Why It’s Hard to Believe the US Embassy Report on Drugs in Zambia

Why It’s Hard to Believe the US Embassy Report on Drugs in Zambia

By Steve Kabani

As of May 2025, Zambia has a total of 2,009 registered retail pharmacies (ZAMRA 2025). The recent US embassy report claims that 95% of these pharmacies roughly 1,909 outlets stocked stolen, US-funded life-saving drugs. On the surface, this statistic is alarming. But on closer inspection, it becomes deeply questionable, both in logic and evidence. Aforensic audit involving nearly 2,000 pharmacies assumes that all are operational and fully functional, which is unlikely. Many registered pharmacies may be inactive, non-compliant, or exist only on paper. Conducting such a massive audit without verifying operational status casts doubt on the credibility of the entire premise.

To begin with, we must ask: What are these US-funded life-saving drugs? These are identified as ARVs, TB drugs, and vaccines for under 5. These are not over the counter medications. They are strictly controlled commodities that are rarely, if ever, available in private retail pharmacies.

Which brings us to the next logical question: Who has ever seen ARVs, TB drugs, or under five vaccines sold in a retail pharmacy? For those who work in, own, or frequently visit these pharmacies, the answer is likely the same, almost no one. Speaking from personal experience in over 10 years in the sector, I have encountered only one customer asking for ARVs and even then, it was a specific South African brand not found in the public system.

ARVs, TB drugs, and under-five vaccines are never stocked in general hospital pharmacies either. Instead, they are housed in designated storage and dispensing areas most of which have been built or refurbished by US-funded NGOs. These areas are not only tightly monitored, often with CCTV surveillance, but also operate under strict protocols.

These medications are not accessed through individual prescriptions, but dispensed through SmartCare, a sophisticated real-time inventory and patient monitoring system that is designed to track the distribution and consumption of these drugs, and report that data directly to the donor agencies. Notably, approximately 60% of personnel in ART clinics are funded by the US agencies, further reinforcing the oversight on these commodities.

This raises a critical question: With such an airtight, donor controlled inventory system in place, how could these drugs be seeping into the retail market? It would require a massive, coordinated breach of a system that was purpose built to prevent exactly this kind of leakage. Moreover, if ARVs or TB drugs were indeed being siphoned off on such a large scale, the public health system would inevitably experience shortages.

Yet we have not. In fact, Zambia has never experienced a widespread stockout of ARVs or TB drugs in recent years. On the contrary, the country has made commendable progress, having achieved the ambitious 90-90-90 targets in most provinces: 90% of people with HIV knowing their status, 90% of those diagnosed on ARVs, and 90% of those on treatment achieving viral suppression. This would have been impossible if these drugs were being stolen and sold in private pharmacies, thereby making them inaccessible to the poor and vulnerable populations who rely on free treatment.

We must also consider the timing of this report. Just two months ago, the US abruptly halted its support to Zambia’s health sector a move widely condemned as baseless and harmful. One has to wonder: Is this report an attempt to retroactively justify that decision? Could it be that a reason is now being manufactured to fit an earlier political or diplomatic agenda?

In conclusion, the claims in the US embassy report are riddled with inconsistencies, logical flaws, and a glaring absence of evidence. Given the tight donor controlled drug distribution systems, the lack of public shortages, and Zambia’s continued progress in HIV treatment outcomes, it is difficult to accept that 95% of pharmacies were selling stolen donor drugs. Until a transparent, evidence-based investigation is presented, this report remains highly suspect and deeply troubling.