIDS Relief (PEPFAR) have been so devastating. The end of USAID funding has led to thousands of unnecessary deaths, plus immense human suffering.
Tributes are placed beneath the covered seal of the US Agency for International Development (USAID) at their headquarters in Washington, D.C., in February, 2025.MANDEL NGAN/AFP/Getty Images
Even more shocking is the fact that Washington is callously making U.S. access to metals and mineral resources a condition for the resumption of aid. That has meant threats to withdraw HIV retroviral therapy from the 1.3 million Zambians receiving such medicine daily from PEPFAR. Thousands more in Zambia have long received tuberculosis and malarial medicines from USAID, saving their lives, and they are now at risk.
Washington also proposed ending all health support unless Zambia agrees to increase its own health expenditures (a fair ask), and hand over personal medical data and biological specimens from treated patients. The U.S. refuses to promise Zambia and similar countries access to the medical results of such information and sample transfers, nor a share in any potential vaccines developed. Kenya and Zimbabwe have rejected such deals; Zambia is trying to negotiate, as it desperately needs financial assistance.
In Zambia, Washington wants even more. It wants to force Zambia to end China’s access to copper, cobalt and lithium, which have all been mined for decades in Zambia’s Copperbelt. It wants Zambia somehow to send Chinese concerns home, even though they purchased these mining properties years ago, and to permit American concerns to take over, with preferential claims to Zambia’s abundant subsoil riches.
The U.S.’s strong-arming proposals to Zambia and Zimbabwe don’t even promise to resume aid at previous levels, and include many more requirements. What’s more, Washington claims (with some justification), that Chinese firms gained their mining concessions and properties by bribing Zambian officials – yet just last year, Mr. Trump paused the enforcement of the Foreign Corrupt Practices Act, which bans American companies from themselves bribing African governments; new guidelines released last June focused more on major crimes.
This twisting of Zambia’s official arm comes at a time when Washington is trying at last to counter the growing influence of China, Russia, Turkey, Qatar and the United Arab Emirates for influence in Africa, especially in the sub-Saharan countries with abundant stores of valuable metals.
As in Iran (yet curiously, never in Moscow), Washington today prefers to use a blunderbuss rather than soft-power negotiating to get its way. That is a huge mistake in post-colonial and super-sensitive Africa, and a lesson the Trump administration doubtless will never learn. And because of that, financing for something so directly helpful and as relatively simple as HPV vaccinations will be foregone – and Africans will die more often than they should.