The United States is restructuring how it delivers life-saving medical supplies for HIV and malaria to low-income countries, a shift that officials and health experts warn could disrupt treatment access across parts of Africa and Asia.

The changes centre on winding down the Global Health Supply Chain Program – Procurement and Supply Management, a U.S.-funded initiative run by Chemonics, which has coordinated the delivery of critical medicines and prevention tools since 2016. According to internal communications and multiple sources familiar with the matter, U.S. officials have been instructed to begin halting implementation of the programme by May 30.

From its inception through 2024, the programme distributed more than $5 billion worth of HIV and malaria-related commodities to 90 countries, with a primary focus on sub-Saharan Africa and parts of Asia. The supplies included antiretroviral drugs, malaria treatments and insecticide-treated bed nets, forming a key component of global disease control efforts.The restructuring follows broader changes to U.S.

foreign aid policy under the administration of Donald Trump, which has prioritised reducing reliance on contractors, cutting budgets and shifting toward direct agreements with recipient governments. The overhaul also comes after the dismantling of the United States Agency for International Development, which had previously overseen much of Washington’s development assistance.

Five sources familiar with the transition said the pace of the changes risks creating supply gaps for essential medicines, particularly in countries with fragile health systems. An internal email reviewed by Reuters warned that accelerating the transition without a clear implementation plan could jeopardise continuity of services.

The communication, sent by the U.S. State Department to staff in 17 African countries and Haiti, directed country teams to prepare for the end of programme operations while outlining potential risks. It did not provide a detailed roadmap for replacement mechanisms, instead asking local offices to identify vulnerabilities and report back to Washington.

A State Department spokesperson said the agency had not issued technical instructions for Chemonics to cease operations by May 30, though the contract is set to expire on September 30 in line with other USAID awards. The official end date is listed as November.

The uncertainty has revived concerns stemming from earlier disruptions. In January last year, a freeze on international aid left millions of dollars’ worth of medical supplies stranded in ports and warehouses worldwide, including HIV drugs and malaria prevention tools. Distribution resumed only after waivers were granted for life-saving interventions.

Six sources said the United States has been in discussions with the Global Fund to Fight AIDS, Tuberculosis and Malaria about potentially using its procurement and distribution systems to replace the existing programme. The Geneva-based institution already manages approximately $2 billion in annual purchases for HIV, tuberculosis and malaria programmes through partnerships with national governments and implementing agencies.

However, two sources said earlier plans had envisaged a transition timeline extending to November 2027, allowing sufficient time for procurement cycles and logistical adjustments. Compressing this timeline into a matter of months could create operational bottlenecks, they said, noting that delivering medical supplies to remote areas can take up to a year from order to distribution.

The Global Fund declined to comment on the discussions. The State Department did not directly confirm the talks but said it would rely on pooled procurement mechanisms to secure supplies at competitive prices from private manufacturers.The policy shift is part of a broader “America First” approach to global health funding, which aims to reduce what officials describe as inefficiencies in the existing system.

A strategy document released in September argued that contractor-led programmes had contributed to waste and inflated costs, and emphasised direct funding for frontline services and national governments.

Under the new approach, Washington has signed 28 bilateral health agreements with partner countries and is increasingly channeling funds directly to national authorities. It also plans to use private logistics firms to handle distribution rather than relying on large development contractors.

Recent agreements with countries such as Kenya, Rwanda and Uganda include commitments to increase domestic health spending alongside U.S. funding. However, implementation has encountered obstacles. In Kenya, a proposed deal faces legal challenges from activists concerned about data privacy, while negotiations with Zambia have been delayed as officials seek to safeguard national interests.

Health experts and aid practitioners say the transition risks compounding existing vulnerabilities in global disease control programmes. Previous disruptions linked to funding changes have already contributed to shortages of malaria treatments for children and gaps in HIV prevention services in several countries.

The State Department defended the overhaul, describing the current system as outdated and inefficient. A spokesperson said the new model would prioritise value for American taxpayers while maintaining support for critical health interventions.

Despite those assurances, several sources involved in programme delivery said the lack of a detailed transition plan remains a central concern. They warned that without clear coordination between donors, governments and implementing partners, the shift could interrupt supply chains that millions depend on for survival.

Africa’s number 2 copper producer Zambia last month picked IRH, a unit of Abu Dhabi’s most valuable listed company International Holding Company (IHC.AD) (IHC), as the new strategic equity partner in the state-owned Mopani Copper Mine.

IRH, which was not immediately available for comment, is actively pursuing the acquisition of metal assets including copper, nickel, graphite, manganese, cobalt and lithium which are essential to the UAE’s clean green energy drive.

Jubilee, which mainly focuses on recovering metals from mineral waste, said it had secured IRH’s investment to process an estimated 350 million metric tons of copper waste rock, which could potentially yield “in excess of 20,000 tons per annum of copper at a cost of below $4,000 per tonne of copper”.

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Jubilee said it had agreed with IRH to form a dedicated special purpose vehicle through which both the acquisition of the copper waste rock and implementation of the processing solution will be funded, at an estimated cost of $50 million.

“Under the funding term sheet IRH undertakes to provide all capital required by the special purpose vehicle through a combination of equity in the special purpose vehicle and shareholder loans,” Jubilee said in a statement.

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The construction and commissioning of the copper retreatment works would be completed within a 12 month period, Jubilee said, with work expected to start in the first quarter of 2024.

Jubilee will design, implement and operate the mining and processing project on behalf of the joint venture, it added.

Zambia’s Mines Minister Paul Kabuswe witnessed the signing of the agreement between state firm ZCCM-IH (ZCCM.LZ) with Chris Griffith, Vedanta’s head of base metals, in Lusaka, officially handing the copper assets, which the state seized in 2019, back to Vedanta.

The agreement will lead to the re-appointment of the KCM board and withdrawal of all legal challenges that are in court, including removing a provisional liquidator who was in charge of the assets, Kabuswe said.

The government, which owns a 20% stake in KCM through ZCCM-IH, said in September it had reached an agreement to allow Vedanta to resume control of the mines and smelter after the company pledged to invest about $1.2 billion at the operations.

Billionaire Anil Agarwal’s Vedanta mounted numerous legal challenges, including suing Zambia at the arbitration court in London, to regain control of KCM after former president Edgar Lungu’s government orchestrated the seizure of the copper assets by forcing the operations into liquidation in May 2019.

While the Zambian administration accused the company of failing to invest to boost copper output, the forced takeover and the legal challenges stifled investments and nearly crippled operations.

The government wants KCM assets to “come back to life,” Kabuswe said, adding that Vedanta must repair strained relationships with the communities by honouring its investment pledges.

“You have to live by what you have told us (that) this is the investment that will be coming,” the minister said.

The board meeting comes after Africa’s second-biggest copper producer clinched a deal with bilateral creditors such as China and the Paris Club to rework about $6.3 billion of overseas debt. The country will have access to around $188 million after the review is completed.

The IMF reached in April a staff-level agreement on the first review, but a debt restructuring agreement with official creditors was needed before the board could complete the programme’s review.

An IMF spokesperson didn’t immediately reply to a request for comment.