Joe Biden appeared to fall asleep during a meeting with African leaders, closing his eyes for more than a minute.
The US president, 82, looked tired and spoke hoarsely during the summit in Angola, held with the Angolan president and his counterparts from Zambia and the Democratic Republic of the Congo.
During a speech by Philip Mpango, the vice-president of Tanzania, Mr Biden closed his eyes and rested his hand on his face, appearing to be asleep.
He then appeared to wake up, before closing his eyes again. Although Mr Biden was wearing an earpiece usually used for translation, all participants on the panel were speaking in English at the time.
The incident came on the final day of a three-day trip to Angola – Mr Biden’s first bilateral visit to Africa since taking office in 2021.
Mr Biden has been accused of falling asleep at several international events in the last year, while facing criticism for his age and gaffes on the world stage.
Wednesday’s Lobito Corridor Trans-Africa Summit featured several African leaders, and took place after a busy morning of visits to a port terminal and food processing factory.
Mr Biden has previously acknowledged that he struggles with the demands of international travel, blaming his performance in a disastrous presidential debate against Donald Trump in June on his visits to Europe and California in a short period.
He said after the debate, which precipitated his withdrawal from the presidential race, that he “nearly fell asleep” on the stage and “wasn’t very smart” for “travelling around the world a couple of times”.
During that visit, which included a G7 summit in Italy, Mr Biden skipped a world leaders’ dinner because of a “jam-packed two days” of diplomacy.
Weeks later, at a Nato summit in Washington, Mr Biden mistakenly introduced Volodymyr Zelensky as “President Putin”.
His track record of looking bewildered and tired on the world stage gave rise to his “Sleepy Joe” nickname by Mr Trump, coined in 2019 during their first election battle.
During the meeting on Wednesday, Mr Biden told his counterparts that he had enjoyed a journey on a train line in the Lobito Corridor, a region of Western Angola where the US has invested in rail construction.
In a speech on Tuesday, he mistakenly referred to Angola as a “vibrant city,” before hastily correcting himself.
“Look, not the city,” he said. “The city, I know, is not Angola. But in Angola, in a vibrant city.”
He also addressed his imminent handover of the White House to Mr Trump, telling an audience: “As you know, I’m in the final weeks of my presidency. You don’t have to clap for that. You can if you want.”
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